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Double Payer 

SF is out of the health-care business if the governor's new plan goes through.

Wednesday, Dec 26 2007

Just days before state Assembly Speaker Fabian Nuñez and Governor Arnold Schwarzenegger announced a deal moving California closer to universal health care, the city of San Francisco said it would expand its aspiring universal health-care program, Healthy San Francisco, by raising the income cap from 100 percent of the poverty level to 300 percent.

That generosity sounds wonderful, but there's a catch: While the city's plan provides health care for eligible residents without insurance, the state's plan requires every Californian to have insurance. So — ta-da! — technically the city can still provide health care, but it's arguably a moot point. For most of San Francisco's 82,000 uninsured residents, the city is out of the health-care business if the governor's plan goes through.

Illegal immigrants will still get free health care through the city if they meet the income requirement and can show proof of residency, as can city-based transients who don't enroll in the state's plan (and are thus breaking the law requiring everyone to have insurance, but that's another story).

For many people, that's not a problem: San Francisco is already a "sanctuary city," and once we accept the idea that the city won't turn in illegal immigrants, making sure they're healthy isn't much of a stretch. Neither is providing health care for the chronically homeless much of a change in established policy. But, well, you can imagine hotheads on KSFO going off about San Francisco offering free health care to foreigners and drunken bums but not to law-abiding members of the working class.

"There may be criticism, but we just don't want people dying on the sidewalk, and in that sense, no, we don't care who they are," says Supervisor Tom Ammiano, who has worked tirelessly behind the scenes to establish Healthy San Francisco. "We want a healthy city." If the state offers these people a better deal, he said, San Francisco will be happy to turn them over to the state program. Jim Soos, assistant director of policy and public planning at the Department of Public Health, echoes that last sentiment: "We'd actually like more people to be enrolled in the state plan," he says. "It saves us money."

Maybe someone should tell the mayor. In his online diary at, Gavin Newsom criticized Schwarzenegger's plan, saying it was flawed and needed "to be sent back for major reconstructive surgery," because it isn't a single-payer plan like San Francisco's. Newsom may have a point, but too many people paying for health care is still a better problem than too few.

About The Author

Benjamin Wachs


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