Sickness in San Francisco
By Jan Larson (07/10/06)
According to an article in the San Francisco Chronicle [1], the city of San Francisco is poised to become the first in the nation to offer universal health care to all residents regardless of income, immigration status or pre-existing medical conditions.
Since this plan has been hatched in the “City by the Bay,” one can’t help but be skeptical. That skepticism is fueled by comments such as those by Lucien Wulsin, director of a Santa Monica, CA health care advocacy group, “we’ll either be very impressed or horrified.”
Personally, I vote for “horrified.”
The idea that government can provide something, in this case healthcare, to a portion of the population that presently can’t afford to pay for it without having far-reaching unintended consequences is ludicrous. Of course ludicrous can often be used to describe governmental action in San Francisco.
The plan being advocated by Mayor Gavin Newsom would potentially add up to 82,000 uninsured to the current 52,000 member San Francisco Health Plan.
There is really just one sticking point – how to pay for it. And isn’t that always the sticking point?
The current proposal is estimated to cost $200 million per year. Of course that also assumes that no people with pre-existing conditions and without health insurance move to San Francisco in future years. Somehow, I suspect that is an erroneous assumption, but I wouldn’t expect the “deep thinkers” that came up with this plan to have considered that.
These thinkers also assume that city businesses will voluntarily contribute $38 million and that the intended recipients of this government largesse will volunteer to pay a monthly premium. Presently, the uninsured can go to emergency rooms when they get sick or injured.
Let’s see if we can follow the reasoning here. I don’t have insurance. If I get sick, I go to the emergency room and get free or low cost treatment. With this new plan, I can pay a premium every month and if I get sick, I can get free or low cost treatment. What shall I do?
Not to worry, however, one of the proposed plan’s objectives is to promote preventative care in order to convince residents to pay the premium.
There is also the problem of finding enough doctors to treat the expected influx of new patients. The article indicated that there are currently 400 physicians serving patients in the present plan, but that number would “probably need to grow significantly” if even a “portion” of the 82,000 eligible for the plan actually enroll. The current physicians are already “overburdened.”
So here we have a group of physicians, already overworked, who are going to have thousands to tens of thousands of new patients waiting to be seen. The key word is, of course, “waiting.” Patients currently may have to wait several months to see one of the 1600 specialists affiliated with the plan. Dr. Mark Smith put a positive spin on the long waits, “Four months is good compared to a yearlong wait.” Isn’t that comforting?
The obviously solution, of course, is to add more physicians and specialists, but as Dr. Steven Blumlein said, “It is a bad business decision to take these patients.”
While the demographics of San Francisco’s uninsured population are reasonably well known, many details remain unknown, such as the percentage that are reasonably healthy and would not require frequent care versus those that suffer from chronic illnesses. The current members of the San Francisco Health Plan are predominantly young (54% are 18 and under) and female (57%) while the uninsured are mostly male (59%) and 25 or over (90%).
So, there you have it. A health care system that is already overburdened will add thousands of new patients of a different demographic than it presently serves. It will require hundreds of additional physicians willing to make a “bad business decision” to make it work. It will rely on voluntary contributions by businesses to be financially viable (the cost of those contributions to be passed onto customers) and won’t restrict who gets access regardless of medical condition providing they are willing to wait months for treatment.
This has “train wreck” written all over it.
[1] http://tinyurl.com/lepzb
Copyright ©2006 Jan A. Larson All rights reserved.
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