San Francisco has its own 'public option'

San Francisco - Over the last two years, three-quarters of San Francisco's uninsured adults have enrolled in a public program that guarantees access to medical services, an effort that is being touted as a national model during the rancorous debate over healthcare reform.

More than 46,000 adults have enrolled in Healthy San Francisco since it was launched; this first-in-the- nation, city-run universal healthcare effort has received high marks in recent independent studies.

The program is funded in part by an employer mandate, a controversial component of the plans under discussion in Washington. One analysis has concluded that this mandate on employers with 20 or more workers has not driven businesses away. Patient satisfaction is high, according to another recent survey.

But although many laud the program, which Mayor Gavin Newsom described as "a public option . . . a strategy to provide healthcare regardless of your ability to pay, regardless of your preexisting condition."

But even some supportive critics, including Dr. Mark Smith, president of the California HealthCare Foundation and an advisor to the San Francisco effort, warn against "making more of it than what it is."

"It is a stretch to suggest that this is a model for a full-fledged insurance plan acceptable to broad sections of the population that competes head-to-head with private insurance companies," Smith said.

Healthy San Francisco is not insurance, is not portable and is worthless outside of the 49 square miles that constitute the self-proclaimed "city that knows how."

But if you have a heart attack in Phoenix or go to a provider outside of the limited network, you're on your own. In addition, dental and vision care are not covered. As the Healthy San Francisco handbook warns those who have health insurance, "Do not drop it. Insurance is always the better choice."

This is a wonderful example for the rest of the country - it's a proof that there is absolutely no need for federal government to be involved in nationalizing / federalizing health care financing and administration.

Just like, for example, San Francisco, Massachusetts, Tennessee and Hawaii, any city or any state can follow this example and vote for self-imposed "public option" / "universal health care" or whatever they want to call their own versions of the path to eventual economic suicide, financial ruin and bankruptcy.

The road to hell is paved with good intentions, and in this case even their intentions only sound good. In reality, the liberals / progressives want to do this on the national / federal level because they recognize (intellectually and from plenty of experience) that the [liberal] states that will choose "universal" health care, whether through mandates or taxes, will soon go broke - so they want other, sane states to pay for their failed utopian programs, to "spread" the financial pain and not look bad by comparison. Essentially, it's the way for them to bankrupt other states through the use of federal program. That's exactly what the amendment by Senator Maria Cantwell (D -WA) is all about - "allowing" states to implement their own "public option". Well, as we can see, they don't need federal health care "reform" to do that - they can do it right now, by themselves, without money passing through the federal government.

This should be one of the strongest points made by GOP, not only in this health care debate, but in any such or similar debate that might follow - let the states or the cities be the laboratories and adopt their own, uniquely [in]appropriate ways to deal with their states' problems... and their citizens live with the consequences of their votes and decisions of their elected governments, instead of one-size-fits-no-one federal mandates.

There are lies, damn lies, and then, there are statistics - which can be bent and used to justify anything, particularly a bad public policy.

So, if these "punks feel lucky", let them tax themselves into prosperity... but not count on other cities or states to bail them out when they start feeling the pinch.

I think California is one of the several states (and only one in the West) with the highest levels of taxes and regulations, that is experiencing an outflow of population from the state. Meaning, it will have the effect of less revenue and higher expenses, exactly opposite of what "static projections" of tax policy planning is expecting.

Obama and the Dems don’t care. They want CONTROL of the healthcare industry so 1) their friends get payoffs, kickbacks, subsidies, 2) they dictate WHO gets healthcare.

The Dems will control ALL data including your bank accounts.

Don’t tell me that some nimrod Democrat won’t deny healthcare if you are a Republican, white or post on Freep (if they find out).

We have a public option in NYC. It's called the New York City Health and Hospitals Corporation.

Ask a NY LibTard this question:

"If you're standing on First Avenue and 30th Street and start feeling severe chest pains, should I take you to Bellevue (the public option) or next door to New York University Medical Center?"

I get hems and haws and "Oh... it all depends..."

Yeah, right.

What the hell does "access to medical services" mean?

They want CONTROL of the healthcare industry so 1) their friends get payoffs, kickbacks, subsidies, 2) they dictate WHO gets healthcare.

"Access" means that the government will get the ability to keep moving the goal posts, ability to CONTROL, to tax, to mandate, to regulate, to actually restrict access and to mean-test WHO gets which level and quality of health care.

..... Any uninsured adult who lives in San Francisco and earns up to 500% of the federal poverty level annually is eligible. That's $54,150 for individuals and $110,250 for a family of four. (Children are covered under a separate city-run program.)
Patients must pay a quarterly participation fee based on their annual income, along with certain co-payments for services. But care is free for those earning 100% of the federal poverty level or below -- about 70% of all participants.
Patients must pick a medical home out of a network of more than 30 public and private clinics, physician groups and hospitals within the city limits. The idea is that patients get consistent care and the system avoids duplicating services. Although about half of the network is government-run, Kaiser Permanente just joined and plans to accept up to 3,000 patients. .....

They can try to pick and choose their statistics (by industry, time span, geography) but it doesn't hide the fact that it's really not an insurance, rather just another, expanded [benefit in a] welfare program.

It has only been in place for the last two years, it's not portable, it doesn't cover vision and dental, among other things, it doesn't replace private insurance, it doesn't specify the quality of care etc. etc. ... and they don't even say how much it cost the city already, how much of this relies on being subsidized by state or federal government, and how long they can carry on without further restrictions or raising what is, in reality, yet another tax...

"'We Have to Go Spend Money to Keep From Going Bankrupt" - Joe Biden's fuzzy math, 2009 July 16.

Most so-called "health-insurance" really isn't insurance, either.

If John Smith has a $500,000 personal injury rider on his car insurance policy but no other health insurance, and he is in an accident for which the treatment will cost $1,000/month for the rest of his life, the car insurance policy he had at the time of the accident will cover the $1,000/month treatment as long as it's needed, until the $500,000 runs out, regardless of whether he ever pays a dime more in premiums. Even if he canceled his policy the day after the accident, provided that he could show his injuries occurred while he was insured, his insurance on the day of the accident would cover all consequent costs.

By contrast, if Joe Johnson were to slip and fall and suffer injuries requiring $1,000/month treatment, and he looked to his "medical insurance" to cover his treatment, he would find that his "insurance" really only covered a year or less worth of treatment. After that, premiums would be raised to cover the predictable costs of future treatment--never mind that the premiums he paid before the condition occurred should have covered all future costs.

To be sure, it might be difficult to protect a real insurance system against fraud from people who fail to report pre-existing conditions. Nonetheless, the current system of pseudo-insurance serves little purpose except to totally distort the health care marketplace.

Thanks for some of the details, though my question was somewhat rhetorical. I'm sure others have noticed as well, but they're trying to redfine what "healthcare" is right before our eyes. I wouldn't expect anything that we would see from an Obama plan to look like what we know as healthcare coverage today.

And as I said in my original post, "access to medical services" cause me to raise an eyebrow, because it doesn't sound like "you can see a doctor for treatment or illness."

Thanks for some of the details, though my question was somewhat rhetorical.

I understood that :-) But I used it as an opportunity to expand and fill in some of the details from the article that clearly show this "public option" to be nothing more than an expansion of government welfare programs, and to include a comment from whitedog57 succinctly nailing what the "public options" of any kind are really all about - social and financial control and redistribution.

Whatever one thinks of strengths and weaknesses, advantages and disadvantages of any particular insurance program, I posted the article to show that
a) "public option" in most of its incarnations is not by any normal definition an insurance program, but a welfare program and
b) this program is, in itself, a proof that there is no need for a one-size-fits-all command-and-control national / federal program since any city, state or "community" can design one suited for itself, if citizens desire it.

Whatever "works" for San Francisco (before program goes bankrupt or be modified / rationed even more to accommodate harsh realities of "marketplace") will hardly work for most places in other states, and would Healthy SF program itself become supplemental to national "universal insurance", supersede it or be canceled by it? Why, instead, not try Obama or Baucus or Pelosi or Reid "public option" (whatever it is on any given day) on the state(s) that think it's a good idea, and see the results. Not that we really need to see it yet again, after experiences in Hawaii, Tennessee, Michigan, Massachusetts but what the heck, let the states experiment with their own versions of welfare and rationing.

If the answer is that people can't leave the country as easily as they can leave the city or state - that alone tells all we need to know about how "beneficial" and how truly oppressive this is for the country. Not to even mention, of course, that why people may not leave the country (state, city, "community") the capital surely will move somewhere else.

BTW, a very good show on insurance (private vs public / state, insurance vs welfare) is in Part 3 of Niall Ferguson's four-part series The Ascent of Money - of all places, on PBS - The Ascent of Money Episode 3: Risky Business

Unfortunately, the two-hour video by the same name, which is available on DVD, doesn't have most of the material in episode 3, so it's not a useful substitute.

Whatever one thinks of strengths and weaknesses, advantages and disadvantages of any particular insurance program, I posted the article to show that...

I recognize that the fact that most "insurance" really isn't insurance is largely tangential to the article, but that's the nature of much discussion on FR. I didn't get into the socialized-risk nature of "group insurance" but the goal there is to subsidize people with greater health-care needs at the expense of those with lesser needs, rather than to actually insure anyone against long-term costs.

I didn't feel it worthwhile to post a vanity on the fact that "insurance" isn't, but I'm not sure where would be best to discuss it. It's an observation I think is certainly relevant in discussions of the U.S. health system, and it's one I've not seen talked about very much.

I understood your intent, and I appreciate your point (hence, reference to Niall Ferguson’s Ascent of Money), and it’s one reason I am trying to avoid terms like “socialized insurance” since it’s really already the nature of current “group insurance” or “pooled insurance” systems of health care financing. Rather I mostly use national or federal to refer to the scale and stepped up government [level] involvement, far beyond the one it already has in health care, and for reasons having nothing to do with benevolence or charity.

What you want to talk about is a very important and complex subject all of its own, and unfortunately I can’t devote the time to discuss it in depth. The discussion on FR is driven, obviously, by the current drive to nationalize whatever remains of private socialized-risk “insurance” system, with its known risks and deficiencies, because whatever they have in mind is substantially worse. Whatever problems there are with current system, it still allows for a private marketplace and (severely crimped, by state governments and their insurance commissions) competition.

So if some insurance company or a group of well-financed people / companies decide to introduce different, “truer” forms of [catastrophic or long-term] health insurance in the future, they could still do that, but only if we first defeat the practical takeover of insurance industry as a whole, by the federal government.

There is nothing wrong with making a vanity post - that’s one of the things that’s so great about FR, compared to many other “news”-driven sites. Or, finding an article on the subject (even if in mostly dry, academic publication or a book review) and introducing it in that form with your thoughts and invitation for a discussion...

But I would think the time for this is not now, since passions and attention are devoted to a very specific goal of defeating whatever would become ObamaCare and your post will probably get lost in that and won’t get much in the way of desired response. The system we have now is broken and needs to be fixed. One way or another, it's going to be "fixed" soon. While the immediate priority needs to be blocking Obama's "fix", it is nonetheless critical that a real fix be developed soon. The only way that can happen is for people to recognize what the real problems with the system are. To date, I've seen very little discussion of some very important problems which cannot be fixed until they are acknowledged.

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