San Francisco to Offer Care for Every Uninsured Adult

SAN FRANCISCO â€” Since contracting polio at age 2, Yan Ling Ho has lived with pain for most of her 52 years. After she immigrated here from Hong Kong last year, the soreness in her back and joints proved too debilitating for her to work.That also meant she did not have health insurance. Not wanting to burden her daughter, who was already paying her living expenses, Ms. Ho delayed doctorsâ€™ visits and battled her misery with over-the-counter medications.â€œSometimes the pain was so bad, I would just cry,â€ she said. â€œI didnâ€™t know what else to do.â€Last month, unable to bear her discomfort any longer, Ms. Ho went to North East Medical Services, a nonprofit community clinic on the edge of Chinatown, and discovered to her delight that she qualified for a new program that offers free or subsidized health care to all 82,000 San Francisco adults without insurance.

It amazes me to realize that, in the world's greatest country, there are people -- ordinary, everyday people, not just the people who slide under society's skin and get blamed for stuff they don't actually cause, like the homeless, who live on the fringes of society, or immigrants, who have taken their chances, leaving their homes, or any other undesirables -- ordinary upstanding individuals like you or me, who are barred from obtaining regular medical treatment because they do not have private medical insurance.It's not a new realization by any means. I have long known it; and we hear it frequently, as Americans debate the issue and as we debated national health insurance here at home. But it's not often that it comes home to me. After all, I live in a society where there is no income tax at all, but where the taxes we do pay nevertheless manage to provide us with universal access to basic health care. We have clinics in almost every community, and we have public and private hospitals, so that almost all of us can obtain some measure of health care.Now this is crucial for me. I belong to a family that is relatively uninsurable. Unless we want to sell our cars and mortgage and remortgage our homes, the fact that our fathers all died before their 60th birthdays, from various chronic or non-communicable illnesses makes it virtually impossible for me and my cousins to get private insurance. Oh, I have coverage. But it's group insurance, and it's tied to a place of work. I wanted to be able to have a more flexible work situation. One of these days I would like to write full time, be self-employed as it were. So I applied for Bahama Health, which is friendly and warm and fuzzy and all that, and which made me think that it was the biggest group insurance in the country, but it turned me down.In the USA, I would be uninsured. And this is unfathomable to me. If our small nation, the size of a flea on the American elephant, can provide universal access to basic health care to all of its citizens, its immigrants, and even its tourists, I cannot for the life of me comprehend the reasoning behind it. After all, this is the nation that prides itself on its democratic principles and sets itself up to be the monitor of the free world. I can't see what principle of democracy is served, however, by excluding huge numbers of people from accessible health care.In San Francisco, the city government is making its own decision about this idea.

The initiative, known as Healthy San Francisco, is the first effort by a locality to guarantee care to all of its uninsured, and it represents the latest attempt by state and local governments to patch a inadequate federal system.It is financed mostly by the city, which is gambling that it can provide universal and sensibly managed care to the uninsured for about the amount being spent on their treatment now, often in emergency rooms.After a two-month trial at two clinics in Chinatown, the program is scheduled to expand citywide to 20 more locations on Sept. 17.Whether such a program might be replicated elsewhere is difficult to assess. In addition to its unique political culture, San Francisco, with a population of about 750,000, has the advantages of compact geography, a unified city-county government, an extensive network of public and community clinics and a relatively small number of uninsured adults. Virtually all the cityâ€™s children are covered by private insurance or government plans.

Now this -- the fact that the programme may not be replicable beyond San Francisco -- is another thing I find remarkable. The USA, we're told, is a federation, a place where the federal government has to balance its power against the state governments. It's a system that sounds pretty good on paper, most of the time. The states control a number of different things, like whether they execute people and how they do it, what kind of education system they provide, at what age people can drink liquor, how people can get married and to whom, and, presumably, health care. And there's apparently a growing grass-roots movement demanding access to basic health care for all, especially given the fact that the most influential generation of Americans in our time (the so-called Baby-Boomers) is aging. But this movement is being blocked. In the USA, that great democracy to our north, it would seem that the major opponents to healthcare, whether it be state-wide or federal, is the insurance industry.This should come as no surprise. The USA is a capitalist nation, and insurance companies are capitalist empires. While they appear to be fatherly and nurturing and friendly, they all too often bear elements that, in any other industry, would scream "scam" writ large. Don't get me wrong. Insurance works best when it's dealing with things -- house insurance, car insurance, property insurance -- all these make sense to insure. I don't mind paying a fairly reasonable premium to help me out when bad things happen to my possessions. Even life insurance makes some sense; it's not designed to help me, after all, but to keep me from being a burden to people I love, to help cover funeral expenses and so on. Insurance of these things makes sense.But health insurance? I can't help thinking it's the biggest scam there is.If you're in the business of health insurance, forgive me, but here's why I say that. Most companies refuse to insure people who are likely to claim on their insurance, like the elderly, or people with a history of chronic diseases, or people who (like me) come from a family where people have a history of chronic diseases. If they don't drop you, your premiums go up. So the healthy get insured, and happily pay their bills, while the unhealthy can't.Now here in The Bahamas, while that's an issue, it's not as bad as we think it is; even the uninsured can get basic health care here. We Bahamians, this little black country, have figured out how we can cover everybody with basic health care with the non-income taxes we pay. In Nassau, particularly, our HIV patients receive treatment. All our mothers are entitled to pre-natal and post-natal care. Our elderly get taken care of. Even our tourists, whether they are insured or not, get to use our hospitals and clinics. And we never grow tired of complaining how our illegal immigrants can find all the health care they want or need -- a fact, by the way, which I believe is a strength of our society and our government, not a weakness.Because, contrary to what the federal and state and county and city governments of every part of the USA seem to think -- except for, apparently, San Francisco -- I happen to believe that people are more important than things. I don't believe that my health, or the health of any other human being for that matter, is a commodity that can be valued by employers or insurance companies and abandoned when it the profit margin grows too narrow.It would appear that this is a peculiar idea. It would appear that capitalism leaves very little room for people when money is on the line. The San Francisco initiative is being challenged by an employers' federation. There are laws, apparently, that determine what "benefits" employers can offer, and how; and it would appear, further that health care is a "benefit". Not a right.

A final financing mechanism has placed the program in legal jeopardy. To make sure the new safety net does not encourage businesses to drop their private insurance, the city in January will begin requiring employers with more than 20 workers to contribute a set amount to health care. The Healthy San Francisco program is one of several possible destinations for that money, with others being private insurance or health savings accounts.Late last year, the Golden Gate Restaurant Association challenged that provision in federal court, arguing that it violates a law governing employer health benefits. A judge has scheduled a hearing for early November.

I'll say it again. I don't mind paying car insurance, life insurance, or house insurance for peace of mind. I don't even mind paying for health insurance, if it means that I can qualify for more sophisticated or daring treatment, should I ever become very ill. But what I cannot comprehend is the idea that I should pay health insurance simply to be seen by a doctor at all. I do not believe that my health is a commodity that the "market" -- any market -- should determine. That's what I elect my governments for.Not, apparently, in the great democracy of the United States of America, where the greatest medical system in the world is accessible only to those who can pay. American governments, apparently, view the health of their citizens as just another thing, to be bought and sold and valued by an industry that has no real accountability to the citizens they "serve".So hats off to San Francisco. And hats off to The Bahamas, to all the politicians through the ages who made it a priority for all Bahamians and residents and visitors to gain access to medical treatment no matter what their status.