It’s now the one-year anniversary for the nation’s first attempt by a city to institute universal healthcare. The Healthy San Francisco program was created by the City of San Francisco to give its 73,000 uninsured city residents access to affordable health care. Technically, the program is not health insurance because beneficiaries can only access benefits within the city limits of San Francisco.

The program is funded by businesses with 50 or more employees that don’t provide health benefits. These businesses began paying between $1.17 and $1.76 per hour per employee in January. In April, businesses with between 29 and 49 uninsured employees also paid $1.17 per hour per employee, or pledged to offer minimum benefits to workers.

Restaurants in San Francisco are particularly negative about the Health San Francisco initiative, claiming that it will create economic hardship for them and force them to close or relocate. Some restaurants have gotten around the problem by passing the cost directly on to consumers. One restaurant added a service charge of $1.25 per dinner “in support of Healthy San Francisco” with an Internet address of the healthcare program.

Time magazine calls San Francisco’s program, operated by the San Francisco Department of Public Health (DPH) and conceived by Mayor Gavin Newsom in his 2005 State of the City pledge, “universal healthcare.” The Healthy San Francisco Web site says “Healthy San Francisco is not insurance, but a reinvention of the San Francisco health care safety net, that will enable and encourage residents to access primary and preventive care. It provides a Medical Home and primary physician to each program participant, allowing a greater focus on preventive care, as well as specialty care, urgent and emergency care, laboratory, inpatient hospitalization, radiology, and pharmaceuticals.”

Currently, the program is enrolling about 600 individuals per week, and enrollees now total 24,000. At least 27 clinics in the city are participating in the program and the City of San Francisco estimates it will cost $200 million per year to provide care to all 73,000 uninsured people within the city limits.

The program in San Francisco is being hailed as groundbreaking and a model for other cities in the US to follow. In an era where most cities and states simply continue to complain about the state of health care, San Francisco has actually chosen to try something. These innovations and experiments in the delivery of healthcare services should be welcomed, because they are “real world learning laboratories.” As such, they quickly demonstrate whether such innovations actually deliver value and contribute to improving the delivery of healthcare.

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