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According to the Kaiser Family Foundation, more than 46 million people in the United States had no health insurance coverage last year. While the nation struggles with reforming health care, one city has begun a program of its own that aims to make health care services accessible and affordable for its uninsured residents.
Until recently, this diverse city with a population of nearly 800,000 had more than 60,000 adult residents with no health insurance.
Over the last two years, three-quarters of them have enrolled in a public program called Healthy San Francisco.
The plan uses mostly existing clinics and non-profit hospitals to supply and coordinate care, but only within the city limits.
Healthy San Francisco was proposed in 2006 by Mayor Gavin Newsom.
"We're a public plan. We're that public option and I don't think you noticed anything but the American flag on City Hall when you came here," he said. "We didn't replace it with the Canadian flag; the sky didn't fall in, and the world didn't come to an end."
The San Francisco program is not an insurance plan. Patients pick a "medical home" -- one of 30 public or private health centers in the city -- where they go for low or no-cost health care.
Phil Woo was a printing press operator 1,500 kilometers away in Colorado. When he left his job to take care of his aging mother, he lost his insurance.
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Woo has high cholesterol and hypertension. He came to the Chinatown Public Health Center, and its director, Dr. Albert Yu, steered him into Healthy San Francisco.
"We coordinate care with the specialist. We coordinate care with the emergency room," Dr. Yu explained.
"We got rid of the middleman," Mayor Newsom noted "We got rid of the payer, in this case the insurance companies and the overhead, and we became the single payer, the public option, the public plan."
Each patient in Healthy San Francisco costs the city about $300 per month. Depending on their income, enrollees pay nothing, or from $20 to $200 a month, plus co-payments for some services. But that doesn't pay for it all.
San Francisco businesses sued the city over a requirement that they spend more than a dollar an hour per employee for health care. The money can be used to reimburse employees for health care costs, to buy them health insurance, or it can go to Healthy San Francisco. Some restaurants have put a surcharge on the menu to pay for the added costs.
Laurie Thomas owns the Rose Pistola Restaurant she says, "The concern of a lot of restaurants, me included, is you know you've got to keep the doors open."
California law requires cities and counties to treat sick people, even without payment. San Francisco officials say their new health program provides a better system to take care of the uninsured, and 600 to 700 new patients are signing up every week.