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Tuesday, March 23, 2010

What Can Healthy San Francisco Tell Us About Health Care Bill?

Posted By on Tue, Mar 23, 2010 at 4:25 PM

click to enlarge WILL YO MAMA CARE COVER MY TATOOS?
  • Will Yo Mama Care cover my tatoos?
Except for the hipster provision, extending to 26 the age brakeless track bike-riders get to stay on their parents' health insurance, most of the effects of the federal health-care legislation on its way to final passage won't be seen for several years.

So for a view of the unintended consequences of the bill's clauses extending health care coverage to a larger proportion of Americans, it's necessary to take a look at San Francisco, where, as of December, 50,000 locals had signed up for Healthy San Francisco, a program where the uninsured can turn to local government and nonprofit-run clinics for care.

Statistics compiled by the city controller suggest that while numerous San Franciscans have signed up for Healthy San Francisco -- and, a study says, they've apparently been happy with their status as newly insured -- care for the poor and downtrodden already on the public health care dole may have deteriorated.

According to figures released by the controller's office in February, enrollment in Healthy San Francisco went from 34,019 in December 2008 to 49,359 in December 2009. During the same period, new patient wait time for an appointment at a Department of Public Health primary care clinic -- which, along with certain nonprofit clinics, act as entry points to the Healthy San Francisco program -- has gone up. During 2009, average wait time jumped from 18 days to 29 days.

For people signing up for Healthy San Francisco, a group that tends to to be sicker and older than the general population, the program has been well-received.

According to an August, 2009 Kaiser Family Foundation study:


Participants in Healthy San Francisco report high levels of satisfaction and voice a resounding endorsement for the program. Ninety-four percent say they are satisfied with the program overall, and nine in ten say they would recommend the program to a friend.
If one were to extrapolate from limited information about the San Francisco experience to the coming new national health care system, it's possible to imagine that hipsters will be quite happy that mom and pop's insurance will cover their fixie collisions, and other formerly uninsured Americans will be happy with their new coverage in years to come.

But if America's solution produces millions more paid-up patients -- without dramatically increasing the number of doctors, nurses and hospitals available to serve them -- it's possible we might begin to see a situation similar to San Francisco's. Here, improved health care access worsens matters for those who had already been served by the existing system.

"It wouldn't surprise me if you have some shortages of

doctors, and longer wait times," said Dean Baker, co-director of the Center for Economic and Policy Research in Washington, DC. "The question is, how much do

we expand enrollments in medical schools? How much do we increase the number of foreign doctors we allow in the country?"Baker adds that America's revised health care system may end up needing tweaks down the road.

"I think they have done a good job of extending coverage to

people who otherwise would have had it. But you're going to have to do some

repairs on that. You don't want people to wait for needed care," he said.The statistics from the Controller's office suggest something similar could be said for San Francisco.

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Matt Smith

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