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San Francisco (Health) Values: Supreme Court Gets It Right On Local Public Option

Once in a while the US Supreme Court gets things right. It did so recently regarding Healthy San Francisco, the city's local “public option” now giving more than 50,000 residents access to health care. The court declined to hear a lawsuit that might have derailed the entire pro­gram.

A local restaurant association had sued to stop this program soon after it was developed in 2007. Employers of more than 20 people are required to provide some kind of health benefits, using Healthy San Francisco, or otherwise. Restaurants are able to have others pay if they wish; As noted in the San Francisco Chronicle last year, “most owners pass along the costs of city-mandated health care coverage to their customers — and say they're delighted to finally be able to afford it. Most din­ers say they're OK with paying extra.” As for the very small number of customers who have complained, noted one eatery owner in the same story, “they were the 1% we didn't want to come back anyway.”

Independent evaluations have shown that Healthy San Francisco has not had an adverse impact on em­ployment, and that patients rate it very highly — as might be expected from people whose only previous access was via emergency departments. The real-world result is as intended, a lessening of human suffering. Having served on the Mayor-appointed commission that first designed the program, I have heard numerous stories of people being helped by Healthy San Francisco. Here's just one:

On my walk to work one morning, I heard my name being called, and there was Morris, an old pal I had not seen in a long time. We stopped to chat and I noted his very obvious limp — in fact, his severely bent knee was visible even through his pant leg. “It was an old football injury that never got fixed, and then the arthritis turned it really bad,” he explained. “It's been miserable. But I am getting it fixed just next week — and it will cost me only a couple hundred bucks because of a new program called Healthy San Francisco — have you heard of it?”

I nodded and told him my history with Healthy San Francisco. Then something memorable happened; Morris — a street-tough guy who has long been self-employed with no health insurance — grabbed me by the shoulders and hugged me, saying “thank you, thank you,” adding, “It hurt so bad for so long.” Clenched in that strong hug, I have to admit I got a bit choked up.

Back in 2007, as Healthy San Francisco got going, I co-authored a Chronicle opinion piece urging the res­taurants to drop their challenge to Healthy San Francisco and to use the funds for better purposes, such as provid­ing assistance to restaurants who wanted to provide health coverage. I do not know how much was spent on their doomed challenge, or who paid for it, but it must have been a lot of money, and that's a shame.

Healthy San Francisco is not perfect, but the perfect is the enemy of the good. It is perhaps characteristic of “San Francisco values” that our city has implemented such a program. Other cities or counties may not have the resources, medical, logistical, or especially political, to implement such a program. They may not need to, if the better parts of the new national health policies make it through to implementation intact. But our local “public option” shows that better, almost universal, access to some level of care can be provided for — while we wait, and work — while not holding our breath — for more sweeping and true “reform.”

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