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Saturday, August 19th 2006

San Fran Deli, I'll Take The Swiss Cheese Sandwich

San Francisco’s move for universal healthcare has a lot of holes in it. It is basically an expansion of city clinics and department of public health services. From the bay area,

“San Francisco is the first city in the nation to provide universal healthcare access to the uninsured,” Mayor Gavin Newsom said prior to signing the ordinance at a news conference held outside of the health clinic.

But there is still a lot left undecided,

Newsom also announced the formation of a 19-member HAP advisory council to oversee and shape the defined benefits of the program. Modeled after the recommendations of the city’s Universal Healthcare Council, advisers and officials will now work to provide consultation to the Department of Public Health for design and implementation of the program.

That includes setting membership rates, designing the range of benefits and health care services, researching utilization and costs and evaluation of the program, including areas of improvement.

“This committee is ready to go to work,” said Catholic Healthcare West CEO Lloyd Dean, who with Health Director Dr. Mitch Katz will co-chair the advisory council.

“This legislation is so very significant and so very important. It is inspiring to stand here in front of this building and tell the public that we are ready to take this dream that the mayor and Supervisor Ammiano have had and make it into a reality,” Dean said.

The ordinance takes effect in January and city officials expect to see the program’s first enrollees by July 2007.

The plan is funded from the current public health budget, enrollment fees, and a mandate that all employers who don’t offer health insurance to their employees contribute,

“This next phase will be the most complex,” Newsom said of HAP’s implementation. “We don’t want to over promise and under deliver. San Francisco has come up with a lot of great ideas in the past and we want to know this plan is going to be no exception.”

Some city business owners say they will be hard-pressed to make the co-payments necessary to help fund HAP, as outlined by Ammiano’s legislation, and there has been some talk of possible litigation against the plan’s implementation.

The passed plan calls for uninsured residents to contribute as little as $3/month in order to be able to access the as yet cobbled together expanded network of public clinics and doctors that will be part of the plan.

AMNews
(subscription required) talks about the evolution of that network, and how many kinks need to be worked out. For instance, it is still unclear how physicians will be reimbursed,

Participating physicians would receive some form of reimbursement but the exact amount is unclear, said Gordon Fung, MD, MPH, who serves as the San Francisco Medical Society president and sat on the Universal Healthcare Council, a group of medical professionals, insurers and business owners assembled by the mayor to study the issue.
82,000 uninsured San Francisco residents will be eligible for health care coverage.

“The funding aspects are still a bit murky,” he said. “The medical society wants to get some firm answers.”

It plans to hold a town hall-style meeting to discuss the plan, ask questions and decide whether the medical society will back the program, Dr. Fung said.

“We all support the principle of covering more people,” he said.

Michael Drennan, MD, a primary care physician who serves as the San Francisco Dept. of Public Health’s director of community-oriented primary care, said the plan reflects the desires of many physicians who work at the city’s 15 neighborhood clinics and 10 nonprofit health centers.

“It’s what we’ve long hoped for,” said Dr. Drennan, who also was a member of the Universal Healthcare Council.

Under the plan, uninsured residents could receive services from a designated network of doctors, other health professionals and health care facilities. Although officials are still in the process of developing that network, the San Francisco Dept. of Public Health will serve as the program’s backbone.

We’re getting unusual mechanisms to try to expand healthcare access. From the very marketcentric Mass. plan to the public health plan in San Francisco which tries to solve the problem without even addressing how to insure everyone.

Despite the title of the post, I’m actually very intriqued by this plan and hope it enjoys a lot of success. Watch for updates on it, as the plans for it congeal.

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