Saturday, June 24, 2006

San Francisco Presents Universal Health Care Proposal

On Tuesday June 20th, 2006, San Francisco Mayor Gavin Newsome announced a plan under which the city would offer health care to any adult resident, regardless of immigration or employment status. This is a composite post combining reports from several sources. Click here for full story from Yahoo News, here for the story from the San Francisco Examiner dated June 21st, here for the full story from the San Francisco Chronicle dated June 20th, and here for the full story from the San Francisco Sentinel dated June 19th.

The plan, which will be called the Health Access Plan, still needs be approved by the city's Board of Supervisors. Its primary target is the estimated 82,000 uninsured residents who earn too much to qualify for Medicaid. San Francisco already provides universal health care for children. Mayor Newsome stressed that the plan was not meant to replace private health insurance, but rather provide a way to consistently treat uninsured people so they don't end up seeking medical care in hospital emergency rooms.

Eligibility: Limited to people who live within the city of San Francisco and will apply only to medical services provided within the city of San Francisco.

Services: It would provide comprehensive preventive and catastrophic health care, covering everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and surgeries. Pre-existing conditions would also be covered.

Estimated Costs: The city estimates the plan would cost $200 million a year.

Funding Source: Taxpayers, businesses that don't already insure all their workers, and participants themselves.
Residents would pay both monthly fees and service co-payments on a sliding scale depending on income. A person with annual earnings at the federal poverty line would pay $3 per month, while someone who makes between $19,600 and $40,000 — or up to 400 percent above the poverty line — would pay an average of $35 per month. Employer contribution, as outlined in the most recent version of the plan sponsored by Supervisor Tom Ammiano, would require every business with more than 20 employees to pay at least $1.60 an hour into the system for all employees not already covered by a health plan, no matter how few hours they work. Specifically, small businesses (20-99 employees) would end up paying $182.50 per month per employee, and businesses with 100 or more employees would pay $273.75 per month per employee.

The funding mechanism, which Ammiano says was crafted with the help of labor groups, raises serious questions about how it would affect local businesses, particularly smaller businesses with high overhead and relatively small profit margins such as restaurants. For many of those businesses, suddenly being forced to pay up to several thousand dollars extra each month seems destined to result in businesses being closed and jobs lost. One employer, Laurie Thomas, the owner of three restaurants in San Francisco, said that she already contributes to health insurance for her employees who work more than 28 hours a week, but that Ammiano's proposed mandate would put her out of business.

Analysis: Instead of marrying off queers, giving welfare checks to the homeless or trying to confiscate guns, San Francisco's actually trying to do something useful for a change. San Francisco recognizes there is a growing segment of the American population too "rich" for Medicaid but too "poor" to afford the quality of health care coverage necessary to prevent economic disenfranchisement from catastrophic illness or accident. This plan not only is promising but has many attributes I personally have recommended in the past. Let's break it down:


1). Includes catastrophic coverage.

2) Strong emphasis on preventive care.

3). Holistic - covers a wide range of services.

4). Combination of premium and co-pay.

5). Means-tested.

6). Not mandatory, unlike the Massachusetts plan.


1). Immigration status of patients not checked - illegal immigrants who broke the law to enter our country would be rewarded for their bad behavior by getting taxpayer-subsidized health care.

2). Does not apparently discriminate between therapeutic (necessary) care vs. elective care. Could people get taxpayer-subsidized elective abortions under this plan?

3). Which "taxpayers" would help pay for it? San Francisco taxpayers only, or all California taxpayers? May be too taxpayer-dependent.

4). May impose too much of a burden on small business owners.

Could this work in Alaska? Strikes against it here are our small population base, and the large percentage who live off the state's road network in the Bush. Another limitation is the difficulty in getting health care providers to move to Bush communities.

Related Previous Post: Citizens Health Care Working Group Proposes Comprehensive Health Care Reform, June 9th 2006.


  1. Anything a government does to "better" citizen's lives usually ends up a mess.
    We have already proved that with Social Security.
    I'll better my own life, thanks!

  2. More often than not, government programs goes bad because of insensitive and incompetent administration. Social Security's on the rocks partially because Congress kept raiding the trust fund.

    At least in San Francisco, you could opt out of their proposed health care plan. In Massachusetts, the only way to opt out of having health insurance altogether is to move.

  3. They started giving out Social Security checks four years after it was started. The first person who started receiving them hadn't even been paying into the system.
    It is not up to the government to feed us, clothe us, give us welfare, etc.
    I don't want to have to opt out, I don't want to pay into the system.
    It's a joke!