http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/11/02/MN111G5PCN.DTL
SF Fast-food toy ban gets supervisors' first OK
Rachel Gordon, Chronicle Staff Writer
November 2, 2010
San Francisco -- The San Francisco Board of Supervisors gave preliminary approval Tuesday to banning toy giveaways in Happy Meals and similar fast-food offerings aimed at kids unless they have reduced sodium, fat and sugar content and include fruit and vegetables.
The legislation, which sponsors said is intended to promote healthy eating and help combat childhood obesity, was passed on an 8-3 vote - the bare minimum needed to overturn Mayor Gavin Newsom's promised veto.
The board is scheduled to take a final vote next week. If it goes on the books, the restrictions wouldn't go into effect until December 2011.
"This is a tremendous victory for our children's health," said Supervisor Eric Mar, chief sponsor of the legislation.
Siding with him were Supervisors John Avalos, David Campos, David Chiu, Chris Daly, Bevan Dufty, Sophie Maxwell and Ross Mirkarimi. Opposed were Supervisors Michela Alioto-Pier, Carmen Chu and Sean Elsbernd.
McDonald's, the world's largest restaurant chain, took the lead in fighting the proposal.
"Somehow the San Francisco Board of Supervisors just took the happy out of Happy Meals," said Scott Rodrick, who owns 10 McDonald's franchises in the city. "It would be an understatement to say how disappointed I am with this legislation."
He said the restrictions could hurt business and cost jobs if customers cross the San Francisco border for a traditional Happy Meal experience. He and other restaurant industry representatives said parents - not lawmakers - should decide what their children eat.
Mar said that right wouldn't be taken away. Toys, he noted, still would be allowed in meals that meet the healthier nutritional guidelines.
"It's not a ban; it's an incentive," Mar said.
Under the proposed ordinance, restaurants may give away a free toy or other incentive item only if the meal contains less than 600 calories, has less than 640 milligrams of sodium and if less than 35 percent of the calories are derived from fat (less than 10 percent from saturated fat), except for fat contained in nuts, seeds, eggs or low-fat cheese.
In beverages, less than 35 percent of the total calories can come from fat, and less than 10 percent from added sweeteners.
In addition, the meals must contain a half-cup or more of fruit and three-quarters of a cup or more of vegetables. A breakfast meal must contain at least a half-cup of fruit or vegetables.
Mar, who had the backing of the city's public health officials, modeled his proposal after a first-in-the-nation law in Santa Clara County adopted earlier this year that only applies to a handful of restaurants in the county's unincorporated areas. San Francisco's restrictions would affect dozens of fast-food establishments.
Dufty, the swing vote Mar needed to assure a veto-proof majority, said the powerful lure of toys that come with kids meals - and the marketing campaigns that accompany them - puts parents who may want to steer their children toward healthier food choices at fast-food restaurants at a distinct disadvantage.
He pointed to a 2006 survey by the Federal Trade Commission that found that 10 fast-food chains spent $360 million to purchase toys to distribute with the more than 1.2 billion children's meals sold that year.
"I want to encourage these major stakeholders to act now. I think we can take a bold move here and say, you know what, you really need to think about the fact that you can market whole wheat products, you can market carrots," Dufty said.
"If you have to put a Shrek doll with a package of carrots," Dufty added, "maybe that's what you have to do, but there hasn't been a real incentive for this industry to do that, and I think that this legislation in a small appropriate way is a step to say you need to do things differently."
E-mail Rachel Gordon at rgordon@sfchronicle.com.
This article appeared on page A - 6 of the San Francisco Chronicle
Showing posts with label Gavin Newsom. Show all posts
Showing posts with label Gavin Newsom. Show all posts
Saturday, November 13, 2010
Wednesday, March 26, 2008
Hopes for Wireless Cities Fade
http://www.nytimes.com/2008/03/22/us/22wireless.html
March 22, 2008
Hopes for Wireless Cities Fade as Internet Providers Pull Out
By IAN URBINA
PHILADELPHIA — It was hailed as Internet for the masses when Philadelphia officials announced plans in 2005 to erect the largest municipal Wi-Fi grid in the country, stretching wireless access over 135 square miles with the hope of bringing free or low-cost service to all residents, especially the poor.
Municipal officials in Chicago, Houston, San Francisco and 10 other major cities, as well as dozens of smaller towns, quickly said they would match Philadelphia’s plans.
But the excited momentum has sputtered to a standstill, tripped up by unrealistic ambitions and technological glitches. The conclusion that such ventures would not be profitable led to sudden withdrawals by service providers like EarthLink, the Internet company that had effectively cornered the market on the efforts by the larger cities.
Now, community organizations worry about their prospects for helping poor neighborhoods get online.
In Tempe, Ariz., and Portland, Ore., for example, hundreds of subscribers have found themselves suddenly without service as providers have cut their losses and either abandoned their networks or stopped expanding capacity.
“All these cities had this hype hangover late last year when EarthLink announced its intentions to pull out,” said Craig Settles, an independent wireless consultant and author of “Fighting the Good Fight for Municipal Wireless” (Hudson Publishing, 2006). “Now that they’re all sobered up, they’re trying to figure out if it’s still possible to capture the dream of providing affordable and high-speed access to all residents.”
EarthLink announced on Feb. 7 that “the operations of the municipal Wi-Fi assets were no longer consistent with the company’s strategic direction.” Philadelphia officials say they are not sure when or if the promised network will now be completed.
For Cesar DeLaRosa, 15, however, the concern is more specific. He said he was worried about his science project on global warming.
“If we don’t have Internet, that means I’ve got to take the bus to the public library after dark, and around here, that’s not always real safe,” Cesar said, seated in front of his family’s new computer in a gritty section of Hunting Park in North Philadelphia. His family is among the 1,000 or so low-income households that now have free or discounted Wi-Fi access through the city’s project, and many of them worry about losing access that they cannot otherwise afford.
Philadelphia officials say service will not be disconnected.
“We expect EarthLink to live up to its contract,” said Terry Phillis, the city’s chief information officer.
But when City Council leaders here held a hearing in December to question EarthLink about how it intended to keep service running and complete the planned network, the company failed to show up.
Officials in Chicago, Houston, Miami and San Francisco find themselves in a similar predicament with EarthLink and other service providers, and have all temporarily tabled their projects.
Part of the problem was in the business model established in Philadelphia and mimicked in so many other cities, Mr. Settles said.
In Philadelphia, the agreement was that the city would provide free access to city utility poles for the mounting of routers; in return the Internet service provider would agree to build the infrastructure for 23 free hotspots and to provide inexpensive citywide residential service, including 25,000 special accounts that were even cheaper for lower-income households.
But soon it became clear that dependable reception required more routers than initially predicted, which drastically raised the cost of building the networks. Marketing was also slow to begin, so paid subscribers did not sign up in the numbers that providers initially hoped, Mr. Phillis said.
Prices for Internet service on the broader market also began dropping to a level that, while above what many poor people could afford, was below what municipal Wi-Fi providers were offering, so the companies had to lower their rates even further, making investment in infrastructure even more risky, he said.
EarthLink, which has seen a recent decline in profits and subscribers, lost its chief executive, Garry Betty, to cancer in January 2007, and with him went one of the nation’s most vocal advocates of municipal Wi-Fi. Mr. Betty’s successor, Rolla P. Huff, announced plans to cut costs and move the company in a new direction by laying off about 900 workers, about half the company’s work force, and withdrawing from municipal wireless projects.
Chris Marshall, an EarthLink spokesman who declined to be interviewed, said in an e-mail statement, “We concluded that our Municipal Wi-Fi operation is not consistent with our strategic direction and we’ve committed to a plan to sell the Muni Wi-Fi assets.”
For San Francisco residents, EarthLink’s change of plans was an especially big letdown. Unlike most other cities where municipal wireless was going to be offered in free hotspots and at a reduced price for residential service, San Francisco planned to offer citywide wireless free in a three-way deal with EarthLink, which was to build the grid, and Google, which would have paid to advertise through the network.
“It was a huge disappointment for us,” Mayor Gavin Newsom of San Francisco said about EarthLink’s shift in course, “and, with all due respect, it doesn’t seem like a smart way to run a business to work with a city for two years over a major plan and then suddenly one day to call and say you are pulling out.”
Mr. Newsom said that rather than select a single Internet provider to blanket the city, he might team up with multiple nonprofits and companies, and set up smaller free Wi-Fi areas, especially in poor neighborhoods.
Smaller cities, too, have run into problems with municipal wireless efforts.
Tempe, for instance, was one of the first midsize cities in the nation to go live in 2006 with its municipal wireless network, after erecting about 900 routers on utility poles and contracting with Gobility, a Texas-based provider, for residential service at about $20 per month. In December, the company suddenly pulled service after failing to get enough subscribers.
“The entire for-profit model is the reason for the collapse in all these projects,” said Sascha Meinrath, technology analyst at the New America Foundation, a nonprofit research organization in Washington.
Mr. Meinrath said that advocates wanted to see American cities catch up with places like Athens, Leipzig and Vienna, where free citywide Wi-Fi is already available.
He said that true municipal networks, the ones that are owned and operated by municipalities, were far more sustainable because they could take into account benefits that help cities beyond private profit, including property-value increases, education benefits and quality-of-life improvements that come with offering residents free wireless access.
Mr. Meinrath pointed to St. Cloud, Fla., which spent $3 million two years ago to build a free wireless network that is used by more than 70 percent of the households in the city.
But projects covering larger cities have proved far more difficult to sustain financially, and much of the attention has turned now to Minneapolis, which is rolling out a network based on a new business model that many market analysts believe will avoid the financial risks that EarthLink encountered in Philadelphia and elsewhere.
In Minneapolis, the Internet service provider agreed to build the network as long as the city committed to becoming an “anchor tenant” by subscribing for a minimum number of city workers, like building inspectors, meter readers, police officers and firefighters.
This type of plan is more viable, according to market analysts and city officials, because the companies paying to mount the routers and run the service are guaranteed a base number of subscribers to cover the cost of their investment.
Some companies have also begun offering technological alternatives that may help expand wireless access.
Meraki, a wireless networking company based in Mountain View, Calif., has jumped into the void in San Francisco with a program it calls “Free the Net.” The company sells low-cost equipment that can be placed in a person’s home to broadcast a wireless signal. The company also sells inexpensive repeaters that can be placed on rooftops or outside walls to spread the original customer’s signal farther. The combination of the two types of equipment creates a mesh of free wireless in neighborhoods. The company says it has almost 70,000 users throughout San Francisco.
Back in Philadelphia, Cesar’s older sister, Tomasa DeLaRosa, said she had faith that city officials would find a way to finish the network and keep her Internet service going.
“Our whole house is totally different now,” said Ms. DeLaRosa, 19, who had never had Internet access at home until last December because she could not afford it.
After signing up for a job training program and completing its course work, Ms. DeLaRosa received a free laptop, training and a year’s worth of free wireless service from Esparanza, a community group.
Greg Goldman, chief executive of Wireless Philadelphia, a nonprofit organization that was set up as part of the city’s deal with EarthLink, said that about $20 million had already been spent on the network, and only about $4 million more would be needed to cover the rest of the city.
Mr. Goldman’s organization is responsible for providing bundles that include a free laptop, Internet access, training and technical support to organizations like Esparanza so they can use them as incentives for their low-income clients like Ms. DeLaRosa to complete job training and other programs.
“For us and a lot of people in this neighborhood,” Ms. DeLaRosa said, “the Internet is like a path out of here.”
March 22, 2008
Hopes for Wireless Cities Fade as Internet Providers Pull Out
By IAN URBINA
PHILADELPHIA — It was hailed as Internet for the masses when Philadelphia officials announced plans in 2005 to erect the largest municipal Wi-Fi grid in the country, stretching wireless access over 135 square miles with the hope of bringing free or low-cost service to all residents, especially the poor.
Municipal officials in Chicago, Houston, San Francisco and 10 other major cities, as well as dozens of smaller towns, quickly said they would match Philadelphia’s plans.
But the excited momentum has sputtered to a standstill, tripped up by unrealistic ambitions and technological glitches. The conclusion that such ventures would not be profitable led to sudden withdrawals by service providers like EarthLink, the Internet company that had effectively cornered the market on the efforts by the larger cities.
Now, community organizations worry about their prospects for helping poor neighborhoods get online.
In Tempe, Ariz., and Portland, Ore., for example, hundreds of subscribers have found themselves suddenly without service as providers have cut their losses and either abandoned their networks or stopped expanding capacity.
“All these cities had this hype hangover late last year when EarthLink announced its intentions to pull out,” said Craig Settles, an independent wireless consultant and author of “Fighting the Good Fight for Municipal Wireless” (Hudson Publishing, 2006). “Now that they’re all sobered up, they’re trying to figure out if it’s still possible to capture the dream of providing affordable and high-speed access to all residents.”
EarthLink announced on Feb. 7 that “the operations of the municipal Wi-Fi assets were no longer consistent with the company’s strategic direction.” Philadelphia officials say they are not sure when or if the promised network will now be completed.
For Cesar DeLaRosa, 15, however, the concern is more specific. He said he was worried about his science project on global warming.
“If we don’t have Internet, that means I’ve got to take the bus to the public library after dark, and around here, that’s not always real safe,” Cesar said, seated in front of his family’s new computer in a gritty section of Hunting Park in North Philadelphia. His family is among the 1,000 or so low-income households that now have free or discounted Wi-Fi access through the city’s project, and many of them worry about losing access that they cannot otherwise afford.
Philadelphia officials say service will not be disconnected.
“We expect EarthLink to live up to its contract,” said Terry Phillis, the city’s chief information officer.
But when City Council leaders here held a hearing in December to question EarthLink about how it intended to keep service running and complete the planned network, the company failed to show up.
Officials in Chicago, Houston, Miami and San Francisco find themselves in a similar predicament with EarthLink and other service providers, and have all temporarily tabled their projects.
Part of the problem was in the business model established in Philadelphia and mimicked in so many other cities, Mr. Settles said.
In Philadelphia, the agreement was that the city would provide free access to city utility poles for the mounting of routers; in return the Internet service provider would agree to build the infrastructure for 23 free hotspots and to provide inexpensive citywide residential service, including 25,000 special accounts that were even cheaper for lower-income households.
But soon it became clear that dependable reception required more routers than initially predicted, which drastically raised the cost of building the networks. Marketing was also slow to begin, so paid subscribers did not sign up in the numbers that providers initially hoped, Mr. Phillis said.
Prices for Internet service on the broader market also began dropping to a level that, while above what many poor people could afford, was below what municipal Wi-Fi providers were offering, so the companies had to lower their rates even further, making investment in infrastructure even more risky, he said.
EarthLink, which has seen a recent decline in profits and subscribers, lost its chief executive, Garry Betty, to cancer in January 2007, and with him went one of the nation’s most vocal advocates of municipal Wi-Fi. Mr. Betty’s successor, Rolla P. Huff, announced plans to cut costs and move the company in a new direction by laying off about 900 workers, about half the company’s work force, and withdrawing from municipal wireless projects.
Chris Marshall, an EarthLink spokesman who declined to be interviewed, said in an e-mail statement, “We concluded that our Municipal Wi-Fi operation is not consistent with our strategic direction and we’ve committed to a plan to sell the Muni Wi-Fi assets.”
For San Francisco residents, EarthLink’s change of plans was an especially big letdown. Unlike most other cities where municipal wireless was going to be offered in free hotspots and at a reduced price for residential service, San Francisco planned to offer citywide wireless free in a three-way deal with EarthLink, which was to build the grid, and Google, which would have paid to advertise through the network.
“It was a huge disappointment for us,” Mayor Gavin Newsom of San Francisco said about EarthLink’s shift in course, “and, with all due respect, it doesn’t seem like a smart way to run a business to work with a city for two years over a major plan and then suddenly one day to call and say you are pulling out.”
Mr. Newsom said that rather than select a single Internet provider to blanket the city, he might team up with multiple nonprofits and companies, and set up smaller free Wi-Fi areas, especially in poor neighborhoods.
Smaller cities, too, have run into problems with municipal wireless efforts.
Tempe, for instance, was one of the first midsize cities in the nation to go live in 2006 with its municipal wireless network, after erecting about 900 routers on utility poles and contracting with Gobility, a Texas-based provider, for residential service at about $20 per month. In December, the company suddenly pulled service after failing to get enough subscribers.
“The entire for-profit model is the reason for the collapse in all these projects,” said Sascha Meinrath, technology analyst at the New America Foundation, a nonprofit research organization in Washington.
Mr. Meinrath said that advocates wanted to see American cities catch up with places like Athens, Leipzig and Vienna, where free citywide Wi-Fi is already available.
He said that true municipal networks, the ones that are owned and operated by municipalities, were far more sustainable because they could take into account benefits that help cities beyond private profit, including property-value increases, education benefits and quality-of-life improvements that come with offering residents free wireless access.
Mr. Meinrath pointed to St. Cloud, Fla., which spent $3 million two years ago to build a free wireless network that is used by more than 70 percent of the households in the city.
But projects covering larger cities have proved far more difficult to sustain financially, and much of the attention has turned now to Minneapolis, which is rolling out a network based on a new business model that many market analysts believe will avoid the financial risks that EarthLink encountered in Philadelphia and elsewhere.
In Minneapolis, the Internet service provider agreed to build the network as long as the city committed to becoming an “anchor tenant” by subscribing for a minimum number of city workers, like building inspectors, meter readers, police officers and firefighters.
This type of plan is more viable, according to market analysts and city officials, because the companies paying to mount the routers and run the service are guaranteed a base number of subscribers to cover the cost of their investment.
Some companies have also begun offering technological alternatives that may help expand wireless access.
Meraki, a wireless networking company based in Mountain View, Calif., has jumped into the void in San Francisco with a program it calls “Free the Net.” The company sells low-cost equipment that can be placed in a person’s home to broadcast a wireless signal. The company also sells inexpensive repeaters that can be placed on rooftops or outside walls to spread the original customer’s signal farther. The combination of the two types of equipment creates a mesh of free wireless in neighborhoods. The company says it has almost 70,000 users throughout San Francisco.
Back in Philadelphia, Cesar’s older sister, Tomasa DeLaRosa, said she had faith that city officials would find a way to finish the network and keep her Internet service going.
“Our whole house is totally different now,” said Ms. DeLaRosa, 19, who had never had Internet access at home until last December because she could not afford it.
After signing up for a job training program and completing its course work, Ms. DeLaRosa received a free laptop, training and a year’s worth of free wireless service from Esparanza, a community group.
Greg Goldman, chief executive of Wireless Philadelphia, a nonprofit organization that was set up as part of the city’s deal with EarthLink, said that about $20 million had already been spent on the network, and only about $4 million more would be needed to cover the rest of the city.
Mr. Goldman’s organization is responsible for providing bundles that include a free laptop, Internet access, training and technical support to organizations like Esparanza so they can use them as incentives for their low-income clients like Ms. DeLaRosa to complete job training and other programs.
“For us and a lot of people in this neighborhood,” Ms. DeLaRosa said, “the Internet is like a path out of here.”
Wednesday, September 19, 2007
San Francisco Providing Medical Care for All
http://www.nytimes.com/2007/09/14/health/policy/14cnd-health.html
September 14, 2007
San Francisco Takes Unique Approach to Providing Medical Care for All
By KEVIN SACK
SAN FRANCISCO, Sept. 5 — Diagnosed with polio at age 2, Yan Ling Ho has lived with pain for most of her 52 years. After immigrating here from Hong Kong last year, the soreness in her back and joints proved too debilitating for her to work.
That also meant she did not have health insurance. Not wanting to burden her daughter, who was already paying her living expenses, Ms. Ho delayed doctor visits and battled her misery with over-the-counter medications.
“Sometimes the pain was so bad, I would just cry,” she said. “I didn’t know what else to do.”
Last month, unable to bear her discomfort any longer, Ms. Ho came to North East Medical Services, a nonprofit community clinic on the edge of Chinatown, and discovered to her delight that she qualified for a new program that offers free or subsidized health care to all 82,000 San Francisco adults without insurance.
The initiative, known as Healthy San Francisco, is the first of its kind in the nation, and represents the latest attempt by state and local governments to patch a broken federal system.
It is financed mostly by the city, which is gambling that it can provide universal and sensibly managed care to the uninsured for about the amount being spent on their treatment now, often in emergency rooms.
After a two-month trial at two clinics in Chinatown, the program is scheduled to expand citywide to 20 other locations on Sept. 17.
Whether such a program might be replicated is difficult to assess. In addition to its unique political culture, San Francisco, with a population of about 750, 000, has the advantages of compact geography, a unified city-county government, an extensive network of public and community clinics, and a relatively small population of uninsured adults. Virtually all of the city’s children are covered by private insurance or government plans.
At the bustling North East Medical Services clinic, where the staff and signage are multilingual, doctors and nurses are trying to build trust with patients who may have last sought treatment from an herbalist. Families crowd the elevators, as teenagers help parents and grandparents navigate the system. Patients like Ms. Ho say they hope their access to the clinic’s services will bring them independence, and a chance to work.
Healthy San Francisco provides uninsured San Franciscans with access to 14 city health clinics and eight affiliated community clinics, with an emphasis on prevention and chronic diseases. It is, however, not the same as insurance because it does not cover residents once they leave the city.
After a phased start-up, the city plans to bring private medical networks into the program next year, expanding the choice of doctors. Until November, enrollment will be limited to those living below the federal poverty line ($10,210 for a single person; $20,650 for a family of four). Then it will open to any resident who has been uninsured for at least 90 days, regardless of income or immigration status.
Only then will city officials learn whether the program appeals to middle-class workers, who comprise a growing share of the uninsured. And only then can they test whether San Francisco has the medical infrastructure to handle the desired increase in demand, and to do so without raising taxes. So far, enrollment has exceeded expectations. The city projected that between 600 and 1,000 people would sign up by the end of August. More than 1,300 did, even though officials have done little marketing. They hope to enroll about 45,000 people — more than half of the city’s uninsured — in the first year. Some clinics are adding night hours and small numbers of staff.
“We really didn’t know what the interest level would be so we’ve very pleased,” said Mayor Gavin Newsom. “At the same time, we don’t want over-exuberance yet because we don’t want to fall of our own weight.”
At the two pilot clinics, efforts are first made to qualify patients for Medicaid or other state and federal insurance programs. Those left over receive a Healthy San Francisco card that makes them eligible for primary care, dental exams, mental health and substance abuse services, hospitalization, radiology and prescription drugs.
Because the coverage is not portable, officials believe that those with private insurance will have little incentive to drop their policies to take advantage of the city’s cut-rate services.
Like Ms. Ho, many of those enrolling were already using the city’s health clinics — or the emergency room at San Francisco General Hospital — in times of acute need, like an asthma attack or stroke. About 57,000 of the 82,000 uninsured San Franciscans have used the city’s health system at some point.
But the new program hopes to persuade them to become regulars who regard their neighborhood clinic as a medical home. Once enrolled, patients are assigned a physician and encouraged to get blood pressure checks, mammograms and other screenings.
“We had a system that was not a system, and was based on episodic visits for chronic and acute care,” said Dr. Mitchell H. Katz, the city health director. “The idea that you should come get a cholesterol test, that didn’t happen.”
It was also common for patients to ignore doctors’ orders because of cost. Before the program started in July, a clinic doctor had ordered X-rays and blood tests for Ms. Ho, but she never got them.
“Now I feel more comfortable coming in to get services and following the doctor’s instructions,” she said, speaking through an interpreter. She added that she recently took the recommended tests and is waiting for results.
The program was born of the city’s impatience with federal and state inaction, said Dr. Katz. In 1998, voters overwhelmingly endorsed universal access to health care in a citywide referendum. In ensuing years, city officials explored ways to provide universal insurance but, like other governments, could not figure out how to pay for it.
“What we did next,” Mr. Newsom said, “was profound and simple. We asked a different question. We asked: how do we provide universal health care to all uninsured San Franciscans? And that one modest distinction allowed us to answer the question we hadn’t been able to answer for a decade.”
Tangerine M. Brigham, the program’s director, projects it will cost $200 million the first year, and Mr. Newsom expects to finance it without a tax increase. The city already spends about that much on care for the uninsured, and those funds will essentially be redirected to Healthy San Francisco.
“”The program was also selected by the state to receive a three-year federal grant worth $24 million a year for expanding access to care. And because enrollees are still uninsured, they remain eligible for state and federal benefits, like discounts on AIDS drugs.
Patients are asked to contribute nominal amounts through membership fees and co-payments that vary by income.
Those from families with incomes below the federal poverty line pay nothing. Those who earn more pay quarterly fees that range from $60 to $675. That is the rate for those with incomes above 500 percent of the poverty level ($51,050 for a single; $103,250 for a family of four), which is where the subsidy ends. The co-payments range from $10 to $20 for a clinic visit and from $200 to $350 for an inpatient stay.
A final funding mechanism has placed the program in legal jeopardy. To make sure the new safety net does not encourage businesses to drop their private insurance, the city in January will begin requiring employers with more than 20 workers to contribute a set amount to health care. The Healthy San Francisco program is one of several possible destinations for those funds, with others being private insurance or health savings accounts.
Late last year, the Golden Gate Restaurant Association challenged that provision in federal court, arguing that it violates a law governing employer health benefits. A judge has scheduled a hearing for early November.
Mr. Newsom, a restaurateur and former member of the association, said the program would only work if accompanied by an employer mandate. But he said the city will have contingencies if it loses in court. “It may set us back” he said, “but it’s not going to end this program.”
September 14, 2007
San Francisco Takes Unique Approach to Providing Medical Care for All
By KEVIN SACK
SAN FRANCISCO, Sept. 5 — Diagnosed with polio at age 2, Yan Ling Ho has lived with pain for most of her 52 years. After immigrating here from Hong Kong last year, the soreness in her back and joints proved too debilitating for her to work.
That also meant she did not have health insurance. Not wanting to burden her daughter, who was already paying her living expenses, Ms. Ho delayed doctor visits and battled her misery with over-the-counter medications.
“Sometimes the pain was so bad, I would just cry,” she said. “I didn’t know what else to do.”
Last month, unable to bear her discomfort any longer, Ms. Ho came to North East Medical Services, a nonprofit community clinic on the edge of Chinatown, and discovered to her delight that she qualified for a new program that offers free or subsidized health care to all 82,000 San Francisco adults without insurance.
The initiative, known as Healthy San Francisco, is the first of its kind in the nation, and represents the latest attempt by state and local governments to patch a broken federal system.
It is financed mostly by the city, which is gambling that it can provide universal and sensibly managed care to the uninsured for about the amount being spent on their treatment now, often in emergency rooms.
After a two-month trial at two clinics in Chinatown, the program is scheduled to expand citywide to 20 other locations on Sept. 17.
Whether such a program might be replicated is difficult to assess. In addition to its unique political culture, San Francisco, with a population of about 750, 000, has the advantages of compact geography, a unified city-county government, an extensive network of public and community clinics, and a relatively small population of uninsured adults. Virtually all of the city’s children are covered by private insurance or government plans.
At the bustling North East Medical Services clinic, where the staff and signage are multilingual, doctors and nurses are trying to build trust with patients who may have last sought treatment from an herbalist. Families crowd the elevators, as teenagers help parents and grandparents navigate the system. Patients like Ms. Ho say they hope their access to the clinic’s services will bring them independence, and a chance to work.
Healthy San Francisco provides uninsured San Franciscans with access to 14 city health clinics and eight affiliated community clinics, with an emphasis on prevention and chronic diseases. It is, however, not the same as insurance because it does not cover residents once they leave the city.
After a phased start-up, the city plans to bring private medical networks into the program next year, expanding the choice of doctors. Until November, enrollment will be limited to those living below the federal poverty line ($10,210 for a single person; $20,650 for a family of four). Then it will open to any resident who has been uninsured for at least 90 days, regardless of income or immigration status.
Only then will city officials learn whether the program appeals to middle-class workers, who comprise a growing share of the uninsured. And only then can they test whether San Francisco has the medical infrastructure to handle the desired increase in demand, and to do so without raising taxes. So far, enrollment has exceeded expectations. The city projected that between 600 and 1,000 people would sign up by the end of August. More than 1,300 did, even though officials have done little marketing. They hope to enroll about 45,000 people — more than half of the city’s uninsured — in the first year. Some clinics are adding night hours and small numbers of staff.
“We really didn’t know what the interest level would be so we’ve very pleased,” said Mayor Gavin Newsom. “At the same time, we don’t want over-exuberance yet because we don’t want to fall of our own weight.”
At the two pilot clinics, efforts are first made to qualify patients for Medicaid or other state and federal insurance programs. Those left over receive a Healthy San Francisco card that makes them eligible for primary care, dental exams, mental health and substance abuse services, hospitalization, radiology and prescription drugs.
Because the coverage is not portable, officials believe that those with private insurance will have little incentive to drop their policies to take advantage of the city’s cut-rate services.
Like Ms. Ho, many of those enrolling were already using the city’s health clinics — or the emergency room at San Francisco General Hospital — in times of acute need, like an asthma attack or stroke. About 57,000 of the 82,000 uninsured San Franciscans have used the city’s health system at some point.
But the new program hopes to persuade them to become regulars who regard their neighborhood clinic as a medical home. Once enrolled, patients are assigned a physician and encouraged to get blood pressure checks, mammograms and other screenings.
“We had a system that was not a system, and was based on episodic visits for chronic and acute care,” said Dr. Mitchell H. Katz, the city health director. “The idea that you should come get a cholesterol test, that didn’t happen.”
It was also common for patients to ignore doctors’ orders because of cost. Before the program started in July, a clinic doctor had ordered X-rays and blood tests for Ms. Ho, but she never got them.
“Now I feel more comfortable coming in to get services and following the doctor’s instructions,” she said, speaking through an interpreter. She added that she recently took the recommended tests and is waiting for results.
The program was born of the city’s impatience with federal and state inaction, said Dr. Katz. In 1998, voters overwhelmingly endorsed universal access to health care in a citywide referendum. In ensuing years, city officials explored ways to provide universal insurance but, like other governments, could not figure out how to pay for it.
“What we did next,” Mr. Newsom said, “was profound and simple. We asked a different question. We asked: how do we provide universal health care to all uninsured San Franciscans? And that one modest distinction allowed us to answer the question we hadn’t been able to answer for a decade.”
Tangerine M. Brigham, the program’s director, projects it will cost $200 million the first year, and Mr. Newsom expects to finance it without a tax increase. The city already spends about that much on care for the uninsured, and those funds will essentially be redirected to Healthy San Francisco.
“”The program was also selected by the state to receive a three-year federal grant worth $24 million a year for expanding access to care. And because enrollees are still uninsured, they remain eligible for state and federal benefits, like discounts on AIDS drugs.
Patients are asked to contribute nominal amounts through membership fees and co-payments that vary by income.
Those from families with incomes below the federal poverty line pay nothing. Those who earn more pay quarterly fees that range from $60 to $675. That is the rate for those with incomes above 500 percent of the poverty level ($51,050 for a single; $103,250 for a family of four), which is where the subsidy ends. The co-payments range from $10 to $20 for a clinic visit and from $200 to $350 for an inpatient stay.
A final funding mechanism has placed the program in legal jeopardy. To make sure the new safety net does not encourage businesses to drop their private insurance, the city in January will begin requiring employers with more than 20 workers to contribute a set amount to health care. The Healthy San Francisco program is one of several possible destinations for those funds, with others being private insurance or health savings accounts.
Late last year, the Golden Gate Restaurant Association challenged that provision in federal court, arguing that it violates a law governing employer health benefits. A judge has scheduled a hearing for early November.
Mr. Newsom, a restaurateur and former member of the association, said the program would only work if accompanied by an employer mandate. But he said the city will have contingencies if it loses in court. “It may set us back” he said, “but it’s not going to end this program.”
Friday, May 4, 2007
Bay Area commuters face nightmare
Yet another example of why I'm happy to be out of California...
http://news.yahoo.com/s/ap/20070430/ap_on_re_us/highway_collapse_45
Bay Area commuters face nightmare
By MARCUS WOHLSEN, Associated Press Writer
4-30-7
The threat of a nightmarish morning commute led many Bay Area residents to use public transportation Monday, one day after a fiery tanker crash caused a heavily trafficked section of freeway to collapse.
Westbound traffic into the city largely flowed as usual Monday morning, except for drivers slowing on interchange lanes headed to the Bay Bridge to look at the damage.
But officials warned the afternoon drive would bring bigger headaches as traffic leaving the city is diverted away from the collapsed eastbound segment.
The elevated section of highway that carries motorists from the San Francisco-Oakland Bay Bridge to a number of freeways was destroyed early Sunday when the heat of a burning gasoline tanker truck weakened part of one overpass, crumpling it onto another.
Authorities predicted that overall the crash would cause the worst disruption for commuters since the 1989 Loma Prieta earthquake damaged the Bay Bridge itself. The sight of the soaring freeway twisted into a fractured mass of steel and concrete was reminiscent of that quake's damage.
"The most worrisome thing is the afternoon commute coming out of San Francisco toward the maze because the traffic from the Bay Bridge fans out from across three freeways," said Jeff Weiss, a spokesman for the California Department of Transportation. "Taking away two-thirds of the capacity is really going to cause a bottleneck."
Nearly 75,000 vehicles used the damaged portion of the road every day. But because the accident occurred where three highways converge, authorities said it could cause problems for hundreds of thousands of commuters. State transportation officials said 280,000 commuters take the Bay Bridge into San Francisco each day.
To encourage motorists to switch to public transit, Gov. Arnold Schwarzenegger authorized free passage Monday on ferries, buses and the Bay Area Rapid Transit rail system. Extra trains were added and bus and ferry operators also expanded service.
Parking lots at outlying BART stations filled up earlier than usual for the morning commute.
"I'm mad," said Crystal McSwain, who has a commuter pass to take a trans-bay bus but switched to the more expensive BART. "My life is upside down, and I don't know how long it's going to take."
However, while some trains appeared more crowded than usual, BART officials said overall ridership did not appear greater than normal. Riders likely delayed their morning commute to avoid crowds, or stayed home, BART spokesman Jim Allison said.
Transportation officials said it could take months to repair the damaged interchanges. Schwarzenegger declared a state of emergency to speed up cleanup and rebuilding efforts.
Despite the fire, the truck's driver walked away with only second-degree burns. James Mosqueda, 51, of Woodland, went to a gas station and called a taxi for a ride to a hospital, California Highway Patrol Officer Trent Cross said.
A preliminary investigation indicated Mosqueda may have been speeding on the curving road, he said. Mosqueda could not be reached for comment Monday; hospital officials would not transfer a call to him.
Police said he was headed from a refinery in Benicia to a gas station near the Oakland airport when the accident occurred early Sunday on the MacArthur Maze, a network of ramps and interchanges at the edge of downtown Oakland and about a half-mile from the Bay Bridge toll plaza.
Heat exceeded 2,750 degrees, softening and buckling steel beams and melting bolts, California Department of Transportation director Will Kempton said.
The cost of the repairs would likely run into the tens of millions of dollars, and the state was seeking federal disaster aid, Kempton said.
San Francisco Mayor Gavin Newsom said the accident showed how fragile the Bay Area's transportation network is, whether to an earthquake or terrorist attack.
"It's another giant wake-up call," Newsom said.
___
Associated Press writer Tom Verdin in San Diego contributed to this report.
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