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.

Gay rights, hate crimes & social justice

Can hate crimes be erased from the U.S.? Probably not. Will same-sex marriage some day become the law of the land? Probably, eventually, so.

A few blocks around the corner from the federal courthouse in San Francisco where the latest battle for marriage equality is beginning an ambitious effort to combat hate crimes through community action was also getting underway on Monday morning.

Not In Our Town (NIOT) is a national movement planning a full-scale web organizing campaign  launch on April 6. Its focus is on mobilizing citizens in response to hate crimes, but its ultimate goal is to help build communities where such crimes won’t happen. Strategies were unveiled for a group of civic and religious leaders in San Francisco as part of the pre-launch efforts.

Not In Our Town began with a PBS documentary about Billings, Montana citizens joining together to respond to a series of hate crimes in their town. The story struck a chord with audiences, and created a model that inspired viewers around the country to hold their own campaigns against intolerance. Now in its second decade, the Not In Our Town movement continues to grow. Media company nonprofit The Working Group, which produced the PBS documentary, is the force behind NIOT’s emerging web-based organizational campaign

In the audience at Monday’s meeting, which was held at the San Francisco Public Library, were San Francisco Interfaith Council Executive Director Michael Pappas, Assistant District Attorney Victor Hwang (whose specific concentration is on prosecution of hate crimes), Director of the Mayor’s Office of Neighborhood Services Mike Farrah and representatives of a host of community action programs such as AfroSolo — a visual and performing arts nonprofit working, among other things, to combat black-on-black crime. Plus a wide assortment of individuals from religious and community groups. The audience mix was, NIOT representatives said, typical of groups around the country from which community efforts have grown.

NIOT grassroots efforts have taken place in communities from Patchogue, NY to Ft. Collins, CO to Richmond, CA and dozens in between. If the interest shown in the San Francisco Library — while most eyes were on the courthouse around the corner — was any indication, an enthusiastic San Francisco NIOT group will join others for the April 6 launce.

Can you beef up your brain?

Not multi-tasking fast enough? Trouble concentrating? Worried about memory loss?

Maybe those neurotransmitters in your poor, information-overloaded brain can be expanded to improve these functions… and maybe not.  A panel of experts on the PBS series Life (Part 2) is tackling the topic of brain exercise — a topic which has been tackled in this space several times in the past (How’s your brain fitness today, 10/5; Diet, exercise and Alzheimer’s, 11/28.)

We talked with panelist Denise Park, PhD, founder of the Center for Vital Longevity at the University of Texas, who starts right out by debunking any notion that those crossword puzzles will keep you sharp: [youtubevid id=”xZBzZZJHic0″]

But all is not lost. Jigsaw puzzles could indeed help. “With jigsaw puzzles you’re manipulating materials,” Park comments, “and actively puzzle-solving; what we call executive function.” This may explain — though only in part — the brilliance of British novelist Margaret Drabble, whose new memoir, The Pattern in the Carpet is subtitled A Personal History with Jigsaws; although my own personal history with jigsaws unfortunately hasn’t enabled me to write like Margaret Drabble.

It is the combination of functions that stimulates, and perhaps enhances, those brain cells, Park explains. She recommends doing something both stimulating and fun: dancing (“I believe the social component is important”), learning to play a musical instrument, etc. — in which motor, auditory and other systems all come into play. Or taking up something like photography, with which one masters one step and then moves on to the next.

“I’m reluctant to prescribe anything to improve cognition,” Park says, “because we don’t know yet. We need to know a lot more.” Still, current findings — Park’s Center is doing fascinating work with aging citizens who are learning to quilt — are heartening, and anecdotal evidence about those of us reciting lists of numbers to each other and then trying to do them backwards, as suggested by the SharpBrains people, suggests that hilarity is good.

And the best news may be that computers aren’t the be-all and end-all here. Park suspects that sitting in front of a computer playing games, even games advertised to stimulate the brain, may have no great brain-building value at all.

So this space advises getting out the dancing shoes or the mandolin, inviting friends in to play numbers games — and maybe buying a giant jigsaw puzzle (for two.)

Diet, exercise and Alzheimers

These paragraphs are a segue from talk of holiday festivities, over the past several days,  into the very un-festive subject of Alzheimer’s disease.

Part of the conversation at the very festive Thanksgiving dinner I was lucky to enjoy (without having cooked a single dish!) centered around food for the brain. One argument was that the good stuff for one’s neurotransmitters — egg yolks, broccoli, soy, starches — should be meticulously watched. I heard my mother’s voice in my head in response. “If you have three meals a day that look pretty on the plate,” she liked to advise, “you’re getting the proper diet.” When pressed she would explain that “pretty” equates to “color-coordinated,” i.e.: toast/bacon/scrambled eggs with parsley; or broccoli/carrots/potatoes/hamburger. I can’t remember whether our plates were 9-inch or otherwise.

Then there is the larger issue of exercise. Fitness, and occasionally brain exercise, have been contemplated several times in this space over the past few months (10/5: How’s your brain fitness today?; 9/7: The new best thing.) These theories hold that it is possible to strengthen, possibly even build anew, those neurotransmitters.

The definitive word on all this has not been written, and answers surely won’t originate with someone who barely passed Science I-II for the math/science requirement of her BA in Art. But some fascinating studies are being done, and new American Recovery and Reinvestment Funds will be going to projects that will be the focus of this space tomorrow.

Meanwhile, Alzheimer’s and various forms of dementia remain the ultimate tragedy in millions of lives, diet and brain exercise and clean living in general notwithstanding.

One of the most poignant insights into this disease you’ll be likely ever to see is currently offered by the PBS series Life (Part 2.) It follows a beautiful, articulate woman named Mary Ann Becklenberg as she confronts her own decline with incredible courage. What science may find answers for in the next few years, Mary Ann Becklenberg is exploring in real time. Schedules and clips are on the Life (Part 2) website.

Chances are, whether you’re over 50 or not, your life will be impacted by dementia. I, for one, am grateful for science and for Mary Ann Becklenberg.