A City's Answer to the Uninsured

Still another worry has been the notion that people would move to San Francisco from nearby areas just to join the program. But Heilig says such concerns are probably unfounded. "People who would move to the most expensive city in the United States to join this program probably wouldn't be making a very good financial decision."

Whether the program can or will be replicated in other cities remains to be seen, but at least one other local government is planning its own venture into universal care. In October, officials in Howard County, MD, announced the Healthy Howard Plan program, which will operate through one hospital--the nonprofit Howard County General--and the Horizon Foundation to offer primary-care services, deeply discounted prescription drugs, in- and outpatient hospital care, and specialty-care services to its estimated 17,000 to 24,000 uninsured residents. County Executive Ken Ulman and Health Officer Peter Beilenson, MD, say they expect first-year enrollment to reach about 2,000, and that the program will be financed by participants, businesses, foundations and government.

Heilig says it's difficult to predict the success of other states' plans because San Francisco's program is still so new--and because of the city's atypical outlook on public care. "San Francisco has a unique attitude, and we have a commitment to doing this kind of work. We also have a large public hospital and community clinic network, which means our capacity is already there," Heilig says. He says officials looking to start a program like Healthy San Francisco should be certain the infrastructure is already in place to handle an influx of new patients, and they should be ready to face opponents who balk at the idea of paying for the program. "Everyone says it's a good idea, but they have to be willing to back that up with action."