Frontpaged at My Left Wing and posted at Daily Kos

Some Democrats get it.

Like Gavin Newsom.

In 2003 he was elected mayor of San Francisco, narrowly beating his Green Party opponent. Since then he has shown that being Democrat doesn’t necessarily mean being an idiot, collaborating with imperialism and ignoring the needs of their constituents, as his strong stand for gay marriage showed.

Now he is proposing a plan to offer all San Franciscans health care. It would make San Francisco the first city in the nation to do this, and if successful, would greatly boost his career.

The plan is not quite universal health coverage – not everyone is forced to join it. But it does expand the already-existing San Francisco Health Plan, designed to care for low-income residents, to include anybody living in SF who needs care – regardless of income, immigration status, or pre-existing medical condition. Under the proposal, anyone who needs care will be able to get it in the city at a low, subsidized cost. An example of how the SFHP already works:

Elaine Cain, 63, said monthly Social Security checks combined with her salary from a part-time job as a gift wrapper at Macy’s don’t give her enough to buy insurance — but she’s perfectly happy with the system in place now for the uninsured.

When she’s sick and needs to see a doctor, Cain pays $35 per visit at San Francisco General Hospital, and two years ago she had surgery there — for $150. She’s currently undergoing occupational therapy for a hand injury and pays nothing for three sessions every week.

“I fell into such a good thing, it’s not even funny,” Cain said. “You do have to wait a lot for appointments, but I’m so happy with General Hospital. I’ve never had such wonderful help and care.”

There are three main issues surrounding any universal health care proposal: funding, resources, and wait times.

Funding

Funding is the big one. It’s one thing to convince San Franciscans, or Americans, that universal health care is a good idea. It’s quite another to figure out how to – and who will – pay.

SF’s plan would ask those receiving coverage to pay for care. The rates and premiums would be a sliding scale – someone earning $50,000 could pay over $2,000 a year, but someone making less money would pay around $3 a month. As the above selection showed, there would still be costs for hospital visits and surgeries, but they are lower than what you’d pay with many HMOs, and again those too would be on a sliding scale.

Capitalism usually involves businesses getting rich by exploiting workers. This means that in a capitalist system there is always pressure to foist the burdens of providing services onto the average person.

We see this battle being played out in SF where it is still being debated how much businesses will be asked to contribute to this system via taxation. The local Chamber of Commerce would prefer businesses not be asked to contribute much if anything, but legislators to Newsom’s left, like Supervisor Tom Ammiano, want to require businesses to pay for employee health care and help contribute to the SFHP system.

This debate is currently being played out all across the globe. In Canada, Britain, and Germany, to name just a few places, fights over funding universal health care are dominating politics. It will be played out here too, especially as conservatives seek to link health care to taxes. They’ll most certainly argue that universal health care is bad because it would raise taxes, and seek to play on widespread anti-tax sentiment to defeat the plans.

In a city like San Francisco this may not seem like a concern, but even there taxes are a subject of debate, and many are loath to raise them. For something like universal health care, residents will likely be willing to do it, but whether this will hold true across the nation remains to be seen. It’s important to keep this in mind – universal health care is tied to the tax question, and until we turn around opinions on taxes, we may either never get universal care or will get a flawed system that rests on the backs of people unable to pay.

Resources

Another important element is resources – are there enough doctors and hospital beds to provide everyone with care? In San Francisco the answer seems to be a cautious yes – the city has several excellent hospitals, and is home to UCSF, the University of California’s campus devoted exclusively to medicine.

But more may be needed:

But if the plan is expanded to cover even a portion of the 82,000 adults believed to be uninsured, the network of 400 physicians will probably need to grow significantly, said Crystal Hayling, president and chief executive of the Blue Shield of California Foundation and a task force member.

This of course returns us to the financing question – in order to recruit doctors, especially in one of the nation’s most expensive cities, the pay will have to be good, meaning more money will have to be put into the system.

Or they could just treat doctors like teachers, pay them a low wage and hope they find a way to scrape by. But that would be more of what we don’t need – expecting people to supplant real wages with moral wages.

Wait times

Finally, we come to the issue of wait times. Americans are used to decades of consumerism, underpinned by the concept of instant gratification – if you are made to wait for something, you feel it’s wrong, somehow inferior, you get frustrated and annoyed. Particularly with health care. Stories of long waits for non-essential surgeries in Canada were circulated to help defeat Clinton’s proposal in 1994.

Wait times are a big issue in Canada, where provinces like Alberta are using the issue of long waits to try and weasel their way out of their obligations under the Canada Health Act and allow private care. In Britain they are also a major issue and the Labour government has tried to reduce wait times, not always with great success, to fend off Conservative attempts to further dismantle the system (it must be said that one reason Labour efforts have failed is their decision to rely partly on private financing to reduce wait times).

Once again this is tied to funding, and to the availability of resources. But if we’re going to be able to expand something like SF is proposing here to all of California and all the nation, we’ll need to make sure wait times are low.

Newsom ain’t perfect, and I still think Matt Gonzalez would have made a better mayor. But Newsom is doing the right thing here. Liberalism and the left are strongest in America’s cities. We should be turning our cities into laboratories of progressive policymaking. If we don’t control the federal government and have to battle to maintain a hold on state governments, we need to be doing all that we can to use our power in the cities to get good things like this done, to prove to America that liberal ideas are good and viable.

Universal health care is an excellent idea, and I hope we can use this as a starting point to get other cities in on the act. Time for me to see what Seattle is thinking about all this…

Arnold Schwarzenegger has promoted his record of bringing enrollment in Healthy Families to record levels.  And when running for governor in the recall election, Schwarzenegger promised to provide health coverage for every child.  This much is true, more than 90% of California children now have some form of health coverage.  Now, his claims of credit are a bit more misguided:

“Frankly, I think kids’ health care in California is close to being a success story because 92 percent of all kids are now insured,” said Kim Belshé, Schwarzenegger’s secretary for Health and Human Services.

But state data compiled by the California HealthCare Foundation show programs that cover children grew much faster under Democratic Gov. Gray Davis than under Schwarzenegger. Davis was recalled, in part, because the state ran up a record budget deficit under his watch. A lot of that money went to expand the same health care programs that Schwarzenegger is now touting.

The governor’s own efforts, meanwhile, have been slowed by factors ranging from the deficit he inherited — in his first budget Schwarzenegger tried unsuccessfully to cap enrollment in Healthy Families — to resistance from his fellow Republicans in the Legislature. With their votes needed to pass a state budget, Republicans succeeded last week in forcing Schwarzenegger and Democrats to drop proposals to extend health insurance programs to all children, including illegal immigrants. The governor had earmarked $23 million to provide coverage for children in 18 counties who do not qualify for Medi-Cal or Healthy Families because their families are not poor enough or are illegal immigrants. (SacBee 7/3/06)

The governor has used the Davis boom-time legacy of spending on child health insurance to build his own record.  He has done little to actually accomplish anything that brings up the rate of enrollment, as the slowing enrollment has shown.

So, health care supporters are forced to turn to the initiative process to get something done.  The tobacco tax, Prop 86, that will appear on the November ballot will provide funds for coverage of all California children.  Now, I have some remaining questions about Prop 86, but the fact that we can’t get universal child healthcare done is a sad statement.  The GOP has chosen to make children thier pawn in this immigration game that they are playing.  It’s not right, and it’s not fair to the children of California.  All of our children deserve quality health care.

The Dems agreed to exclude the $23 million that Schwarzenegger had included in his May rewrite of his proposed budget.  However, it looks like the Governator agreed to work with them over the summer to get additional funding for the county health insurance programs.

With four days to go before the end of the fiscal year, legislative leaders and the governor reached agreement Monday on a state spending plan that they predicted would be in place by the July 1 deadline for the first time in six years.

The roughly $131-billion deal would pay back billions the state borrowed from schools in recent years to close budget shortfalls, as well as accelerate repayment of billions of dollars in bonds the state sold to fund transportation and other projects. … The deal includes a reduction in community college fees, new arts and physical education initiatives in public schools, a modest expansion of child care and other programs for the poor and a substantial boost for law enforcement.

Left out of the deal are the funds the governor and Democrats were hoping would be used to expand healthcare programs for low-income children. GOP lawmakers refused to support such an expansion because it would make health insurance available to children who are here illegally. Democrats received a commitment from the governor to work with them on expanding health insurance for low-income children later in the summer. (LA Times 6/27/06)

Now, getting the GOP to agree to additional health care spending in this area seems to be a difficult position.  Once again the problem is that the Reps have decided that they must toe this line in the sand, and a very artificial line at that.  The only people this is hurting are children?  Are we prepared to make children the pawn in some national pissing match?  It seems ludicrous and mean spirited…because it is.  The Democrats have been working in earnest to see this budget through to completion, all the while trying to deal with the GOP veto over the budget working to thrwart the will of the people.

So, my congratulations for completion of the budget, but the work is not yet complete.  We need to increase funds to the health insurance programs.  For more information on the California Budget, take a look at California Progress Report.  Frank’s going to be in Sacramento today reporting on the budget process.  Also, for background try the California Budget Project.