Supreme Court leaves 'Healthy San Francisco' program to its own success

Healthy San Francisco, the city’s healthcare-for-all program, remains firmly in place after the Supreme Court’s dismissal of a suit by the Golden Gate Restaurant Association last week. It may or may not be the model for everywhere else, but a lot of reassured folks here are happy with it. Many are also healthier in the bargain. PBS NewsHour correspondent Spencer Michels talked with several Healthy SF participants for last night’s report, while outlining how the program is working.

Until recently, San Francisco, a diverse city with a population of nearly 800,000, had more than 60,000 adult residents with no health insurance. They were not poor enough for Medicaid, nor old enough for Medicare.

While the nation struggled with reforming health care, this city began a program of its own that so far has enrolled more than three-quarters of its uninsured. It’s called Healthy San Francisco, and it is not, strictly speaking, health insurance. Rather, it’s a way to provide health care, but only within the city limits.

The plan was not particularly radical. It used mostly existing resources, like city clinics and nonprofit hospitals, to supply and coordinate care. Instead of flitting from one clinic or emergency room to another, enrollees choose a medical home, one of 30 public or private health centers in the city, where they go for low- or no-cost health care.

Once you choose your “medical home,” you can’t walk into another and get treatment. But the two Healthy San Francisco participants this writer asked (along with the patients and clinic directors Michel featured on the PBS show) indicate that customer satisfaction with the system — and with their one medical home — is high.

As to the costs, and who covers them, most San Franciscans other than the restaurant owners are fine with the plan. Restaurant-goers have gotten used to the friendly, small-print message at the bottom of the menu that lets them know an amount added to the tab goes to help pay for Healthy SF.

Each patient in Healthy San Francisco costs the city about $300 per month. That’s in line with insurance costs. It totals $126 million a year.

Depending on their income — and most are below the poverty level — enrollees pay nothing or from $20 a month up to about $200, plus co-payments. But that doesn’t pay for it all. The city has mandated that businesses with 20 to 100 employees spend at least $1.23 an hour per worker for health care, and that larger companies pay more.

That money can be used to reimburse employees for health care costs, to buy them health insurance, or it can go to Healthy San Francisco.

The Restaurant Association’s argument before the Supreme Court was not on Constitutional grounds, but rather that the city’s mandate that employers pay into the program violated federal law. The Court declined to deal with it all; the mandate stays. Susan Currin, CEO at San Francisco General, says emergency room use is slightly down. Director Hali Hammer of San Francisco General Hospital Family Health Center (one of the more popular medical homes) says they have hired new providers and expanded hours. The number of participants is growing at about 700 per week, and the Kaiser Family Foundation recently found that 94 percent of those participants are satisfied with the program. Paying that small extra amount for dinner out makes at least a few of us occasional diners-out feel a slight good-citizen glow. Something’s working.

San Francisco Ramps Up Care for City’s Uninsured | PBS NewsHour | Oct. 12, 2009 | PBS.

After Tax Day: A Tax Savings Tool

House Speaker Nancy Pelosi, via her intermittent e-mail list, sends this little Tax Day gift message:

Congress and the President have worked together to enact an array of broad-based tax cuts for working and middle-class families and small business owners — ending an era of Republican tax breaks focused only on the wealthy. All totaled, the 111th Congress has enacted more than $800 billion in tax cuts, in the Recovery Act, health insurance reform, and other job-creating tax incentives for American business.

The Recovery Act, which has saved or created more than 2.5 million jobs through March 2010, includes 25 tax cuts you may be eligible for.

Followed by a fairly stern reminder that you’re on your own for filing the right forms and obeying the law, the Recovery Act folks offer a tool to start you on your way:

The Recovery Act Tax Savings Tool is intended to help taxpayers determine their potential eligibility for various tax benefits available under American Recovery and Reinvestment Act.

Go for it. A little recovery never hurt anybody.

Recovery Act Tax Savings Tool | The White House.

Barbara Ehrenreich speaks out on social, economic inequality — and how to make things better

Author/activist Barbara Ehrenreich addressed an enthusiastic audience in San Francisco Monday night, supporters of the Washington D.C.-based progressive think tank Institute for Policy Studies, on whose board Ehrenreich serves. Also on hand for brief remarks and conversation were IPS Director John Cavanagh, IPS fellow and Emmy Award-winning filmmaker Saul Landau and 2010 IPS fellow Tope Folarin.

The event was billed as an overview of such critical current issues as ending the Afghan war, creating a fair tax system, fixing the country’s tattered social safety net, shutting down Wall Street speculation and seeking local and global climate justice. And if that seems a tall order, the mood was decidedly more upbeat than overwhelmed.

Ehrenreich, whose 2001 best-seller Nickel and Dimed exposed the social and economic injustices assailing the working poor, says her current, ongoing focus is on the failure of our social safety net. “It’s not working,” she says, “but it can be fixed.”

To that end, the speakers distributed copies of a recently released IPS study (in cooperation with the Center for Community Change, Legal Momentum and Jobs with Justice.) Titled Battered by the Storm: How the Safety Net is Failing Americans and How to Fix it, the study lists five key findings:

  • Levels of long-term unemployment, underemployment and discouraged workers are reaching historic levels;
  • The percentage of poor children receiving temporary assistance under TANF (the main federal “welfare” program) has fallen from 62% in 1995 to 22% in 2008;
  • TANF benefits are far from sufficient to support the families that depend on them: 2008 assistance payments averaged only 29% of the money needed to bring families up to the official poverty line;
  • Even while labor force participation of mothers has increased, the supply of affordable child care has lagged behind, creating a significant barrier to employment for many, especially single mothers; and
  • Roughly 57% of unemployed people are receiving unemployment compensation; for those receiving benefits, amounts are less than half of wages, and many are losing work-related health benefits.

Saying the safety net has eroded over the last three decades, the report offers an “Emergency Relief Package” totaling just over $400 billion and including jobs program, state and local fiscal relief, insurance and food stamps measures designed to aid middle and low income Americans. These groups, IPS leaders contend, have seen their income decline as the rich get richer. The study also suggests a number of ‘no new money’ measures such as foreclosure relief. Financing could be accomplished, the study says, through tax changes affecting higher income levels, a tax on financial transactions over $100 billion and an end to overseas tax havens.

Her concern with the squeezing of middle and lower income Americans, Ehrenreich says, has grown as their plight has worsened in recent years. “This recession has not narrowed the gap of inequality,” she says, “it has widened the gap.”

Anthem Blue Cross 'doing the right thing'?

In testimony before the California Assembly Health Committee yesterday, Anthem Blue Cross President Leslie Margolin said of her company, “I think we do the right thing, and we try to do the right thing every day.”

What that means is, turn a profit for the company every day. If you are in business to make money, that is the right thing to do.

On the other hand, when Margolin says the company’s goal is to provide “care, comfort and coverage to those in need,” that is simply not true. Physicians and health care professionals provide care and comfort. Anthem provides coverage which sometimes pays for these things and often does not, if they can help it.

Is there no way to connect those dots? Care and comfort for those who need and deserve it — i.e., every human being — are not going to happen until we get the coverage people out of the equation.

OK, not going to happen any time soon. It could happen in California, except for Governor Schwarzenegger‘s probable veto. It should happen in Washington, except for the money and muscle of the coverage people. In lieu of those realities, a health bill that takes a tiny step in the right direction would be welcome.

Health care reform solution: eliminate insurance

“Insurance? My whole point is I want to kill it.”

Gil Ahrens knows health insurance. One terrible accident. Years of life turned upside down. Denials of payment. Claims argued. Liens placed on property. Throughout a long and arduous struggle to get life back on track, obstacles created by insurance issues stood in the way of what should have been everyone’s focus: care. It is a story familiar, in one variation or another, to millions of Americans.

Author of the recently released Shattered, Shaken and Stirred, Ahrens began his eye-opening journey through the catacombs of our health insurance system almost simultaneously with a devastating automobile accident. He escaped with a badly mangled foot and other injuries, his wife was left paralyzed. Their three-week-old daughter survived intact — but that was about the only good news the Ahrens family would have for a very long time. For the successful California businessman/entrepreneur and his family, life was forever changed; the book tells the years-long challenge of that change.

In recent appearances and radio talks, Ahrens has spoken out against what he describes as a health system “in shambles. In its current state, health care is a bigger threat than terrorism. And needless to say, we are paying through the nose.”

Shattered, Shaken and Stirred, written in the form of a letter to his now-school-age daughter, is part description of unbearable tragedy and misfortune, and part how-to guide for rebuilding one’s spirit. But underlying it all is an unvarnished message to America from one person who has been entrapped in the system: insurance is the #1 evil of American health care.

Elsewhere around the globe are examples of how to do health care right. The world’s top ten livable cities, Ahrens points out, share one characteristic: their citizens have health care. Not health insurance, health care.

“Americans do not want coverage,” Ahrens says; “they want care.

Does that not make sense?

Abortion foes winning health concessions

Anti-abortion forces, sensing victory in the health bill, are happily using their clout. They will undoubtedly win big. David M. Herszenhorn and David D. Kirkpatrick report in the New York Times that staunch anti-abortion Representative Brad Ellsworth (D-IN) is likely to get what he wants, which means other leading opponents of a woman’s right to choose, including a few elected representatives and the U.S. Congress of Catholic Bishops, will also get what they want.

Struggling to finish their big health care legislation, House Democratic leaders signaled Tuesday that they were prepared to make several changes to the bill to satisfy abortion opponents, including many Democrats, who had threatened to block it.

The opponents are insisting that tax dollars not pay for health insurance that would cover abortion. That is a tricky proposition given that the health care bill would provide hundreds of billions in federal subsidies to help moderate-income Americans buy health insurance, mostly from private carriers.

But Democratic leaders have little choice but to make some concessions. As many as 40 Democrats have said they might oppose the health care bill without tighter restrictions on abortion – a potentially decisive number.

So okay. We desperately need health reform, and such concessions apparently have to be made.

I just wonder if any of these guys know anything about what it was like in the days before Roe v Wade, which is the scenario to which they wish to see us return.

And I find it interesting that they, who seek to exercise so much control over what a woman may do with her body, are mostly men.

Democrats Near Deal on Abortion Coverage – Prescriptions Blog – NYTimes.com.

An Immigrant, Undocumented, Uninsured

I have a friend I’ll call Maria. She lives in San Francisco, but her story is very probably the same as any number of Marias in Atlanta, New York, Chicago and elsewhere. You may not know her, but I’ll bet your paths have crossed.

Maria came here from Mexico 22 years ago. She has never applied for citizenship, largely because for the first few years she was in the country her English skills were so limited it would not have been remotely possible. Recently she has been afraid to try. Maria has a 20-year-old undocumented daughter, an extraordinarily smart illegal immigrant/recent college graduate niece and a large, extended family of mostly undocumented immigrant adults and American citizen children. The niece, tired of living in a very rough part of town, went online a few years ago and found them some minimally affordable rental housing toward the ocean. They have a strong sense of belonging.

Maria and the other women clean houses for a living; the men work for landscaping companies. They drive cars without licenses because they can’t get licenses. But they are little threat due to the fact that one minor brush with the law and (Maria’s daughter explained to me in some detail) you’re out $1,000 including towing charges and fines.

Maria’s family does not do in-home care; however, there is another large, mostly undocumented community of Pacific Islanders who are highly recommended and routinely called upon when seniors (and others) here require but cannot afford extended nursing care. Not nurses by a long shot, they are nevertheless highly skilled.

Whenever Maria or other members of these communities need medical care they go to the county hospital. If the need is sudden or extreme, they go to the emergency room. Either way, they pay small amounts and they get excellent care. I’m grateful for that. They are all truly good people, honest, hard-working and contributing members of the larger community. They don’t pay income taxes (and have no Social Security accruing) but they buy local, pay their rents on time and add to the economy.

I do not support illegal immigration and am SURELY not advocating health insurance coverage for the undocumented, the very mention of which is enough to sink any reform in a New York minute. But it is a subject of contention constantly just below the national surface — or sometimes above the surface, as with the ill-mannered Joe Wilson.  As reported last week in the San Francisco Chronicle (and widely elsewhere), the current policy is clear:

Under long-standing federal policy, people who are in the United States illegally don’t qualify for federal health programs, and the current proposals for reform in Congress hold to that. With the exception of limited emergency Medicaid primarily for pregnant women and children, and some hospital funding, federal dollars do not pay for the care of people who are in the country illegally.

The health care reform bill in the House explicitly bars “undocumented aliens” from receiving federally subsidized health benefits. A Senate version doesn’t address the issue, suggesting that current policy would remain unchanged. A second Senate bill has yet to be released.

Some would have us go farther, requiring a system verifying immigrant status to be incorporated in the final health bill.

“If you don’t have a provision that clearly requires applicants’ immigration status to be verified, just to state that illegals won’t be covered is misleading,” said Yeh Ling-Ling, executive director of the Alliance for a Sustainable USA in Oakland.

Opponents argue that such verification systems would add a layer of bureaucracy and cost, and unintentionally screen out U.S. citizens who lack proper documentation. They also contend that denying a segment of people access to health care, even if they are illegal residents, could increase costs for emergency care as well as the risk for contagious disease in the general population.

However angry those are who are raising their voices about “illegal aliens,” that last sentence is worth consideration. If you cannot bring yourself to care much about the health of uninvited fellow residents of our corner of the planet, you may still want to look at this reality: treating colds in emergency rooms is an expensive folly; colds left untreated for want of an option breed more colds.

A lot of the anger is easy to understand. The economy has tanked, times are tough, you gotta blame somebody. But until all we documented citizens are ready to quit eating strawberries and drinking wine, and to forgo such niceties as in-home care and mopped kitchens, we would probably do well to care about the lives of our undocumented neighbors.

Via: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/09/11/MN4A19GI9I.DTL#ixzz0R040rESh

Insuring the Uninsured: A No-Brainer

I’ll call her Joan. She is 61 years old, working in real estate and living comfortably in an upscale rental apartment thanks partly to rent control. She has a small 401k and a small, steady income from shared family ownership in a stable investment property. But the real estate business, you may have heard, hasn’t been wonderful lately. Joan lives frugally, gives of her time and resources to community nonprofits and is highly respected in business and social groups. She has no health insurance.

“I would if I could,” she told me some time ago. “But it’s either buy insurance or buy dinner. I’m fond of eating.” Twice in the past year Joan has had to have medical treatment; once for a nasty wound in a bike accident, once for an infection that required an overnight hospital stay. She went to the only place available, the understaffed emergency room of a crowded public hospital. Who picked up the tab? You and I. I am happy to do so, for Joan and everyone else who winds up in these predicaments. But come on, it’s not exactly cost-effective.

Expanding coverage to those currently uninsured is only one segment of this moving-target health reform; I hope it doesn’t get lost the way other key elements seem to be straying from the scene. People like Joan would be the first to purchase insurance through any reasonably-priced plan. Unfortunately, I don’t see many insurance companies eager to offer such a thing, and I don’t know where many of the currently uninsured will go if the public option comes off the table.  There were some 47 million uninsured at the latest count. Add to those the swiftly-rising numbers of independent contractors and freelancers of all sorts.

Getting non-emergency care out of the nation’s emergency rooms seems an enlightened thing to do… if we could just have a little more light and less heat in the discussion.