With opposition from the left on the rise against health care reform in its current greatly compromised form, I think a legitimate question to ask is: "Well, what else then?"
Sure we all would love to have single payer, but it's clearly not going to happen in the current environment and hopes for a public health insurance option or even a Medicare buy-in don't look much better.
I would arge that the Healthy San Francisco program provides a politically realistic model that would ensure universal access to health care at a fraction of the cost of the health care reform bill under consideration in Congress, and requiring few significant changes to the current system of private health care insurance.
Healthy San Francisco provides universal healthcare access to the estimated 82,000 San Francisco adult residents who are not eligible for existing public health insurance. Healthy San Francisco is not insurance -- instead, it is a model of providing participants access to primary and preventive healthcare, as well as specialty care and other types of healthcare services. Here are the basics about the program:
- Participants must receive services in San Francisco.
- Services do include preventive and routine care, specialty care, urgent and emergent care, ambulance services, hospital care, mental healthcare, laboratory services, alcohol & drug abuse care, prescription medicine
- Services do not include vision, dental, gastric by-pass surgery or services, infertility, long-term care, non-emergency transportation as well as several other types of services.
- Healthy San Francisco is not health insurance, therefore, services provided outside the city and county of San Francisco are not provided or paid and services must be provided by a Healthy San Francisco provider. If a patient arrives at the wrong clinic, they are directed to the proper clinic or have the option of paying for the visit themselves.
- Participants are assigned a "Medical Home" and a primary care physician.
Eligibility
The program is available to all San Francisco residents, regardless of immigration status, employment status, or pre-existing medical conditions and who are between the ages of 18-64 and are not eligible for public health insurance. Combined family income must be at or below 500 percent of the federal poverty level to qualify.
Healthcare Providers
Providers include public health care providers operated by the City, as well as private non-profits. If a participant goes to an emergency department for non-urgent care, they will be assessed a fee of $25 to $50, depending on income level.
Private health care providers who become part of the program are given a grant based on an estimate of how many people they will serve in that year with assurances that the grant will increase if additional patients are seen.
Employer Participation
San Francisco employers are required to spend a minimum amount per hour on healthcare for employees who work 10 or more hours per week in San Francisco. This was challenged in a lawsuit, but upheld at the 9th Circuit.
To comply, employers may:
- purchase employee health insurance,
- contribute to Healthy San Francisco for its San Francisco employees,
- contribute to individual Medical Reimbursement Accounts for employees' out-of-pocket medical expenses,
- reimburse employees for healthcare expenses, or
- pay employees' healthcare providers directly.
If employees are San Francisco residents and meet the eligibility requirements, employer payments to the Healthy San Francisco program will reduce the program fee for the employees. If the employees do not live in San Francisco or do not meet the eligibility criteria, the employer must allocate to the employees' Medical Reimbursement Account or purchase medical insurance.
Employers can obtain waiver forms from employees who receive health coverage through another employer.
Nonprofit employers with less than 50 employees or small employers with less than 20 employees are exempt.
Financing
Healthy San Francisco is a "shared responsibility" plan, and is financed through contributions from employers, sliding scale fees from participants, the City and County of San Francisco, and other public funding such as federal start-up funding. The funding as of the end of its first year in operation was as follows:
- the City of San Francisco pays $123 million by redirecting existing uninsured funds,
- federal healthcare expansion award totaling $24 million,
- employer contributions of $7.4 million from 700 businesses so far, (estimated to reach $15 million),
- individual contributions of $6 million, and
- additional federal and state contributions of $14 million.
Source: http://www.cga.ct.gov/...
This program could be scaled up to the federal level. There are already thousands of federal, state and locally-funded public and nonprofit health care delivery facilities around the country who could automatically be "drafted" to participate as providers, and there could also be deals reached with other providers that already provide a significant amount of "unreimbursed" medical care.
Again, a program like this would not need a lot of new regulations, or even new funding. It's a reorganization of existing funding, along with a mandate along with an affordable new option for businesses that do not currently provide health insurance. There's no need to require private insurance companies to change their practices at all, and there's no need to require individuals to purchase private health insurance. Yet, universal access to health care is achieved.
I'm not saying that San Francisco has the perfect solution. But it provides a model for providing universal health care without going through the private insurance companies, but still stopping well short of "single payer". If the Blue Dogs and the moderate Republicans do not want to sign on to the wide-ranging health care reform that's been proposed, why not just do something like this instead to at least guarantee that everyone has access to care, and that nobody goes bankrupt over health care bills.
It is another alternative, right?