Ahhh……so a public option will work?

Posted by Deepish Thinker on August 22, 2009

The New York Times has found a working example of a public health care option that may, or may not, put all your concerns to rest.

The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program.

This sounds like good news.  However, there are some caveats:

  • Mandated health spending by employers is substantially higher than in Massachusetts (which doesn’t have a public option) or any of the national plans being considered by congress.
  • The public option is somewhat limited in that services are only available in San Francisco (it isn’t technically insurance)
  • The costs are being passed on to consumers in the form of higher prices.  Healthcare surcharges are now common for service businesses.

Salient facts not mentioned in the Op-ed piece are that:

  • San Francisco started with an uninsured population of 60,000 out of a total population of 809,000.  7.4% uninsured is less than half the rate for the country as a whole.
  • In the the last census the City and County of San Francisco was 19th wealthiest county in the US with a per capita income 1.5 times that of the country as a whole.

So, one of the richest counties in the country was able to institute a very expensive health scheme that includes a public option in order to cover a relatively small uninsured population.

Furthermore, this has not resulted in obvious negative employment consequences, or dumping of employees onto the public option, because employers have been able to pass on most of the cost to consumers, and the mandated employer spending is so high that the public option doesn’t really compete with private insurance.

On the whole, it appears that San Francisco’s plan works by not being very much like anything that the administration is proposing.