The Healthy SF Plan in brief: (NOT a snark)

- Universal coverage. Open to all San Francisco residents ages 18 to 64 regardless of employment or immigration status. - No pre-existing conditions exclusions. - No deductibles. - No annual or lifetime caps. - Health Card for member access. - Covered services . No limits on doctor visits and hospital stays and includes drug rehab, labs, family planning, prescription drugs, mental health and more. - Medical Home. A local neighborhood clinic (you choose your clinic) for a primary care doctor. Referrals to specialists and hospitals as needed. - Preventative focus encouraged to reduce the City's emergency room visits.

What it doesn’t do: Services not included.

- Care only available in San Francisco. Not true cover-you-anywhere health insurance. - No dental or vision, no acupuncture :o( - Limited network of 27 City clinics and 5 hospitals. More private hospitals are joining, Kaiser just added.

What it costs for Participants::

- Sliding scale based on income, assets and family size up to 500% Fed Poverty Line (FPL). Free for low income. Income maximums for an individual = $54,000/pays $450/qtr. or family of 4 = $110,000/pays $1800/qtr. That's per quarter! - Minimal Co-Pays. $0 to $10 doctor visit, $0 to $50 ER, $0 to $25 drugs.

A similar Gold Standard private insurance plan would cost, if you could even get it as an individual with pre-existing conditions, a minimum of $700/per month for individual Anthem Blue Cross.



What the Kaiser (PDF) Survey results say about Healthy SF:

Great talking point facts when at your friendly town hall meeting or Tea Bagger party!

Overall Results: Patient Satisfaction: 94% Satisfied; 63% "Very Satisfied" 31% "Somewhat Satisfied" Available: 60% of participants were NOT eligible for health insurance from their employer when they signed up! Now that's universal care. Program Enrollment Process: 86% Satisfied Health Needs Met: Before program 66% Satisfied (34% very well satisfied); After enrollment in program 90% Satisfied (57% very well satisfied). WOW! Feeling Well Protected: Remember Healthy SF is NOT health insurance, even so, 50% felt "well protected" the same percentage as people who have health insurance plans today. Services and Access Results: Treatments and Drugs You Want: 89% Satisfied, 9% Not Satisfied (where's the exclusions "list"?) Routine Appointments: 84% Satisfied, 13% Not Satisfied (the doctor will see you now) Specialist Appointment: 80% Satisfied, 16% Not Satisfied (where are the death panels?) Doctor Communication: 88% Satisfied, 7% Not Satisfied (do they allow this?) Quality of Care: 91% Satisfied, 4% Not Satisfied (nuff' said) See the Doctor you Want: 84% Satisfied, Not Satisfied 10% (choice, who knew?) Administrative Answers: 89% Satisfied, 7% Not Satisfied. (what planet is this from?) Cost Results: Cost: 44% say they are "paying less" and 15% say they are "paying more". Remember "paying more" means in comparison to when they had health insurance paid by their employer. Overall Cost: 88% Satisfied, 6% Not Satisfied. (3% overhead vs. 33% profits)

In summary, PARTICIPANTS ARE 80%+ SATISFIED ON EVERY METRIC OF SF's PUBLIC OPTION.

Okay so what about business and the fiscal impact? aka the Blue Dog fiscal boogieman.

Financial Impact for SF City and Corporations:

Overview of population served. 73,000 uninsured SF residents (about 10% of the population). 45,000 people signed up in 2 years in Healthy SF. About 60% of those 45,000 are at the Fed Poverty Line and have substantially higher health care needs (the uninsured population comprises more homeless, skews older, higher percentage of mental health and drug abuse issues, higher percentage of non-English speaking immigrants).

Cost to the City: 2009 budget of $113 million or about $280/per participant/per month. The City covers $199/person of this (from its existing health care funding base of local/State/Federal funding) and the participant fees and employer fees cover the remainder. Note the key here is a) the city has reorganized its existing health care assets (clinics, hospitals, programs) and funding dollars into one universal coverage and access plan and b) the plan has shown to substantially reduce very high-cost emergency room visits with regular access to local preventative care. Health care rationalized, not rationed.

Okay so what does business pay? First, if you already provide health insurance for your employees, then you don't pay. If you have more than 20 employees and you choose not to cover them, then you pay. The SF plan is mandatory for businesses to either provide health insurance coverage or pay the City to provide the coverage through Healthy SF. (note mandatory choice for the employer not for the individual - what a concept!)

Are businesses happy? No, and surprisingly, yes. The SF Restaurant Assoc (GGRA) has sued to halt the employer mandate, lost and is now appealing to the Supreme Court. The City has stood its ground and they have been joined in amicus briefs by, surprise, some more enlightened companies, for example.

Nibbi Bros, a major SF construction company, says it, "has an interest in not being at a competitive disadvantage when dealing with employers who choose not to bear any of the direct or societal cost of health care."

What about the California Budget crisis and its impact on Healthy SF?

It sucks. SF has been forced to cut its Public Health services. Staff cuts have been deep and clinic services reduced.

It lives. The Healthy SF program lives on - BECAUSE it saves $$$, and it is more efficient in the use of health care dollars. In fact, in February, the income limits were raised from 300% FPL to 500% of the FPL - meaning more people are covered.

Finally, for the personal stories on how Healthy SF has saved lives (get out the hankies):

Fellow Kossack diary - a life saver!

CNN TV report on - another life saver!

My story. I am recently unemployed. My wife has been going through breast cancer treatment. She has been rendered by the insurance industry as effectively uninsured and is scared to death. Fortunately, my family of four is able to live in SF at my mother's house. I saw an ad (imagine advertising for universal health care) for the Healthy SF program on the side of a City bus. My wife and I went down to Healthy SF, signed up that day, paid the $60 quarterly fee (unemployed family of 4) and selected our Medical Home. Within several days we had scheduled appointments for family checkups and an oncologist visit. My wife's and my sense of relief and gratitude is overwhelming for the Healthy SF program and the people (Mitch Katz and Mayor Newsom among many others) who created it and continue to make it possible every day.

Oh, and the final question of the Kaiser survey: Do you think other cities should create programs like Healthy SF, or not? 92% Yes, 6% Don't Know, 2% No (well there are a few Republicans left in SF).

So at your next health care discussion or town hall meeting, ask this simple question:

San Francisco has a Public Option right now that 94% of the participants are satisfied with. It costs half what normal insurance costs, includes pre-existing conditions and no deductibles. Why can't we have a Public Option like this also?

NOW LET'S GO MAKE PUBLIC OPTION HEALTH CARE AVAILABLE TO EVERYONE!!!

Second diary - and Rec Listed - THANKS!

It just says to me how much we really need the Public Option.