The Urban Healthcare Crisis: A Million Uninsured New Yorkers and Counting

I feel quite lucky having health insurance. It is comforting to know that if I'm knocked off my bike and break an arm, I won't need to put my hospital expenses on a credit card. Not everyone is that lucky. The other night I met an aspiring actor who was told that he makes too much money to qualify for public insurance even though there is no way he could afford private health insurance.

This story is all too common in New York City, where in 2005 it was estimated that 1.2 million city residents did not have health insurance and seventy percent of uninsured adult New Yorkers were actually employed. Now that unemployment in the city is nearly 10 percent, the number of uninsured is certainly higher than it was four years ago. And meanwhile those who are still working part-time to make ends meet or still working full time with no benefits remain much out of luck in our current health care system.

The health care debate playing out in Washington will have a critical impact on New York City. The good news is that New York City doesn't have to wait while Congress gets its act together. It can follow the example of San Francisco. Since 2007, the Healthy San Francisco program has provided access to primary and preventive care, emergency room visits, prescription medications, and more. It is not insurance, but it does cover all city residents who earn 500 percent of the federal poverty level and are ineligible for public insurance programs like Medicaid.

The program has been incredibly successful to date, extending health care services to 75 percent of San Francisco's uninsured population. And San Francisco is providing these services for less than the cost of private insurance, proving that government-run programs can be more cost-effective than the private sector.

If New York City were to replicate the success of San Francisco's policy, about 900,000 uninsured New Yorkers could gain access to health services.

Now, you may be wondering: how did San Francisco manage to pay for this program? After all, without a reliable funding source, replicating San Francisco's policy in New York would not be possible.

Healthy San Francisco is paid for with federal, state, and city funds, participant fees (based on a person's ability to pay), and an employer spending requirement. Plus, significant cost-savings stem from fewer hospital and emergency room visits. More than half of the program's revenues come from medium and large-size employers who make minimum health care expenditures on behalf of their employees. A business is exempt if it already makes contributions toward health care for employees, but employers do need to pay their fair share. Otherwise, it's the taxpayer who picks up the tab.

We need to take action now on extending health care to the uninsured and reaching the most vulnerable and underserved residents. Even if Congress passes a health care bill, it is not clear that all of the city's uninsured will be covered. All we know is that uninsured Americans won't receive coverage until 2013. That means millions of New Yorkers over the next few years may not receive the preventive care to keep them healthy, productive, and out of the city's emergency rooms.

The city's public health system is straining to provide emergency services to the uninsured and unable to focus on preventive care at all. The city agency that provides health services to the uninsured, the Health and Hospitals Corporation, is spending $500 million annually and hardly making a dent.

San Francisco's health care access policy has a clear, proven record of success. New York would do well to adopt it.