Brigham says the city didn't just jam the existing system with tens of thousands of less impoverished new patients. For one thing, 75 percent of Healthy San Francisco beneficiaries were already receiving some sort of publicly subsidized health care, including services from existing programs such as Medicaid, Healthy Kids, Healthy Workers, and Healthy Families.

This means Healthy San Francisco wasn't as ambitious as it may seem at first glance; only about 12,500 enrollees are new to the public health care system, and the rest were merely re-enrolled in a program with a new name. What's more, the city has added $36 million to existing program funding in order to accommodate new Healthy San Francisco patients. This has meant spending more than $8 million on additional staff, more than $5 million in reimbursements to UCSF Medical Center for patient care, and $7 million to other outside medical providers.

"We knew that, in order to do this program effectively, we had to expand capacity internally and externally, and we've been purposeful in using those additional dollars to do both," Brigham said. Most Healthy San Francisco enrollees have used their new benefits to obtain services that were once available only to those receiving other forms of public health care. Now, San Francisco's indigent care system has had to make room for middle-class people.

"I guess I wouldn't call it 'stretched,'" Brigham said. "We've expanded the system to accommodate new individuals who've selected the Department of Public Health as their medical home."

Providing basic health care to more people doesn't just translate into longer lines; Brigham said it produces corollary benefits for everyone. Healthy San Francisco patients "use services more efficiently. They're not using emergency rooms for conditions that are avoidable. You've been able to see reduction in emergency room visits and the like." Additionally, Brigham said, average wait times should go down as construction is completed at the public clinics in Chinatown and Potrero Hill.

Expanding access to health care is a good thing, in spite of the unexpected consequences. But if America's solution produces millions more insured patients without dramatically increasing the number of doctors, nurses, and hospitals available to serve them, the rest of the nation might begin to see a situation similar to San Francisco's.

"I think [San Francisco has] done a good job of extending coverage," said Baker of the Center for Economic and Policy Research. "But you're going to have to do some repairs on that. You don't want people to wait for needed care."

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