Posts Tagged Bay Area

This employer supports health care mandate

Published: April 4, 2010 | No Comments

Editor’s Note: This is the fifth part of a series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator. To see the entire series, go here.

By Richard C. Paddock

The business of Nibbi Brothers is constructing buildings, not filing legal papers. But when San Francisco city officials asked the company to support its universal health care program, Nibbi Brothers agreed to join the court battle over Healthy San Francisco.

The Potrero Hill construction company submitted an amicus brief to the U.S. Supreme Court last year urging the justices to uphold the law that established San Francisco’s health care program and required companies to pay for health coverage for their workers.

Bob Nibbi, president of Nibbi Brothers Construction, supports the Healthy San Francisco program because it forces his competitors to offer health benefits to their workers, as his company has done for years.

In its brief, Nibbi Brothers argues that Healthy San Francisco is good for employees and the community. The city should avoid a “race to the bottom,” the company says, in which employers try to remain competitive by refusing to provide health benefits for their workers.

Bob Nibbi, the construction company’s president, said his firm already pays more for employees’ health care than required under the law. He would like to see his competitors — especially contractors who cut costs by employing non-union workers — contribute to their employees’ health costs.

“What we spend on health care greatly exceeds the bar that the ordinance sets,” Nibbi said. “But there are some of our competitors out there who don’t have the obligation to pay for health care.”

Nibbi Brothers is something of a rarity in San Francisco. Bob Nibbi and his brother, Michael, are the third generation of brothers to operate the construction company, which has been in business for nearly 60 years.

Nibbi Brothers uses only union labor. And long before Healthy San Francisco came along, the company provided its employees with a full range of benefits, including medical coverage.

Nibbi said he would like to see construction maintained as a well-paying, skilled trade. But his firm increasingly finds itself competing with contractors who hire non-union workers and pay minimal, if any, benefits.

“As a union contractor it becomes harder and harder for us to compete with those kinds of companies,” he said. “The benefit of the health care ordinance is that, at least for health care, it raises the bar a little bit for those companies.”

Without the San Francisco law, Nibbi said, employers who chose not to provide health insurance would leave their workers to rely on the public health care system, placing a greater burden on taxpayers.

“Basically they are not paying the full freight for the necessary health care that employees and their families are going to need,” Nibbi said. “They are taking advantage of the public system, the public resources that are out there and supported by the taxes that we pay.”

With its stand on the lawsuit, the construction company is opposing the Golden Gate Restaurant Assn., which brought the lawsuit challenging the levy on employers to fund Healthy San Francisco.

Nibbi sympathizes with the restaurant owners and acknowledges that the health care law places a heavier burden on low-wage, labor-intensive businesses.

“The city does not make it easy to be an employer here,” he said. “The restaurant business is a very tough business. For us, you can maybe forecast a day 20 or 30 years from now when a union contractor is more of an endangered species and we could be in a similar situation.”

For universal health care, but not on his shoulders

Published: March 28, 2010 | 1 Comment

Editor’s Note: This is the fourth part of a six-part series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator. To see the entire series, go here.

By Richard C. Paddock

Daniel Scherotter, a restaurant owner and chef, is leading the fight against Healthy San Francisco. It is not that he opposes the health care program. He simply thinks the city’s businesses, particularly restaurants, should not be required to finance universal health care.

As a past president of the Golden Gate Restaurant Assn. and chef and owner of Palio D’Asti restaurant, Scherotter is backing a lawsuit that challenges the Healthy San Francisco law. The case is now before the U.S. Supreme Court.

Daniel Scherotter, a restaurant owner and chef, is leading the fight against Healthy San Francisco, the city's universal health care program.

“San Francisco loves its restaurants but it doesn’t treat us very well,” he says.

For Scherotter, the adoption of Healthy San Francisco is one in a series of city actions that has placed a growing burden on small businesses and made it hard for them to survive. San Francisco’s $9.79 minimum wage and its required 9 days of employee sick leave are among the highest in the nation, he notes.

Under Healthy San Francisco, companies with 20 or more workers must provide employees with health insurance or health reimbursement accounts or pay the city $1.31 per hour for each worker. The rate rises to $1.96 an hour for employers with 100 or more workers.

“Healthy San Francisco is definitely onerous,” Scherotter says. “It’s the straw that broke the camel’s back, which is why we’re suing.”

At one point, he lived in Italy and came to appreciate Europe’s health care system. Like many San Franciscans, he favors universal health care and likes the way care is provided under Healthy San Francisco. His problem is with forcing the low-wage, labor-intensive restaurant industry to shoulder the costs.

Even before the recession, the number of restaurants in San Francisco was shrinking about 5% a year, he said. Several restaurants near his Sacramento Street establishment have closed. Others have gone to self-service to reduce their labor costs.

“I look around here and I am the only major restaurant on the street,” he says.

Scherotter is the son of a lawyer and has a degree in philosophy. But what he really loves is cooking. After college, he came to San Francisco in 1993 to attend the California Culinary Academy.

He got one of his first jobs as a cook at Palio D’Asti in San Francisco’s financial district making $9 an hour and worked his way up, eventually becoming the chef and buying the restaurant.

Many restaurants have added a surcharge to help cover the cost of Healthy San Francisco and put a note on their menus informing customers of the extra fee.

“It has been effective in making a statement,” says Scherotter, although he doesn’t add a surcharge at Palio D’Asti.

Scherotter would like to see the city – and the nation – take an entirely different approach to health care: spend more on better quality food and less on health insurance.

“Only a chef could say this, right?” he offered. “But why food doesn’t have a part in the health care discussion I don’t have any idea.”

Europeans who eat a Mediterranean diet are healthier than the average American, he notes, not because their doctors are better but because their food is healthier. Buying cheap, government-subsidized, processed food leads to higher health care costs.

“People spend very little money to eat crap and then have to pay for health insurance,” he said. “It’s about as backwards as it can get. It would make more sense for employers to give lunch insurance to their employees.”

In San Francisco, a rush for health care

Published: March 20, 2010 | No Comments

Dr. Kenneth Tai is a physician and medical director of North East Medical Services, a network of clinics that has 11,000 Healthy San Francisco members as patients.

Editor’s Note: This is the third part of a six-part series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator. To see the entire series, go here.

By Richard C. Paddock

When the Healthy San Francisco program began three years ago, Dr. Kenneth Tai and his clinic on the edge of Chinatown were flooded with thousands of new patients. Many had serious health problems that had long been neglected.

Some patients had suffered debilitating strokes and were not receiving adequate care, said Dr. Tai, medical director of the North East Medical Services clinic. Others came in with pains they had ignored only to find they had cancer.

“We have quite a number of sick patients that have come through because of Healthy San Francisco,” he said. “A lot of patients with stroke and they can’t walk. Or cancer that was diagnosed because of Healthy San Francisco. They were not being cared for appropriately because of access issues.”

Today, more than a quarter of the clinic’s 40,000 patients are enrolled in San Francisco’s innovative health care program. Dr. Tai sees it as an important step in serving patients who had been unable to afford medical care.

“Healthy San Francisco is a great start toward a universal health care program,” he said. “Healthy San Francisco has enabled a lot of patients to sign up and not worry, ‘Will I be able to pay?’”

The North East Medical Services is a non-profit community clinic that began treating poor patients in Chinatown 38 years ago. It now has five locations.

NEMS, as it is known, was one of the first two Healthy San Francisco clinic sites. “It’s our mission to serve the underserved,” Dr. Tai said. “When Healthy San Francisco came along, that was the type of patient we were serving a lot of already.”

Dr. Tai, 35, became medical director a year ago and spends half his time as an administrator and half seeing patients. Most of the clinic doctors and staff are multilingual. Dr. Tai, who was born in Taiwan and grew up in Chicago, speaks Mandarin and Cantonese.

Of the 11,000 NEMS patients covered by Healthy San Francisco, about half are new to the clinic. The clinic receives a flat fee from the city for each patient and provides all primary care services, preventive care visits, urgent care, medications and lab work. Those with serious medical problems are referred to a hospital.

“Fiscally speaking, it is at best break even,” he said. “The reimbursement is definitely not high. We try to provide the best quality care without breaking the bank.”

In the early days, the clinic was overwhelmed with Healthy San Francisco patients eager to see a doctor. Many were so happy with the free service, they returned frequently. To reduce the crowds, NEMS began requiring a $5 co-payment for the poorest patients and $10 for those with higher income.

“Once patients get their universal access program, the demand is very great,” Dr. Tai said. “They all want to come and see a doctor.”

The clinic also has expanded rapidly. In the past year, it has hired a dozen new doctors. Using federal stimulus money, it added 10 exam rooms to its main clinic on Stockton Street.

With the city program, Dr. Tai sees a shift towards prevention, which experts hope will contribute to a healthier community and reduce medical care costs.

“It’s really going from a paradigm of taking care of the sick to a model that tries to prevent people from getting sick,” he said. “That’s where we are heading with Healthy San Francisco and where we are heading as a nation. We are very excited about that.”

Richmond searches for answers to soaring homicide rate

Published: March 20, 2010 | No Comments

By Heather Tirado Gilligan

A corner store in Richmond's notorious Iron Triangle district, on once-lively MacDonald Ave. Photo by Heather Tirado Gilligan.

Even as murder rates are declining across California and the nation, homicide is on the rise in Richmond, the gritty industrial city on the east side of San Francisco Bay. A resident of Richmond is nearly three times as likely to be murdered as someone in Los Angeles, Sacramento or San Francisco.

In the last two months alone, Richmond has seen seven murders. This year’s crimes include the killing of a pregnant mother in a drive-by shooting February. Another February shooting shocked local residents and spectators statewide when teen-aged gunmen opened fire on two churchgoers, also teenagers, as the choir sang during Sunday services. And a murder of a toll-booth worker last year on the Richmond-San Rafael Bridge and the subsequent chase of the suspected shooter played out on television screen across the country.

The latest surge is a step back for the city after years of progress. Between 1991 and 2001 Richmond’s murder rate dropped from 69 killings for every 100,000 people to just 18. The rate has been rising steadily since then, except for a one-year dip in 2008. Last year there were 47 murders in the city of about 104,000 people.

What is at the heart of Richmond’s plight? The simple answer is poverty. Poverty and violence go together. Look at a map showing both of them and it is clear that murders occur almost exclusively in areas of high poverty. And Richmond is one of the poorest cities in the state.

But that simple answer doesn’t capture the real story in Richmond. People of all walks of life, from the government, law enforcement and the community, are trying new strategies to reduce the violence. The city is using ex-cons to reach out to at-risk “trigger-pullers.”

This map shows the correlation between homicide and poverty in the city of Richmond. Click on the map for a larger image.

The police are spending more time in the community. And religious and neighborhood groups are standing up to try to face down violent crime. Divisions remain about the best violence prevention strategies to employ, but people are united by their persistence, their refusal to step back and let crime rule their city.

“It’s not any surprise that the areas where we see most of the homicides in our city are the poorest areas of our city,” said Devone Boggan, director of Richmond’s Office of Neighborhood Safety. “But I’ll never buy into because I don’t have money I have a right to go shoot and kill someone.”

Hear Devone Boggan in his own words.

Devone Boggan, director of the Office of Neighborhood Safety

Poverty and Crime

People such as Boggan and the office he directs are rowing against a very strong tide. The improvement in overall national homicide numbers has obscured a rise in homicides among young black men, according to researchers James Allen Fox and Marc Swatt. Among young black men nationally, the homicide rate increased by 31 percent between 2001 and 2007, and the rate jumps to 54 percent for gun-related homicides.

“Richmond has had a serious violence problem for many, many years,” said Barry Krisberg, a senior fellow at the Center for Criminal Justice at Berkeley’s Boalt Law School. “What we see is that violence rises when you have concentrated and compacted poverty. Unlike other cities, Richmond is still characterized by really compacted poverty.”

Richmond Mayor Gayle McLaughlin agrees. “Poverty is clearly at the root of violence,” she said. “Racial injustice, social injustice are a part of the history of this city and all of this is part of the problem.”

Krisberg questions the effectiveness of crime preventions solutions undertaken outside of efforts to tame poverty. “It’s my opinion that cities have to reduce poverty if they want to see significant reductions in violence,” he said.

Looking for local answers

But people in Richmond refuse to accept that economics is destiny when it comes to violence. One possibility of change lies in the men the Office of Neighborhood Services employs as outreach workers—formerly incarcerated Richmond natives.

“We should build on the assets of those coming home from incarceration,” Boggan said. “For the city to take a step in actually hiring folks who have interesting pasts…and that’s a criteria for the work, I think is a positive step.”

ONS runs Richmond’s version of Project Ceasefire, a violence reduction program that originated in Boston. The city agency uses outreach workers to identify people who are most likely to offend, and tries to redirect them to resources in the community that can help them learn marketable skills and find work. The office identifies what they call “known-trigger pullers” in the community and targets them for services. They focus on young people aged 14-24.

Outreach workers like Sal Garcia, who was incarcerated in the late 1980s on a narcotics charge, share a similar background to the clients they reach out to on the streets. They also share a common pain. “The majority of people who are dying in Richmond are Latino and African American. Kids who look like me,” said Garcia.

Hear Sal Garcia in his own words.

Sal Garcia is an outreach worker for the Richmond Office of Neighborhood Safety.

The outreach workers have a lifetime of experience dealing with the problems that drive at-risk young people to lives of crime, including losing family members to violence. “Back in ’92,” Garcia said, “I lost my brother.”

Reducing retaliation is key to their mission to reducing crime, outreach workers say. Outreach worker Sam Vaughn says that he participated in the wave of violence that plagued Richmond in the 1990s. He regrets his past, he said, especially after seeing his young nephew follow in his footsteps and end up in prison. Still, he draws on his past involvement in crime while reaching out to young people in Richmond, particularly when he talks to victim’s family members who may be thinking about revenge.

Hear Sam Vaughn in his own words.

“When you have a young man that’s been murdered and you have his older brother who feels like I have to pay somebody back for this, for me watching my mom cry, or me realizing that my dad had to sell his truck to pay for the funeral, there’s anger and a lot of frustration involved in that, so you definitely want to engage people with those kinds of emotions,” Vaughn said.

Sam Vaughn, Richmond outreach worker.

Vaughn and Garcia comprise half of the office’s staff of outreach workers. Garcia has worked for the office since 2007, when ONS was created, and Vaughn joined the staff in December 2009.

“It amazes me how large and ambitious the mandate is of this office and how the resources don’t match that mandate,” Boggan said. “You have an office of four outreach workers and one director. I think that’s a crime.” The office has been chronically underfunded: Richmond budgeted about $800,000 for ONS this year, $1.2 million short of what the city initially promised, Boggan said.

“That’s absolutely true,” Mayor McLaughlin said of the budget shortfalls at. She blames declining tax revenues and the state raiding of city coffers for the decreased city funding of violence prevention. “We could use a lot more neighborhood change agents,” she acknowledged.

But Andre Shumake, president of the Richmond Improvement Association, a faith-based organization working in violence prevention for the past 10 years, thinks ONS might be getting too much money already. No matter the amount of their resources, city agencies are ill-equipped to reach into the communities, a task most suited to grassroots organization like his own, he said.

Andre Shumake, president of the Richmond Improvement Association, thinks neighborhood-based efforts against violence will be more effective than projects led by the government.

“For the most part, it’s our nieces, nephews, sons and daughters who are out there committing these crimes,” Shumake said. Because of these close connections, he advocates a community-generated approach to violence prevention. “People look at the problem and feel so overwhelmed and think it’s insurmountable,” Shumake said. “It’s not. It’s really not.”

When the Richmond homicide rate skyrocketed in 2006, Shumake worked with other faith-based organization to create what they called a tent city. Local residents camped out for 40 days and 40 nights, Shumake said, to call attention to the violence raging in the city, and to deepen community bonds. Richmond churches, including the Richmond Improvement Association, are mobilizing now to respond to the Feb. 14 church shooting by organizing marches and rallies that took place on Feb. 27 and March 5.

Hear Andre Shumake in his own words.

Mayor McLaughlin favors such a community-based approach, she said, specifically citing the outreach work of the churches. “That’s a very key piece, the community organizations.”

When the community speaks out against violence, she said, it shows people who might break the law “that the community will not tolerate that.” “We have decades of injustice to overcome,” McLaughlin said. “I feel very confident that we are going to show what an urban area struggling with violence can do.”

She said the police department is shifting its tactics as well, with two cops on a walking beat and a new bike patrol. Community policing is at the heart of the police department’s crime fighting strategy, said police spokeswoman Sgt. Bisa French. Officers work beats for at least a year, and during that time attend community events and meetings so residents who live on their beat can get to know them. The police department’s three substations are also a part of a community policing strategy, as they allow officers to spend more time in their assigned neighborhoods, French said.

Yet Garcia, one of the outreach workers, cited the police’s inability to connect with the community as part of the cycle of violence. Young people would welcome a police presence if they felt that the police were there to protect them. According to Garcia, young people often carry guns because they are afraid they will become victims if they don’t have a weapon. “These kids are asking for boundaries,” Garcia said. “If there is a presence out there, they know that they are safe.”

Garcia also challenged McLaughlin’s optimistic point of view, criticizing the district attorney for failing to pursue and prosecute homicide cases in Richmond. “Everybody knows who these individuals are,” Garcia said. “They feel they can get away with it.”

Children growing up witnessing violence are more likely be violent, a heartbreaking cycle that outreach workers see every day. “I see a lot of young men out there that are good kids. They have a heart, they have emotions, they have families, they love people,” Vaughn said. “But they really have seen the wrong things; people have told them they wrong things. They’ve dealt with pain that…a 12 and a 13 and a 14-year-old should never have to see.”

Focusing on young people is Richmond’s best hope, according to Krisberg. “Long-term, if you really want to reduce violence in Richmond, you have to focus on the young people, the children,” Krisberg said. “There must be a prevention component and a law-enforcement only approach is not going to do the trick.”

Bay Area planners back local fuel tax for transit

Published: March 15, 2010 | No Comments

Note: Here is my Sunday column from the New York Times, on the idea of a local sales tax on fuel to pay for transit. For the rest of the Times’ Bay Area report, go here.

By Daniel Weintraub

Democrats in the Legislature threw a fiscal lifeline to public transit last week, bolstering financing for buses and trains at a time when the state is cutting just about everything else.

But leaders of the Bay Area’s Metropolitan Transportation Commission saw the moment as a lost opportunity for fundamental change in the way California pays for public transit.

The Bay Area commission is perhaps the state’s strongest advocate for a proposal that would allow voters to adopt local fees on gasoline and diesel fuel to finance transit service and pay for street and trail improvements that would benefit pedestrians and cyclists.

That provision was in a version of the transportation bill passed by the Assembly last month. But it was dropped in final negotiations with Gov. Arnold Schwarzenegger before lawmakers sent the package to his desk.

As it now stands, the legislation would engineer a complex tax swap, repealing the state sales tax on gasoline while increasing the per-gallon excise tax and the sales tax on diesel fuel. The end result would be an immediate $400 million infusion for transit operations and $350 million a year dedicated to transit beginning in 2011. It is not clear how much of that money would come to the Bay Area.

Randy Rentschler, who follows state legislation for the commission, said his agency’s leaders were grateful for the relief, but still thought the Legislature had taken away far more than it gave back last week.

That is why they see a local fuel fee as such an important step: it could free transit from the whims of state government and its often disruptive revenue swings.

“Local government and state government need a clear separation,” Mr. Rentschler said. “Some people would use the word ‘divorce.’ ”

A local fee, he said, could provide a big boost in financing for transit. Transit operations in the region now cost about $2.2 billion a year. A fee of 10 cents a gallon would raise about $300 million annually in the Bay Area.

That money would help reverse the damage from recent service cuts and fare increases the local districts have adopted. The San Francisco Municipal Transportation Agency raised fares by one-third last year, and the Alameda-Contra Costa district increased basic fares by 14 percent. BART raised fares by 6 percent and charged for parking at more stations.

But most transit districts in the Bay Area and throughout California have been lukewarm to a local-option fee. Many transit operators worry that the state will continue to cut their financing, forcing them to seek support for a fee increase from local voters, with the prospects for approval uncertain at best.

The version of the gasoline fee in the Assembly bill was even more problematic, in the view of transit operators, because it was linked to regional efforts to reduce heat-trapping gases that exacerbate global warming. The regional plans will be years in the making.

Transit agencies face an immediate financial crisis because the state has reduced aid at the same time that the recession has depressed local sales tax collections and fare revenue. The transit districts need money now to preserve service, and most cannot afford to wait on the chance of something more promising a few years down the road.

“There is a lot of uncertainty right now,” said Seamus Murphy, who manages government affairs for the San Mateo County Transportation District. “We don’t know how that fee would be implemented, or whether it will be, or when.”

But Mr. Rentschler, of the transportation commission, said the apparent certainty in the latest plan was illusory. He said that any new money from the state would be great while it lasted, but that he had seen such promises evaporate before. Even this agreement was concocted to find a way around a legal judgment that had ordered the Legislature to give far more money to transit.

“The question is what is going to happen in the future if the state’s deficit is chronic,” he said. “If past is prologue, the deal we cut this year won’t be worth much next year.”

Senator Mark James DeSaulnier, Democrat of Concord, agrees that transit needs a sustainable revenue source to grow as land-use planners seek to shift more people out of their cars to reduce heat-trapping gases.

“I don’t think we’re letting go of the idea,” he said of the Democrats in the Legislature. “This is something we need to do.”

Healthy SF: providing care, and peace of mind

Published: March 14, 2010 | 1 Comment

Editor’s Note: This is the second part of a six-part series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator. To see the entire series, go here.

By Richard C. Paddock

Aurelio Duran has always known he is lucky to live in San Francisco. At first, it was because he loved the city and its music scene. Today, it is also because San Francisco offers universal health care.

Duran, a machinist and singer who emigrated here from Ecuador more than 40 years ago, is a vigorous 64. He had a job at a company in Oakland that made artificial hearts and planned to work until he was 66.

Aurelio Duran, 64, is a retired machinist and singer who began receiving medical care through Healthy San Francisco two-and-a-half years ago after losing his job, having trouble with his own health insurance and suffering from kidney stones. Photo by Richard C. Paddock.

But starting in 2006, he experienced a run of bad luck: He was laid off when his employer went bankrupt. He couldn’t find another job and his unemployment insurance ran out after six months. And when he suffered a recurrence of excruciating kidney stones, he found his doctor no longer accepted his health insurance because of a dispute with the insurance company over reimbursement.

As Duran struggled to get the medical care he needed, he learned from a friend about Healthy San Francisco and its goal of ensuring that every San Franciscan receives adequate health care. Duran was delighted to discover that he was eligible – and that he did not have to pay a dime.

He enrolled in mid-2007 and made San Francisco General Hospital his medical “home.” His primary care physician referred him to various specialists; his kidney condition soon cleared up and he received an examination for glaucoma and treatment of a minor prostate problem.

Duran later put in for his pension and now pays $50 a month for Healthy San Francisco.

“I feel great,” he said as he sat in the living room of his home in the city’s Excelsior District. “Since three years ago, my health has improved greatly. The hospital is full of good doctors.”

Duran came to the U.S. from Ecuador in 1969 at age 24. He had served as a machinist for three years in the Ecuadorian Navy and in 1969, when the United States experienced a machinist shortage, he received a U.S. work permit.

In 1974, he paid $29,000 for the Excelsior house where he and his wife still live. For 20 years he sang in the Bay Area band “Sonido Cinco,” meaning Sound Five.

Today, he believes the care he receives through Healthy San Francisco has restored him to good health and will help him avoid the emergency room.

If the program wasn’t available? “I don’t want to think about it,” he said, “not even for my worst enemy.”

His situation will change again in June when he turns 65 and must switch to Medicare. He is anxious about the possibility of changing doctors, but will be pleased to have coverage throughout the country.

For Duran, like other patients, the biggest disadvantage of the city program is that it is limited to San Francisco. For now, he has no medical coverage whenever he leaves the city. He thinks twice about crossing the Bay Bridge, even for the afternoon.

“When I have something important to do, I have to take my chances,” he said. “Otherwise I would feel like a prisoner in my home.”

Water for Life

Published: March 11, 2010 | 1 Comment

The East Oakland Boxing Association is about more than boxing. The center also has a youth internship program that trains young people in skills that could help them get a job or start a business. The center also has a community garden and hosts a farmer’s market. Recently, a group of youth interns worked with another nonprofit to overhaul the center’s water use and improve its water conservation. This is their story.

Water for Life from Martin Ricard on Vimeo.

Health reform is already here — in San Francisco

Published: March 7, 2010 | 1 Comment

Editor’s Note: This is a six-part series on the Healthy San Francisco program, which provides nearly universal health care for the city’s residents. Each part of the series will examine the program through the eyes of different people in the community, including a patient, a doctor who runs a clinic, two employers with different views of the program, and a hospital administrator.

By Richard C. Paddock

The overhaul of the health care system finally approved in Washington will take effect in phases over the next few years. But in San Francisco, a new method of delivering health care is already in place.

Known as Healthy San Francisco, it is designed to care for the poor and under-served. It provides universal access to health care, comes with a public option, and has no exclusion for prior medical conditions. The only catch is that coverage is available just within the 49 square miles that make up San Francisco.

“There’s nothing else like it in the country,” says Mayor Gavin Newsom. “It’s not perfect. It’s not portable. It’s not insurance. But it’s health care.”

San Francisco Mayor Gavin Newsom.

Since the program began enrolling patients three years ago, it has signed up 50,000 of the estimated 60,000 eligible uninsured adults in San Francisco.

Residents aged 18 to 65 whose income is below the federal poverty level can join Healthy San Francisco and pay nothing except a small co-payment for medical visits. Residents who earn up to five times the poverty level pay a fee on a sliding scale up to $150 a month.

Patients can choose a “medical home” from among three dozen public and private clinics and hospitals, including Kaiser Permanente, which joined last year. In theory, the person’s primary care doctor is responsible for managing his or her care and coordinating among any specialists, clinics or hospitals that the patient visits.

A survey of patients by the Kaiser Family Foundation in August found that 94% are satisfied with the program. The study also found that Healthy San Francisco patients are sicker than the average San Franciscan and use health services more.

San Francisco General Hospital plays a major role in providing health care under the Healthy San Francisco program.

A separate city study of patient care comparing the program’s first two years found that emergency room visits among members dropped 27% per capita in the second year, an indication that the program could eventually reduce health care costs.

Tangerine Brigham, director of Healthy San Francisco, notes that the program has been able to take several steps included in the stalled federal legislation: Establish medical homes for uninsured patients, offer a choice of providers, and focus on preventive care. Providing care under Healthy San Francisco is costing less than $300 a patient per month, she said.

“We have done those things and we haven’t disrupted the health insurance market,” she said. “More importantly, people seem to be satisfied and, my god, it’s run by the government – a public option.”

Businesses with 20 employees or more that do not provide health insurance for their employees must pay $1.31 an hour for each worker. Businesses with more than 100 employees must pay $1.96 an hour.

About 1,000 businesses have chosen to pay into the program rather than provide health care. About $14 million of the program’s $126 million budget comes from employer payments.

The Golden Gate restaurant association filed suit in 2006 seeking to block the required employer contribution and won in district court. The decision was overturned by the U.S. Ninth Circuit Court of Appeals and the restaurant owners appealed to the U.S. Supreme Court. The high court has asked the Obama Administration to weigh in before deciding whether to accept the case.

But even the Restaurant Association praises the success of Health San Francisco in providing medical care for the uninsured.

“What Healthy San Francisco does is improve the health care safety net and no one can be opposed to that,” said Kevin Westlye, the association’s executive director. “It’s the employer mandate we object to.”

Gavin Newsom photo by Josh Thompson.
SF General Hospital photo from DANTC.

Part 2: A patient’s perspective.

Duran later put in for his pension and now pays $50 a month for Healthy San Francisco.

In 1974, he paid $29,000 for the Excelsior house where he and his wife still live. For 20 years he sang in the Bay Area band “Sonido Cinco,” meaning Sound Five.

Today, he believes the care he receives through Healthy San Francisco has restored him to good health and will help him avoid the emergency room.

If the program wasn’t available? “I don’t want to think about it,” he said, “not even for my worst enemy.”

“When I have something important to do, I have to take my chances,” he said. “Otherwise I would feel like a prisoner in my home.”

Part 3: A doctor deals with the rush for care

Dr. Kenneth Tai is a physician and medical director of North East Medical Services, a network of clinics that has 11,000 Healthy San Francisco members as patients.

The North East Medical Services is a non-profit community clinic that began treating poor patients in Chinatown 38 years ago. It now has five locations.

“Fiscally speaking, it is at best break even,” he said. “The reimbursement is definitely not high. We try to provide the best quality care without breaking the bank.”

“Once patients get their universal access program, the demand is very great,” Dr. Tai said. “They all want to come and see a doctor.”

The clinic also has expanded rapidly. In the past year, it has hired a dozen new doctors. Using federal stimulus money, it added 10 exam rooms to its main clinic on Stockton Street.

With the city program, Dr. Tai sees a shift towards prevention, which experts hope will contribute to a healthier community and reduce medical care costs.

Part 4: For universal health care, but not on his shoulders

Daniel Scherotter, a restaurant owner and chef, is leading the fight against Healthy San Francisco, the city's universal health care program. Photo by Richard C. Paddock.