San Francisco's Single-Payer Health Plan

by: catfish

Wed Jan 06, 2010 at 16:48:37 PM EST

This month's San Francisco magazine profiles the health care plan (and that's what it is: a health care, not insurance, plan. Imagine the ability to cut costs when you cut out insurance companies, insurance claim forms, insurance b.s.)  

Healthy San Francisco (HSF) is not perfect or glamorous. For example, customers seeking care outside the city are on their own and must pay out-of-pocket. Small businesses with 20 or more employees were required to pay extra taxes. Also, financial constraints mean the plan needed to roll out slowly; they just opened up enrollment to people making up to $54,150, though officials hope to open HSF to all income levels by the end of 2010.

But it does make health care affordable and it does focus on care; it is not an insurance plan. One of the concepts that would have enlightened our national debate was that of requiring each HSF customer to begin at a "medical home" - or home base medical clinic or hospital where the patient's primary care checkups are performed. This is designed to begin the cycle of preventive care, cut down on Emergency Room visits and ideally control costs.

So how is "Healthy San Francisco" working out? Hear from some of their customers:

On affordability:

HSF is, hands down, one of the best healthcare bargains anywhere. For individuals earning less than $10,830 annually, the program is free. For everyone else, basic enrollment is $20 to $150 per month (versus $409 for the average Califor­nia insurance premium), with rock-bottom copayments: $10 for primary care visits, $200 for hos­pital admissions, and $5 to $25 for medications. The fees are so low, in fact, that at times I've felt like I'm duping the system.

For anyone used to getting the shaft from insurance companies, HSF's welcoming stance is a shock to the system. Robert Arnold, a 43-year-old documentary filmmaker who could easily pass for 30, lives the quintessential Peter Pan/San Fran­cisco lifestyle, complete with two roommates and no real assets. Years ago, he traded in his $80,000-a-year Macromedia job in favor of more creative work. This past September, he swapped his private insurance for public care. As a strong backer of healthcare reform with a public option, he felt a stab of pain every time he wrote a check to Blue Shield, which he knew was funding anti-reform lobbyists. As his age crept past 40 and his monthly premiums nearly doubled, his anger festered. "Paying into the health insurance company's corporate profits is just not cool with me," he says.

What struck Arnold most about HSF was that instead of trying to disqualify him-often the knee-jerk reaction of private insurers-the program did everything it could to make it easier for him to enroll. "I guess it makes sense, since they are focused on providing a service instead of making a profit," he says, "but it just felt so different." In contrast, he had to make four calls to Blue Shield, getting lost in its automatic phone system each time, before he found a live person who could cancel his plan.

Anecdotes suggest Health San Francisco (HSF)'s quality of care isn't too shabby either:

In a recent Kaiser Family Foundation survey, a whopping 94 percent of users expressed satisfaction with HSF, while almost as many said they planned to continue with the program and would recommend it to friends. Those numbers are as high as you'll find for medical care anywhere. Even doctors-some of the loudest and most influential critics of health­care reform in the past-have been impressed by the results so far, my father included. When I fell ill, he was nervous about my being treated in a public hospital, so he got on the phone to my doctors at S.F. General and grilled them. He quickly concluded that my care was first-rate-as good as what I'd receive at an elite private insti­tution.

In fact, I've been struck by the number of people who insist that HSF offers better care than their private insurance did. These are not people foisted on me by some eager-to-impress PR machine. They are just normal folks, like Margaret Cooley, a 55-year-old writer whose husband used to work at Apple. When she tripped and fractured her wrist during a visit to Illinois two years ago, a doctor recommended implanting a device to help her maintain full use of her hand, and Blue Cross okayed the surgery. But a few weeks later, medical bills started filling her mailbox, eventually totaling $14,000. The procedure, it turned out, was only covered if it was done at a hospital. "I contested it," Cooley says, "but Blue Cross said it wasn't their fault that I didn't understand my coverage."

Dropping her private plan was a no-brainer: As she says, "I felt it was pretty much worthless anyway." A year later, when Cooley felt an odd sensation in her wrist, HSF sent her to a UCSF ortho­pedist who happened to be studying the long-term effects of the type of device in her arm. Cooley's implant was on the verge of causing permanent damage, a possibility the Illinois doctor had neglected to mention; HSF sent her for surgery right away. "Can you imagine if I had gone around with that device in my wrist and no one even bothered to tell me, because they don't want me to use my health insurance again?" she asks. "I just feel so lucky."

Sharon Donnelly, 50, feels even more fortunate. She has hydrocephalus, a condition in which fluid develops in her brain. She has a shunt in her head that requires continual monitoring and, every few years, replacement via surgery. That condition, along with high blood pressure and high cholesterol, makes it nearly impossible to find insurance on her own. Yet last year, she quit her library assistant job, giving up her private coverage and enrolling in HSF soon after. As a kid, she went to top specialists affiliated with Columbia and Harvard. Her HSF care, she says, is just as good.

What makes Donnelly's story amazing, though, is that her HSF team detected an entirely different-and potentially fatal-condition that had been overlooked by her Pacific Heights general practitioner when she was covered by private insurance. Like the staff at many community clinics, the nurses at her "home," Lyon-Martin, were accustomed to patients who rarely seek medical attention-so they were trained to look for every possible ailment. During Donnelly's first physical, a nurse noticed that her thyroid was asymmetrical and immediately ordered a CT scan and biopsy. The tests turned up thyroid cancer. Now, five months later, Donnelly is undergoing treatment, and if she ever gets another job with insurance, she'll fight to keep her HSF docs. As she often says, "Healthy San Francisco saved my life."

As they say, please read the whole thing. Not every customer was happy.

There is still time to influence the debate in Congress, both houses will still have to vote on a final joint-version of the bill. Politico reported the administration does not expect to sign the bill before the State of the Union address.

Now I have to run and make my Cobra payment before they drop me...