Universal Access to Health Care or Universal Coverage


Months ago, San Francisco jumped into the game with its own universal health plan. Its plan focuses on an employer mandate and then access to health care services at “14 city health clinics and 8 affiliated community clinics, with an emphasis on prevention and managing chronic disease” for the 82,000 uninsured city residents (out of the total 750,000 population). In a recent NYT story on the plan, one figure jumped out at me. Three in 10 uninsured residents had never accessed a city health clinic before. One would presume that they are a healthy lot, as are the majority of the uninsured nationwide.
Interestingly, the SF plan is not about providing universal health coverage but universal access to health care.
The uninsured will have access to city clinics (and other private providers over time, if the current plan holds). Instead, “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, which 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). That 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.”
Clearly, some understand that universal access – to health care or affordable private health insurance – is the best that a free society can do. It will be interesting to see how many in SF will want access and pay the quarterly fee, given the small number of uninsured who use a significant amount of health care.