Universal Health Scare

Proposition J promises medical insurance for everyone in San Francisco. It's a laudable goal -- but do you really want Willie Brown doctoring your insurance premiums?

The war council has been meeting twice a week lately to plan strategy, and when angry retirees gather, "war" is only a modest exaggeration.

Men and women who spent decades toiling as cops, firemen, and civil servants muster at the Sunset headquarters of the Retired Employees of the City and County of San Francisco to hash out their battle plans.

It is a tiny, low-budget office. If even a dozen people show up, they have to wedge themselves between the desk and the coffeepot. Mounds of pamphlets and yard signs urging voters to reject Proposition J in next week's election spill onto the floor.

A runt in this year's litter of state and local ballot initiatives, Prop. J has drawn scant notice from the press or public. It has not been highlighted in advertising campaigns or candidate debates. When voters arrive at the polls on Nov. 3, Prop. J will just be there on the ballot, another sleeper proposition with no discernible context or significance.

But many of the city's retired workers see the proposition as a stealth attack by Mayor Willie Brown. With their stack of signs and a smattering of small donations, they are doing their best to wage battle against Prop. J, a task made difficult by the unfortunate fact that virtually no one outside their small group has any idea what it is.

On its face, Prop. J appears harmless, even downright noble. It calls for the city to "create a voluntary health care purchasing program to make affordable health care available to uninsured city residents."

And as a Declaration of Policy, it carries little legal weight. If passed, Prop. J will merely give voice to the general will of the voters: Some form of charter amendment would have to follow in a future election to turn theory into practice.

But Prop. J is not as impotent as it seems. It is the first step in one of Brown's most ambitious designs -- making affordable health insurance available to every resident of San Francisco. Experts estimate that more than 130,000 people in the city have no health coverage. Some are unemployed, but most work, either for themselves or at small businesses that can't afford to offer medical policies.

When they fall ill, many of those people wind up in the emergency rooms of local hospitals, the most expensive way there is to administer medical care.

Plunging into tricky waters where many other politicians have foundered -- Bill Clinton notable among them -- Brown is trying to bring an approximation of universal health care to San Francisco. Under his plan, anyone who has lived in the city for at least six months will be able to buy affordable insurance coverage. Small-business owners and their workers will kick in some of the costs, and the city will either subsidize or pay outright the premiums of the neediest.

If Brown succeeds, the health insurance plan could become his greatest mayoral legacy, easily eclipsing anything he might still accomplish by way of fixing Muni, building the new 49ers stadium, or doling out tax breaks and favors to developers.

But if his grand scheme fails, opponents say, Brown could decimate the health coverage now afforded to hundreds of thousands of city employees and retirees. And critics are wary that the plan gives Brown -- a mayor known for rewarding his friends and allies with pork -- a virtual lock on parceling out hundreds of millions of dollars in health insurance contracts.

Acquiring medical insurance for residents of an entire city is a decidedly ambitious task, and few argue with the theoretical merit of the idea.

"What we are trying to do is keep people well, keep people healthy," says Dr. Sandra Hernandez, the city's former health director and a primary architect of the Brown health initiative. "As a matter of values, this community does believe that everybody should be insured."

Not one of the angry retirees who have been gathering in the Sunset lately to agitate for Prop. J's defeat has a quarrel with that notion.

The problem, the retirees say, is that Brown will use them as bait to lure insurance companies into cooperating with his plan. The retirees -- as well as all current employees of the city, school district, and community college district -- will be the leverage used to muscle insurance companies into offering rates within reach of the city's uninsured.

But the retirees and current city employees have not been told what they will get in the bargain. They have no inkling what their own health care coverage will look like under Brown's plan.

Will they be able to keep their current doctors or be forced into HMO plans? Will their premiums go up? Their benefits down? And will the $24 million of their money that is now sitting in a city trust fund to cover medical claims be siphoned off for the new plan?

"I think we all agree that improved health care delivery is a good idea," says retired city employee Dee Hermman. "But why jeopardize delivery for the most vulnerable of us?"

Steve Kawa, the mayor's assistant most responsible for the health insurance initiative, says folks just need to be patient. If Prop. J passes, the answers will come in due time.

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