Could San Francisco have figured out a model for providing universal health care on a tight budget?
The California Endowment Health Journalism Fellowships at USC Annenberg is helping to sponsor a reporting project by the San Francisco Public Press to take a closer look at whether local health care reform ideas are working in one major metropolis.
The city recently launched a grand experiment, stringing together a bare-bones community clinic network and a county hospital into an ersatz universal health care program.
Local officials claim to be saving millions of dollars through coordination, prevention and digital medical records. If the program pencils out as promised in San Francisco, it might be a model for the nation or other cities. Gavin Newsom, who ascended from San Francisco’s mayor to lieutenant governor, made such promises, but he left the city in January. Now the Department of Public Health is working hard to reduce costs and improve health outcomes.
Healthy San Francisco was designed to bring health care to San Francisco’s estimated 73,000 uninsured adults. Two years later, at least two-thirds of them — or 54,000 people — had enrolled, and the system was delivering health care at a cost of $126 million.
The city deems the program a success as measured in social equity. But there has been little analysis of cost savings. No media outlet has thoroughly reported whether Healthy San Francisco is a better financial bet than the former patchwork of private insurers and public hospital emergency rooms covering the medical emergencies of the uninsured.
At a time when federal health care reform is under attack — with Congressional Republicans threatening to repeal the Affordable Health Care Act, and 28 states challenging it in court — we need to take a closer look at whether a local version of universal health care is cost effective. Congressional opponents of the federal system are most concerned about cost, claiming that the new law will balloon the deficit. States argue that the federal law violates their sovereignty and that of its citizens.
A close examination of the finances and cost-effectiveness of Healthy San Francisco would be welcome reading for anyone interested in the future of health care in the U.S. Our story also will provide lessons for other municipalities and states considering how to address health care access shortages at a time of squeezed budgets and rising costs.
We are developing a data-driven story examining the cost effectiveness of Healthy San Francisco and laying out the context of past efforts to include those who lacked health coverage. We will find out how much is being spent, how much is being saved, and by whom and what trend lines can be expected (as a whole and on a per capita basis). We’ll also assess the costs to medical practitioners, users and hospitals.
