Universal Health Scare

But if it is set up the way Brown envisions, retirees will also be excluded from the Health Care Purchasing Authority board. Currently, employees and retirees get to elect their own representatives to the Health Services Board, which administers medical benefits. Their votes will be shut out if Brown appoints all of the members of the new purchasing authority.

"Our representation would be eliminated and we would become subject to the political appointments of the mayor," says Tony Sacco, president of the retired firefighters association. "This is ruling by decree."

Hernandez says she understands such frustrations, but believes time will show that the retirees have nothing to fear from the plan. "Once the charter amendment is written, all of the concerns that retirees have should be detailed so people really understand what we are and are not trying to do," Hernandez says. "It will be harmless to the city workers and retirees."

Though the snubs go a long way toward explaining why the retirees are so reluctant to accept protestations that their health care benefits will not suffer under the plan, their concerns are born of more than just hurt feelings. From the Blue Ribbon Committee's report, opponents contend, it's just not possible to tell if the purchasing alliance will work. There is no guarantee that retired city workers will be able to keep their current health coverage. Opponents fear they will be sacrificed on the altar of Brown's ambition, and they refuse to buy into the plan without more assurances.

"I really, sincerely believe that this is not the answer. I don't know what the mayor's spin on this is or why he decided to go with it," says Harry Paretchan, president of the city's Health Services Board. Paretchan, a fireman for 28 years, retired about six years ago and was elected to the board by other retirees. "I have no ax to grind. I'm not a politician," he says. "Nobody has a problem with universal health care. But just leave the city employees out of it."

Paretchan wonders, among other things, how the city is going to enforce the six-month residency requirement to screen out people who aren't eligible for city subsidies. "It's very simple to say a person has to maintain residency for six months, but how are they going to determine it?" he asks. "People will be able to come from all over the United States and step into this program."

Then there's the question of health care for those folks who don't sign up for insurance. They're still going to be showing up at San Francisco General and the city's free clinics for help. Right now, the city spends about $90.7 million for indigent health care. Under Brown's plan, much of that money could be rerouted to the insurance purchasing plan to cover the city's subsidies of premiums for the poor.

How is the city going to keep paying for indigent care if its indigent health care money has been funneled over to the Health Care Purchasing Authority?

Dr. Herminia Palacio, a city Health Department official who sat on the Blue Ribbon panel, says she's convinced the city will have enough money to both subsidize the health insurance plan and keep the public hospital and clinics available as a safety net for the desperate.

If people who are now uninsured join the purchasing plan, she notes, S.F. General will take in more money from insurance companies for treating them. As more and more employers join the insurance pool and more claims are paid, the amount of money available to treat the previously uninsured will actually increase.

And with affordable insurance and preventive care, she says, fewer people will wait until things are so bad that they have to go to the emergency room for treatment. "There will be efficiencies with that $90 million that will be gained from allowing people to access the system earlier. Each dollar of the $90 million should go farther," Palacio says. "No one is interested in dismantling the safety net. We hope this will make the safety net stronger."

One maxim about retired folks holds true in almost every election -- they vote. The question is whether the city's retirees will be able to convince enough other people to vote with them against Prop. J.

Most city residents know little about the proposal, and will learn of it in the voting booth. It is almost impossible to resist the single sentence that will appear on the ballot. Who's going to be against health care for the uninsured?

"It's worded very carefully," says Paretchan. "The way it's worded, who's not going to vote for it? That's a very clever ploy on the mayor's part."

Six members of the Board of Supervisors have come out for Prop. J -- including board President Barbara Kaufman and Supervisors Sue Bierman, Michael Yaki, Leslie Katz, Amos Brown, and Mark Leno.

Tom Ammiano is the only supervisor questioning the plan. His reservations developed after he was pelted with questions about the plan by retirees.

"They're not being obstructionist," Ammiano says. "They have very legitimate concerns about nuts-and-bolts issues and their own welfare, and they have not received an answer. I don't understand why they put this on the ballot when there are still so many questions about it."