jsnuka

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San Francisco OKs Universal health plan

By LISA LEFF, Associated Press Writer
Wed Jul 19, 12:32 AM ET



SAN FRANCISCO - San Francisco moved closer Tuesday to becoming the nation's first city to provide health care coverage for all its residents.


The city's Board of Supervisors unanimously approved a plan that would give adults access to medical services regardless of immigration or employment status. The plan's estimated cost is $200 million a year.

Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and operations.

Unlike health insurance, it would not pay for services obtained outside San Francisco.
Participants would have to receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.

The Board of Supervisors must vote on the plan, which has been strongly opposed by the business community, once more for it to become final.

Businesses with more than 50 employees would have to start participating next July, while smaller enterprises would begin in April 2008.
 

DrBowtie

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I saw this. Employers will have to play between $1.06-$1.60 per hour per person. Looks like prices will be going up in San Fran.
 
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jsnuka

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BrettBatchelor said:
I saw this. Employers will have to play between $1.06-$1.60 per hour per person. Looks like prices will be going up in San Fran.
Explain your reasoning to me for the increase.
 

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$200 million seems a bit low to me. Every CT scan costs around $1000, and then big time surgeries would be even more. I didnt' really read, but does this plan cover surgeries? If not, then I'd say that it is enough, but the amount of CT scans that are done in normal emergency rooms a day would seem to rip away at the $200 million quickly. Also, in the end I don't see how it is much different from whats going on today. If employers have to charge consumers $1.60 extra to cover the costs of this, then really its like a tax for universal healthcare. That being the case, only those working and with money to spend would be affected, which would leave out all the poorer classes. This in the end means that the poorer classes in poorer communities wouldnt' really be paying for the $1.60 extra, but they would be benefiting from the universal healthcare. That happens currently, where many people use the emergency room as their primary care office, and we foot the bill. I'm not on anyone one side of the subject, i'm just saying that the plan has striking similarites to what is going on now. But hey, if it works then we as a country are one step closer to completely destroying my future paycheck.
 
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jsnuka

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I see where the numbers come in now.

==========================================================

The San Francisco Board of Supervisors voted unanimously Tuesday to make the city the nation's first to provide all residents with health care, approving a plan that would give adults access to medical services regardless of their immigration or employment status.


Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and operations.


Unlike health insurance, however, it would not pay for any services participants seek outside San Francisco. Instead, residents would receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.


With backing from both Mayor Gavin Newsom and all 11 supervisors, the so-called Health Access Plan proved to be a politically popular concept in liberal San Francisco despite unmitigated opposition from the business community.


"What feels very good is the full board and the mayor getting on board," said Supervisor Tom Ammiano, who first championed the idea of making employers pay for some part of their workers' medical costs. "That says the political will is there to make it happen."


To offset the estimated annual price tag of $200 million, firms with 20 or more workers would be required to spend $1.06 for each hour worked by an employee, and those with more than 100 workers would have to pay $1.60 per hour up to a monthly maximum of $180 per worker. Companies that already offer health coverage would still have to pay if their insurance contributions did not meet the city's funding levels.


The Board of Supervisors still needs to vote on the plan once more for it to become final. The ordinance adopted Tuesday calls for businesses with more than 50 employees to start participating starting next July, while it would take effect for enterprises with 20 or more workers in April 2008.


Michael O'Connor, a nightclub owner who serves on the San Francisco Small Business Commission, predicted that the "noble burden" of the mandate would keep businesses from locating in the city and make goods and services here more expensive as employers pass on the costs to customers.


O'Connor said many business owners were disappointed by Newsom's backing of the plan since the mayor got his start in business as the owner of a wine shop and several restaurants.


"One would think that someone who has owned and opened restaurants would be pretty clear on what the profit margin is, and how hard it is to get them open. A $5,000 licensing fee is difficult. A new $60,000 (health care) fee is disabling," he said.


Before the board vote, Newsom defended the proposal as a creative solution to the problem of securing decent health care for uninsured residents, noting that businesses would not be alone in defraying the costs. Of the $200 million, the city would provide $104 million and participants would contribute about $56 million.


"This is a moral debate as much as a political debate," Newsom said.


The initiative adopted Tuesday developed as a compromise between Newsom and Ammiano, who last year introduced legislation that would have required businesses to create health savings accounts for uninsured workers. In a nod to concerns from business, the final plan requires employees to work at least 12 hours a week to be eligible and has an opt-out provision for workers who are insured through their spouses.


Because fees would be adjusted on a sliding scale, city officials did not expect to see a rush of residents canceling their existing health insurance to take part in the city program.


URL: http://sfgate.com/cgi-bin/article.cgi?file=/n/a/2006/07/18/financial/f172119D15.DTL
 
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jsnuka

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If this works, it will be interesting to see how it plays out across the country, given that it will be taking hold in a major city and how it affects the 2008 election cycle as far as the Presidential election.
 

Oculus Sinistra

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jsnuka said:
I see where the numbers come in now.

To offset the estimated annual price tag of $200 million, firms with 20 or more workers would be required to spend $1.06 for each hour worked by an employee, and those with more than 100 workers would have to pay $1.60 per hour up to a monthly maximum of $180 per worker. Companies that already offer health coverage would still have to pay if their insurance contributions did not meet the city's funding levels.

Michael O'Connor, a nightclub owner who serves on the San Francisco Small Business Commission, predicted that the "noble burden" of the mandate would keep businesses from locating in the city and make goods and services here more expensive as employers pass on the costs to customers.

Before the board vote, Newsom defended the proposal as a creative solution to the problem of securing decent health care for uninsured residents, noting that businesses would not be alone in defraying the costs. Of the $200 million, the city would provide $104 million and participants would contribute about $56 million.
Everybody is opposed to this while in good health.

Firms with between 1 and 100 employees
= 1.06/hour x avg of 40 hours/week x 100 (max # of workers)
= 4240/week x 4 weeks avg in a month
= 16,960/month x 12 months
= $203,520/year

Firms with more than 100 workers
= $180/month x 101 workers
= 18,180+ month
= $218,160+/year

That seems a bit steep to me, but then again I don't run a business.

I understand what is said about small businesses... perhaps it should be lowered to 50 cents/hour. If you had ten employees, that would reduce the cost for businesses to 20,352/year, which is definitely more manageable.

The problem is that a move like that creates an incentive for businesses to retain fewer employees to keep their costs down... which potentially means more unemployment. I assume a smart business would find a way to break itself up into many "small businesses" that operate together such as to exploit the 50 cents/hour rate.

I would imagine that firms with more than 100 workers are aggravated by paying ~$18 grand a month, but I've seen supermarkets with a daily payroll of $18 grand, so it's not like they're drowning here. I'm not concerned about the "big guys" so much.

What I'm concerned about, as I'm always concerned about with universal health care plans, is how this will affect the people who live paycheck to paycheck. A business, to offset it's costs, will either

1) take money directly out of each paycheck

or simply

2) charge more money for its services

The second option isn't really advisable since it could turn away customers, so it's more likely that we're looking at the first option. Whereas before a person could elect to get into a health insurance plan, now they're forced into it. So you could argue that it takes away people's personal freedom.

Continue down that line of reasoning: you can give them back their personal freedom, but at what cost? Their health coverage. And the bigger problem with health care is not that people don't have insurance, but that -- insurance or not -- people don't utilize medical services as much as they should.

A plan like universal health care assumes that now that people have access to medical care, people will start using it, thus decreasing the yearly morbidity/mortality rates from preventable medical conditions. But people aren't going to flock to the hospitals now... or are they?

And if they did, you could argue that it's worth the cost. Businesses, however, will never argue that it's worth the cost.
 

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Exactly. Wages will decrease or cost of goods will increase. No good company is just going to eat the cost and have it kill profits. Maybe an exodus from SF is looming?
 

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BrettBatchelor said:
Exactly. Wages will decrease or cost of goods will increase. No good company is just going to eat the cost and have it kill profits. Maybe an exodus from SF is looming?
I am curious what the price differential is between what they're paying now per employee to offer health insurance versus what they WILL pay per employee for the new universal health care system...
 

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Oculus Sinistra said:
I am curious what the price differential is between what they're paying now per employee to offer health insurance versus what they WILL pay per employee for the new universal health care system...
I dunno. Hard to tell since the pooling of risk should drive things down, but adding high risk populations might drive it up compared to a healthy small business.

I think this will be more of a guinea pig experiment.
 
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I really hope that San Francisco does this the right way. This has the potential to be a really interesting experiment, as well as a chance to improve the health of an entire city.

The 200mil price tag seemed extremely low to me, however.

what will 200mil buy?
HIV meds for 16.5K people for one year. (at $1000 per month)

2 doctor visits per year for 2 million people, only paying the doc 50 bucks, and not paying for any tests or medications.

1 doctor visit per year for 2 million people, only paying the doc 50 bucks and allowing only a $50 per year test/drug budget per person.

If they don't tightly regulate access to care and limit payments for surgerys, ICU visits, EM visits, etc. then they will run out of money the first quarter of the year.

SanFran's last city-sponsored public welfare program offered money to anyone who came to the office and said that they were A) poor/homeless and B) living in San Fran. It was extremely unregulated and the abuses of the system (even by lower class (but not impoverished) and middle class people (who would take the train into town on disbursement day to claim their 500 bucks) eventually led to an end to the program. Something tells me not to expect that the city fathers of San Fran will do what it takes to guarantee that the money goes as far as it actually should. Still, I pray that their plan works out well.
 

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doctajay said:
Also, in the end I don't see how it is much different from whats going on today. If employers have to charge consumers $1.60 extra to cover the costs of this, then really its like a tax for universal healthcare. That being the case, only those working and with money to spend would be affected, which would leave out all the poorer classes. This in the end means that the poorer classes in poorer communities wouldnt' really be paying for the $1.60 extra, but they would be benefiting from the universal healthcare. That happens currently, where many people use the emergency room as their primary care office, and we foot the bill. I'm not on anyone one side of the subject, i'm just saying that the plan has striking similarites to what is going on now. But hey, if it works then we as a country are one step closer to completely destroying my future paycheck.
You say the poor wouldn't pay into the system, but would still recieve out. That is the same as the system today, in addition it would be probably be the same as any NHP. Something like 20-30% of the population pays no income tax in the US (i know they still pay sales tax), so any NHP (combined w/ a progressive tax bracket) would inevitable result in poor people recieving out more than they paid in.

Some see this as desirable, others do not, this is a matter of personal preference. However, any NHP, no matter how others may try to slant it, is a transfer program. It takes the wealth of some individuals and gives it to others, 'robin hooding' if you will.
 

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Oculus Sinistra said:
I am curious what the price differential is between what they're paying now per employee to offer health insurance versus what they WILL pay per employee for the new universal health care system...
If an employer is paying for health insurance for its employees now, it is most likely higher than the universal health care system payments that will be required. For example, my SF employer pays about $200+ a month for our Kaiser plan. Under the new plan, my company wouldn't have to pay any additional premiums since they already offer health insurance at rates comparable or higher than the universal plan. (although my employer does not offer health insurance to part-timers and will have to comply on that end...i think they would have to either provide insurance to part timers or pay into the fund? this I'm very curious about).

As someon who lives and works in SF I think this is great b/c health insurance can be a huge fiscal burden when it isn't provided by the employer or school.
 
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vesper9 said:
If an employer is paying for health insurance for its employees now, it is most likely higher than the universal health care system payments that will be required. For example, my SF employer pays about $200+ a month for our Kaiser plan. Under the new plan, my company wouldn't have to pay any additional premiums since they already offer health insurance at rates comparable or higher than the universal plan. (although my employer does not offer health insurance to part-timers and will have to comply on that end...i think they would have to either provide insurance to part timers or pay into the fund? this I'm very curious about).

As someon who lives and works in SF I think this is great b/c health insurance can be a huge fiscal burden when it isn't provided by the employer or school.
Some businesses will definitely need to buy extra health insurance for its employees since this program does not provide any out of city coverage. Many jobs require travel and I just don't see how this will work if their employees cannot get coverage outside of the city. So some businesses may end up paying for both the city's health care experiment cost as well as the regular health insurance cost. Because the city cannot mandate all doctors to join the program, some people will want to stick with their regular doctors and how will it work out?
 

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lol, look for people to continue to flee San Fran (as they are Mass). Notice how people never move to places where medicine (or anything) is socialized, but always move FROM those places to places where some sembalance of freedom remains....
 
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travis said:
lol, look for people to continue to flee San Fran (as they are Mass). Notice how people never move to places where medicine (or anything) is socialized, but always move FROM those places to places where some sembalance of freedom remains....
Socialized medicine is great for the public but bad for doctors with heavy student loans. For example, see how much the doctors in the UK are paid and no wonder many of them are coming to the US (btw, medical schools in UK are much cheaper than in the US so the doctors there can survive with making so little): http://www.nhscareers.nhs.uk/nhs-knowledge_base/data/5340.html
 

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saradoor said:
Socialized medicine is great for the public but bad for doctors with heavy student loans. For example, see how much the doctors in the UK are paid and no wonder many of them are coming to the US (btw, medical schools in UK are much cheaper than in the US so the doctors there can survive with making so little): http://www.nhscareers.nhs.uk/nhs-knowledge_base/data/5340.html
Socialized medicine is not better for patients or doctors.

http://www.neoperspectives.com/britishhealthcare.htm
 

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mdterps83 said:
You say the poor wouldn't pay into the system, but would still recieve out. That is the same as the system today, in addition it would be probably be the same as any NHP. Something like 20-30% of the population pays no income tax in the US (i know they still pay sales tax), so any NHP (combined w/ a progressive tax bracket) would inevitable result in poor people recieving out more than they paid in.

Some see this as desirable, others do not, this is a matter of personal preference. However, any NHP, no matter how others may try to slant it, is a transfer program. It takes the wealth of some individuals and gives it to others, 'robin hooding' if you will.

Since the city is paying for it, they won't be dragging down medicare so the rest of the indigent health care in California will benefit. Especially when the sick from all around the nation and world start heading to San Fran just for the medical care. After all, they're not checking on residency or employment status.

Once it's up and running, the east bay cities would be well advised to have transportation vouchers to send everyone they can across the bridges.
 

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flighterdoc said:
Since the city is paying for it, they won't be dragging down medicare so the rest of the indigent health care in California will benefit. Especially when the sick from all around the nation and world start heading to San Fran just for the medical care. After all, they're not checking on residency or employment status.

Once it's up and running, the east bay cities would be well advised to have transportation vouchers to send everyone they can across the bridges.
Exactly. Sometimes I wonder what planet San Francisco lives on. This is going to go down in flames so horribly it will probably push back UHC in America for another couple of years.

A universal health plan could, obviously, work. It would lower the average level of care received by insured people (to raise that of the uninsured), but it's not going to completely fail. But doing it in one city with no proof of residency? Every seriously ill person with no money will just go to SF for free healthcare. They'll be bankrupt within a year.
 
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saradoor

southerndoc said:
They would stop raping all Americans and the medical community.
The medical insurance companies will just find different ways to survive. One obvious way is to scare the general public into thinking that they will still need private medical care insurance anyway since there will always be *better* doctors who are in private practice. Another way is to get more people to buy more expensive life insurance policies because when medicine is not as lucrative as before the quality will for sure go down. Oh, don't forget malpractice premiums for doctors in private practice will go up.

So they will have you one way or the other. :(
 

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southerndoc said:
They would stop raping all Americans and the medical community.
lol, not very civil are we... :)

Attacks on insurance companies are common, but I don't think they can be blamed for the position the government has placed them in. Did you know that states have mandated what insurance companies must cover? Here in NV we had some 52 things, plus countless other regulations and gobblydegook, oversight etc.. they have to put up.

Here is an excerpt from an opinion piece:
http://www.neoperspectives.com/medical_lobbying.htm

Another argument we frequently encountered was less humorous, as it was more indicative of a fundamental ignorance: the attacks on the companies that insure doctors for Medical Malpractice. Just like Big Phrama, Big Oil, and Big Wal-Mart, Big Insurance has been delegated resident villain by those on the Left, and demonized as responsible for at least some of the Medical Malpractice woes (same with workers comp). However, the facts are that insurance companies flee states with skyrocketing Malpractice verdicts, and flock to those with lower more stable rates, giving doctors greater choice of provider. The idea that insurance companies would just increase their profits, leaving rates unchanged if Malpractice reforms were enacted, can be dismissed even before checking the validating historical record. If an insurance company, or group of insurance companies, conspired to do such a thing, their profit margins would be high for only a very short amount of time, as their actions would create ample incentives for new insurance company startups, or for existing outside companies, to enter the market in order to take market share from the 'excessively profiting' companies. Incidentally, this same sort of reasoning will show why there can be no such thing as price gouging, or monopolizing.
 

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southerndoc said:
They would stop raping all Americans and the medical community.
Politics is politics. The companies would all be a PART of any US plan and would then be allowed to rape with the big guns of government behind them.
 
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