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San Francisco has its own 'public option'

Its city-run universal healthcare effort enrolls more than 46,000 adults and has received high marks in recent independent studies.

October 04, 2009|Maria L. La Ganga

"Healthy San Francisco is a really good idea and a good program, a reorganization of the public clinic system giving each resident a medical home," said Kevin Westlye, executive director of the Golden Gate Restaurant Assn. But "we vehemently disagree" with the employer mandate, he said.

Dr. Mitchell Katz, director of the city's public health department, is sympathetic, acknowledging that the employer mandate is seen by many as a third assault on business in recent years. The city has also raised the minimum wage and required employers to cover a certain number of paid sick days.

But "anyone who says it's just a beefed-up [clinic] system, either they're not being honest, or they don't know" Healthy San Francisco, Katz said.

"You can join Kaiser," he said. "You can see a private doctor through the Chinese Community Healthcare Assn. . . . People today are getting their surgeries done at private hospitals."

And a study by the UC Berkeley Institute for Research on Labor and Employment, released in August, concluded that "the substantial job losses that some worried would be generated by the employer requirement have not materialized."

The study looked in particular at eating and drinking establishments in San Francisco, San Mateo and Alameda counties between December 2007 and December 2008, the most recent data available that overlapped with the Healthy San Francisco program.

It found that food service employment in San Francisco rose 0.2%, but dropped by 0.1% in the two counties without an employer healthcare mandate. In the six years before the mandate, restaurant job growth in the three counties was similar.

Ken Jacobs, chairman of the Berkeley institute, sees that as a major lesson from the San Francisco model, which actually charges employers more than any plan floated nationally and yet has not cost the region jobs.

The city's plan is government-run and subsidized -- a so-called public option -- and has not caused workers or employers to bail out of private insurance, another lesson for the national debate.

The restaurant association and the San Francisco Chamber of Commerce dismiss Berkeley's numbers.

Jim Lazarus, the chamber's senior vice president, called the report "a bogus, biased document that tries to compare San Francisco's historically better unemployment rate to surrounding counties'."

When the city passed the employer mandate, Jennifer Piallat, owner of Zazie Restaurant, said she couldn't raise her prices to cover the cost. She'd already done it twice -- once to absorb increased gas prices passed on by her suppliers and once to adjust for the minimum wage.

Instead, she put a $1-per-person surcharge on the menu, which allows her to offer health insurance through Kaiser Permanente, dental coverage and a 401(k).

"I'm not saying that Healthy San Francisco is a great plan," Piallat said. "I just feel that it gave me the ability to charge this surcharge to give my employees benefits. . . . If I had done it alone, it probably would have hurt us."

Though her customers have largely taken it in stride, one woman demanded an audience so she could say how "truly offended" she was "that I have to pay a dollar to subsidize your employees' healthcare," Piallat recounted recently.

Piallat's response? "While we're being honest, I'm offended that you're wearing a 4-carat diamond and complaining about a dollar."


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