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…