San Francisco takes a new tack on universal healthcare

This past Friday, the New York Times reported on a new universal healthcare effort in the City of San Fransico. (No doubt other papers reported on it also, but the NYTimes article was the one that came up on my Health Econ class's discussion board). Back in the last millennium, the city's residents passed a referendum to provide healthcare for all, but until recently, the city has been unable to put together a successful program. This program, called Healthy San Francisco, came together when they took a slightly different look at the subject: since many of the city's residents already have coverage, couldn't universal coverage be achieved by concentrating only on those without coverage? So far, it appears that it can, but the program is still coming together.

The issues, for those new to the subject, include the fact that our current system for universal healthcare (viz: the emergency rooms of the nation's hospitals (viz (videlicet) is a term I don't get to use enough)) is just about as inefficient a system as Rube Goldberg could ever devise. Ill, uninsured people avoid seeking medical care (because they can't pay for it) until their situation becomes dire, at which time they report to an ER. Medical issues that at their incept might have been treated with simple, inexpensive treatment are often much worse by the time patients seek treatment, meaning that treatment is more costly in terms of time spent ill, time spent in treatment, time spent by the healthcare provider, physical and support services (X-ray, blood work, etc.) and financial cost. A wound on the leg that might initially have required cleaning, stitches, and instructions on wound care might eventually require expensive antibiotics for infection, and amputation of a deeply infected, gangrenous leg. And treatment in the ER costs more than what the same treatment might cost in a primary care setting (in costs to the provider, which are often passed along to the patient)

So SF has launched a program to address these issues. The NYTimes article is unfortunately vague on how the program is funded, since this would be the most interesting part for me, as the need for such a service is not news. Without that information, it is difficult for me to see how easily the SF program might be adapted for other communities. It will be interesting to see how the program fares