Health Security Ordinance Passed Unanimously

by Landon Dickey on July 19, 2006

“They said it couldn’t be done,” commented Board President Aaron Peskin in regard to San Francisco’s push for universal health care. But at last, after seventeen separate hearings scrutinizing and re-scrutinizing every stipulate of Tom Ammiano’s Health Security Ordinance, the measure was passed unanimously at Tuesday’s Board of Supervisors meeting. Even before the final vote, one could sense Ammiano’s confidence in the headway the legislation had made as he spoke before the board.

“There’s only been rare moments when we stand on the verge of something as significant and innovative…as this merged piece of legislation,” he humbly noted. And indeed the efforts of Ammiano and the other seven sponsors of the ordinance have been both “significant and innovative”. Though jurisdictions in Massachusetts, Maryland, and New York, are experimenting with health care reform, San Francisco, according to Ammiano’s office, is on the “cutting edge of universal health care reform”.

The Health Access Program (HAP) provides prescription drug, hospital-based, and specialty care services to patients previously relying on emergency room visits as their only form of health care. It signifies a shift from reactionary to preventative care for the nearly 82,000 uninsured residents of San Francisco. The legislation provides patients a “medical home” where they can receive primary care services and testing for illness.

Supervisor Alioto-Pier, however, argued there is room for improvement in the specifications of the HAP’s designated services. Specifically, she pointed out exceptions in the legislation which “leave out vision, dental, cosmetic, and fertility” services from the HAP’s required coverage. She begged the question, “Why at this point are we making exceptions?”

This time Alioto-Pier asked the tough questions, and Dr. Mitch Katz had the answers. Though his initial explanation — that certain items were not covered in order to protect commercial healthcare — was not particularly satisfying, he approached Alioto-Pier’s follow-up questions gracefully. When Alioto-Pier expressed concerns that a patient with glaucoma would not be covered, Katz explained the legislation merely did not cover the costs of prescription glasses rather than the costs of treating optic diseases.

A similar point was stressed in the case of reconstructive surgery. Though the program will not pay for the costs of nose reconstructions or facelifts, it would cover the costs of reconstructive surgery for a patient with breast cancer.

As Katz emphasized in his rebuttal, the board always has the option of stepping in and ruling on any point of contention as the program is implemented. Despite what he characterized as “imperfect” language used in the legislation, he assured the supervisors they could always rehash any particular rule they found inadequately defined and “act accordingly”.

The ordinance unanimously passed on first reading, earning a standing ovation from the audience as well as the hugs and handshakes of each board member. Needless to say, most business owners probably remained seated.

Though concessions were made to businesses, the bottom line is they still have to pay. Newsom was hesitant in agreeing to this but eventually, according to Ammiano, the two arrived on “common ground”. Businesses will be required to pay health care expenditures, though they may choose in what capacity they will do so. Whether it is by means of directly paying employees, organizing a commercial health care basket for all employees in a firm, or paying the city, smaller businesses especially will feel the sting of this universal right.

But it is well worth it, even for businesses because healthy workers are more efficient workers. It is the economic concept of efficiency wages; you pay your employees higher than market wage rates in order to ensure greater productivity. Worker health is a key-determining factor of worker productivity. Ideally, the fewer sick days a worker is taking, the more hours he is putting into labor.

Of course this probably does not strike most businesses as a particularly promising outcome. Despite the board and the mayor’s office express opposition, firms may try to finagle the system to dump workers into the HAP and avoid minimum spending requirements. Unfortunately, the uninsured are only left with the vague reassurance that the Office of Labor Standards Enforcement (OLSE) will be tasked with ensuring employers comply. I say unfortunately because it is the same body that has struggled for the past two years to implement the minimum wage law.

Future complications aside, the board achieved a major accomplishment. In the words of Ammiano, the supervisors managed to put “health care before profits” and “petty politics”. Unlike their colleagues in Washington D.C. who are “running in place”, San Franciscan politicians are miles ahead of the pack, setting the pace.

Without a doubt the race is not yet won, but for now we can rejoice in this “fine and glowing moment for labor”.

Filed under: Archive