« Quote of the Day | Main | Proportionality »
July 20, 2006
Left My Insurance In San Francisco
Been awhile since we engaged in much top-grade health wonkery here, so today I'll go over the recent haps. Consider it health wonkery day. First up is San Francisco, where the Board of Supervisors unanimously approved a plan that would make SF the first city in the nation to offer comprehensive, universal care to everyone, regardless of immigration or employment status. So now you can leave your heart in San Francisco and, when you go to pick it up, get a triple bypass while they're conducting reinsertion.
What's fascinating about the proposal is that what SF is offering is actually a city-run insurance plan, paid for by a light assessment on employers, consumer premiums tied to income, and copays evaluated the same way. This wouldn't change the way the uninsured are treated so much as give them a comprehensive insurance option. When you sought care if the SF area, they'll seek to sign you up for this program, which'll give you a card, a premium, a primary care doctor, and home clinic. It's a method of integrating those on the outskirts of the health system into the mainstream so they can receive preventative care and basic services. The downside is that the plan won't get you any care out of SF's border.
If this works, it'll be a real milestone, more proof that the state can run a general pool insurance program. Dangers will be an influx of poor or needy folks seeking health insurance, though anyone who's been to San Francisco knows the city hardly has space for more homeless. I'd be fascinated to know what the premium scale is, and whether insurance companies will begin offering SF residents out-of-city packages that ensure coverage while traveling. The big question will be whether this attracts only the uninsured and indigent, or it becomes a viable option for the middle class. We'll see. For now, though, SF joins with Massachusetts in the category of states and municipalities fed up with federal sluggishness on the health crisis and pioneering innovative solutions. A round of applause for all involved.
July 20, 2006 | Permalink
TrackBack
TrackBack URL for this entry:
http://www.typepad.com/services/trackback/6a00d8341c572d53ef00d834a3558153ef
Listed below are links to weblogs that reference Left My Insurance In San Francisco:
Comments
I live here in SF, so I'm (of course) very interested to see how this plays out.
One very nice side note in this is that it's the result of a compromise between two very different plans from the moderate Mayor Newsom and lefty Supervisor Ammiano. They actually worked out their differences and came up with a workable plan, rather than trying to score points with their respective constituencies. This, of course, is exactly how representative government is supposed to work...in theory.
Posted by: Tom Hilton | Jul 20, 2006 12:58:54 PM
Some preliminary number crunching.
82,000 people out of the 744,000 who live in SF is right at 11% ... the percentage of uninsured in Massachusetts, right? So it's an easier problem for them than the country as a whole.
$200M for 82,000 people is $2440 per capita, which is about 55% of per-capita health spending in the US, but roughly in line with per-capita health spending.
Man, more feathers in Newsom's cap. That's awesome.
Posted by: Nicholas Beaudrot | Jul 20, 2006 1:10:12 PM
SF Mayor Gavin Newsome will have earned a national spotlight if he pulls this off. I understand (I'm a former resident of SF) that his homeless housing plan is also a beacon to other cities (but I don't have current facts).
Newsome as the Dem. presidential candidate in 2112? He'd get my support over Obama, anytime. Perhaps he could also run to replace Arnold when (and if) Arnold wins another four years this fall - and is term-limited after that.
Hurrah for a liberal 'points of light'!
Posted by: JimPortlandOR | Jul 20, 2006 1:53:23 PM
But your wallet is still in El Segundo
Posted by: Comandante Agi | Jul 20, 2006 2:00:41 PM
Sorry, but I just don't see how this can work. SF will get an influx of more indigents (many with expensive health care needs like diabetes), which will make the plan both unpopular and disastrously expensive. I believe Hawaii does something vaguely similar, but they're protected by being in the middle of the ocean. I think you need a much larger catchment area than one city to make something like this viable. I applaud their intentions, but have to wonder if they've really thought this through.
Posted by: Rebecca Allen, PhD, ARNP | Jul 20, 2006 2:13:21 PM
I remember reading other articles about poverty on here, in particular in the post Katrina era. The argument at that time was that the indigent, elderly, and those living in extreme poverty could't escape the pit of despair that was N.O.
Then there were statements from Ezra on the potential good of the provided relocation for these people to escape the flooding. Since they couldnt/wouldnt have done it themselves, perhaps they could start a new and better life. I didnt completely disagree. (Any updatse on how the reality turned out?)
Now the main argument against this health care plan is that the poor and indigent will flock to S.F.? Why are the indigent so mobile all of a sudden? And how well do those below the poverty line really keep track of metropolitan insurance plans around the country?
Perhaps many of the local poor may come out of the woodwork here, since these things are often underestimated. Sounds like they have planned for that as best they can however.
For me its nice to see a locality taking responsibility for itself. They're getting together and working to solve the problem instead of waiting for the federal government to come to the rescue.
Posted by: david b | Jul 20, 2006 3:38:38 PM
..achem.. "the woodwork here" Should read:
"the woodwork there".
Edited for readability.
Posted by: david b | Jul 20, 2006 3:40:43 PM
The realities of ecnomonics will come banging on their door shortly after this is instituted.
Posted by: Fred Jones. | Jul 20, 2006 4:08:01 PM
well yes. ..and Ill take a risk here and predict that the law of gravity will continue to be in affect while this project is attempted.
Care to make a more specific point?
Posted by: david b | Jul 20, 2006 5:01:32 PM
I live about one hour away from SF.
This means that I can get my friends who live in SF to declare that I live at that residence. Get my "free health care" card, and then voila I get free access even though I dont live in SF.
So what we have here is not a SF health plan, its a "greater northern california" health plan. Except of course the people paying for it are only in SF. Which means you get a few people in SF trying to financially float a program that will draw many millions from surrounding areas.
I give this program 1 year before they declare bankrupty and restructure.
Posted by: joe blow | Jul 20, 2006 6:57:09 PM
Joe Blow: sounds like a brilliant plan...if you don't already have insurance, and if you have friends in SF who are willing to risk jail for you, and if you don't mind traveling two hours round trip every time you want to see a doctor (oh, and good luck parking, buddy), and if the expense of traveling to SF (gasoline & tolls or BART fare, lost productive time, parking) doesn't wind up approaching what you would pay for a doctor's visit as an uninsured patient.
In other words, it might well go bankrupt (who knows?) but not for the reason you're talking about.
Posted by: Tom Hilton | Jul 20, 2006 8:32:05 PM
Your example is an interesting one, but there are some details within it that might not be so obvious.
-You are seeking healthcare outside your area, so you in the example would be uninsured. That is a relatively small number of people.
-You would be mobile, and able to make your way to the SF area. That hints at some form of income.
-You have indicated your willingness to happily partake in the system, while cheating it.
Since you're participating in the system, i.e. 'getting the car' according to the plan you would be contributing to it. So while that may not make up for the total cost of your participation it would mitigate it somewhat.
There are certainly a group of people that are informed, and willing to take advantage of programs. Look at air quality checks and cars, people cheat those. Any program that doesnt predict that is badly planned, and so far it doesnt appear that the planning here is that slipshod.
There are mitigating factors here too: Some people believe it or not are honest. I find the numbers pretty high, especially amongst the working poor. Also many people not in the medical system just plain dont go to the doctor, other then for emergencies. ..and as I mentioned earlier the poorest just cant travel that far.
Now the question is whether the money the already spend on the uninsured which is fairly significant at $200m plus the contributions will be enough to compensate for the cheaters. It can be depending on what the contribution is. I wish them luck.
Posted by: david b | Jul 20, 2006 8:33:51 PM
two very different plans from the moderate Mayor Newsom and lefty Supervisor Ammiano. They actually worked out their differences and came up with a workable plan, rather than trying to score points with their respective constituencies.
I think that's substantially overstating their political differences. Their constituencies overlap quite a bit. I voted for Ammiano in 1999 and Gonzalez in 2003, for example, on the general drag-everything-to-the-left principle, but I'm quite happy with Newsom as mayor.
Posted by: Hamilton Lovecraft | Jul 20, 2006 10:52:20 PM
No one has mentioned the disproportionate amount of HIV and AIDS in San Francisco and it's possible detrimental effects upon any public heathcare system.
Yeah, that won't matter....just think happy thoughts.
Posted by: Fred Jones. | Jul 21, 2006 7:42:38 PM
I am quite keen on seeing how this plays out. Oregon has become increasingly interested in healthcare for it's citizens, with several plans being floated. It will be interesting to see how certain bugs get worked out. Thankfully they already have funding through Ryan White and other sources to take care of their "dis-proportionate" population of those suffering HIV and AIDS.
Posted by: DuWayne | Jul 21, 2006 8:52:07 PM
I live in SF, and I work at one of the city clinics, which currently serves a mostly homeless and uninsured population and does it pretty damn well on a shoestring. But there's still a long backlog of people waiting to get a primary-care doctor.
The Health Access Plan may be a great thing, ***IF*** the city is willing and able to expand services greatly. We need more doctors, more nurses, more space. Otherwise there's just no way for the clinics to see any more people than they're seeing. It's not clear yet how much money we have to work with, and whether the Dept. of Public Health can come up with a workable expansion plan on short notice after years of cutbacks. Those aren't reasons not to try - something like this is desperately needed, and there are all kinds of significant side benefits, chiefly (a) making it so people don't wait till they're very sick and then use the ER for everything, which is incredibly expensive, and (b) employment.
A couple of corrections to comments above:
1. This is not free coverage, it's sliding scale: if you have any income, you'll be paying.
2. In my experience, the seriously poor and homeless don't relocate for health care. They may relocate for cash benefits, climate, safer shelter, etc. Unfortunately, health care is often pretty low on people's priorities even when their living circumstances are seriously affecting their health and vice versa.
Posted by: Hob | Jul 22, 2006 3:09:47 PM
aig auto insurance aig auto insurance
Posted by: aig auto insurance | Jul 29, 2006 5:55:44 PM
auto insurence auto insurence
Posted by: auto insurence | Aug 2, 2006 8:16:52 AM
Insurance always makes people feel more safety. For instance while I am driving my car I know that if something bad happens with it the insurance company will help me fix it.
Posted by: michael jones | Aug 20, 2007 9:29:07 AM
I think it will be definitely interesting to see how this "San Francisco Health Access Plan" works out because if it works then it may work for Houston, Texas as well!!!
Posted by: Dasani | Nov 5, 2007 9:25:03 PM
