S.F. offering healthcare to neediest

SAN FRANCISCO -- Forget the driver’s license and credit cards. The most important piece of plastic in Cheng Wang’s wallet is his new medical identification card featuring a picture of a heart and this city’s signature skyline.

Wang, who has diabetes and other ailments, says the Healthy San Francisco program saved his life.

When he immigrated here in May to be closer to his elderly mother, the 64-year-old Taiwan native brought enough pills to last seven months. When those ran out, he didn’t know what to do. He had no medical insurance. And it scared him.

Then he learned about a groundbreaking city health plan that provides a network of care to residents regardless of their ability to pay, immigration status or existing medical conditions. Wang, a proud man with oversized glasses, said it’s important to him that the program is not purely a handout. It’s a bona fide medical plan offering care free of charge to those who can’t pay and on a sliding scale to those who can afford to contribute to their care. When he finds work, he’ll pay, he said.

“It’s precious,” said the retired printer, holding out his card. “It gives me peace of mind.”

The city’s initiative is a first-of-its-kind local solution to what has become a pressing issue nationwide: how to provide the poor and middle class with affordable healthcare.

Americans spend more than $2 trillion a year on healthcare -- nearly a fifth of the national economy, according to federal statistics. Still, more than 60 million people remain uninsured or under-insured.

“We struggle every day to see that the poor do not fall into a chasm without medical care,” said Linda Bien, president of North East Medical Services, which is participating in the San Francisco program. “Across the country, even people with medical insurance have trouble receiving care. The system is broken. And new models have to be put out there so we can reconsider: What does work?”

Launched in July at two pilot clinics in Chinatown, Healthy San Francisco now has 14 city health clinics and eight affiliated community clinics. More than 82,000 San Franciscans are without healthcare of any kind. Program managers hope to have enrolled all of them over the next two years by advertising the service in three languages at clinics and social service agencies.

Officials stress that their universal healthcare plan is not insurance. The program does not travel with members, who are only covered for visits to participating clinics and the public hospital in San Francisco. It also does not cover dental or eye care. Those below the federal poverty level of $10,210 in annual income for a single person and $20,650 for a family of four pay no fees.

Starting next month, the plan will be open to individuals with incomes up to 500% of the poverty level. Quarterly fees on the sliding scale range from $60 to $675. Co-payments for those who don’t qualify for free care range from $10 to $20 for clinic visits and $200 to $350 for a hospital stay.

The goal of Healthy San Francisco is simple: Get involved earlier in preventive care for city residents before chronic illnesses become serious enough to require hospital care at the county’s expense.

“Our system didn’t serve the population,” said program director Tangerine Brigham. “It was easy for people to do episodic care or seek no care at all.

“The idea was, ‘Well, if I don’t have my own Marcus Welby, I might wait for trauma care.’ We’re trying to give everyone their own Marcus Welby,” Brigham added, referring to the fictional family doctor in a 1970s television drama.

The program’s inception dates to 1998, when voters in a citywide referendum endorsed universal access to healthcare. But the next step did not come until Mayor Gavin Newsom took office in 2004.

Newsom began studying the matter. City officials estimated that they were spending $111 million annually to treat the uninsured at San Francisco General Hospital. Why not, Newsom and his staff asked, take some of that money and invest in prevention so that underprivileged residents would not have to resort to hospital visits to treat illnesses?

“We simply asked a profoundly different question,” Newsom said. “For years, people here beat their head against the wall figuring out how to provide universal health insurance to the uninsured. Then we asked another question: How do we provide universal health care? That made all the difference.”

Brigham said the program should cost $200 million the first year, and officials expect to finance it without a tax increase. They will also receive a federal grant of $24 million a year. In addition to membership fees and co-payments, the city will also receive money for the program from employers with more than 20 employees, who, starting in 2008, will be required to contribute a set amount to healthcare.

Dr. Mitchell Katz, the city’s health director, said many of the 2,800 Healthy San Francisco members enrolled so far consider it important that the city is doing what the state and federal government have not done.

“People like the fact that they’re not on the dole; they belong to a plan,” he said. “With the people I have talked to, that is the key. It’s not labeled charity care -- you’re a poor person, come here. Sure, the poorest of the poor will receive free care, but for the others, they pay what they can afford to pay.”

Dunyi Lei knows the gamble of going without medical care. For years, the 63-year-old immigrant from south China worked as a supermarket stock clerk without medical insurance for either himself or his family.

“For so long I could not afford to even get in the door of a doctor’s office,” he said. “When I got sick, I would buy over-the-counter medications. If things got worse, I’d go see an herbalist. Doctors were a last resort.”

Lei joined Healthy San Francisco in July and immediately began receiving care for a heart condition. In August, when he suffered a minor heart attack, his son knew what to do: He rushed Lei to San Francisco General Hospital.

“Without my plan,” Lei said, “I might not be here today.”

Dr. Ted Li has worked at North East Medical Services in Chinatown for two years. He knows there are people in the community who are dying slowly from undiagnosed diseases. Maybe now, he says, that will change. “There are so many conditions that would not be fatal if we can only catch them in time,” he said.

Li said he recently saw two Healthy San Francisco members who arrived for routine checkups. Both men appeared in good health. But simple tests showed that both suffered from dangerously high cholesterol and high blood pressure. They are now under treatment.

“For months, I saw a woman on the street with these festering scars on her face. I knew she was sick and I always wondered if she was a patient at our clinic,” he said. “Then one day after Healthy San Francisco started, I saw her in the waiting room and I asked her why she had never come in before. She said it was the cost. It’s a common story.”

Officials hope the new program catches on with needy San Franciscans. The fact that the plan is not portable will discourage people from dropping existing plans -- and Healthy San Francisco will be there for people who need it most, they say.

“In the absence of universal health insurance nationwide, we have to deal with reality. If history is our guide, we shouldn’t hold our breath,” Newsom said. “We have to look at the issue of healthcare in a different light and not just funnel more resources into the existing framework of the insurance model. Here in San Francisco, we seem to have stumbled onto something that is working so far and we really believe can deliver.”

Brigham said that she has already heard from several cities considering such an approach, including New Orleans. “Things can still go wrong,” she said. “Maybe we haven’t effectively communicated our availability, so people won’t enroll. But we think we’re ready to make a difference in people’s lives here.”

Still, challenges remain. The Golden Gate Restaurant Assn. has sued the city to challenge the required contributions by employers, saying the new rules will adversely affect small businesses operating on slim profit margins. A hearing is set for November.

Association Executive Director Kevin Westlye says the city should enact a quarter-cent sales tax to cover the program’s costs.

“They tell us to absorb the added costs by raising menu prices,” he said. “But we know that if you do that, the public buys down to less expensive entrees or they don’t show up at all. This could be catastrophic to small restaurant owners.”

As for Cheng Wang, he’s enjoying his new life as a San Francisco resident with his health concerns under control. He sees doctors regularly for his diabetes, hypertension and heart problems. Even his mother, age 93, says he looks better.

“All I can say is that not knowing if you will be able to get the medication you need is a terrible way to live,” he said. “It’s a gamble I could have lost.”

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john.glionna@latimes.com