The following post is part of my periodic good ideas series, where I highlight good ideas from other cities that could improve Richmond if implemented here.

San Francisco’s mayor Gavin Newsom recently echoed a recurring theme in state- and city-level politics:

The political dialogue must change, Newsom insists. “If it’s not going to happen through national leadership or statewide leadership,” he says, “then it has to happen on a local level.” [VIA Time Magazine]

Sound familiar? It should. Politicians have been hammering that theme as their reason for enacting anti-immigrant legislation.

Newsom, however, isn’t talking about the federal government’s failure to enact meaningful immigration reform- he’s talking about the millions of Americans who lack health insurance.

And he’s got a plan: Healthy San Francisco.

The idea is not to provide universal insurance for San Francisco’s 82,000 uninsured residents, but rather universal access to health care.

Uninsured San Francisco residents can enroll in the Healthy San Francisco program, pay monthly fees and co-pays according to an income-based sliding scale, and then go to any number of participating clinics, hospitals, and doctors. A key difference between this program and insurance is that the benefits don’t travel- outside San Francisco you can’t get care.

From the program’s website:

The following services are included with Healthy San Francisco:

  • Preventive and Routine Care
  • Specialty Care
  • Urgent Care
  • Emergency Care
  • Ambulance Services
  • Hospital Care
  • Alcohol and Drug Abuse Care
  • Laboratory Services and Tests
  • Mental Health Care
  • Family Planning
  • Durable Medical Equipment
  • Prescription Medicine

Not covered are vision, dental, organ transplants, and many other important services and procedures.

The big question, of course, is funding. Amazingly, they’re attempting to fund the program without a general tax increase.

The city estimates that it spends $111 million on emergency care for uninsured residents. So by providing basic preventative care they can trim that figure and redirect the excess.

Program director Tangerine Brigham (great name!) addressed where the remaining funds would be found:

Brigham said the program should cost $200 million the first year, and officials expect to finance it without a tax increase. They will also receive a federal grant of $24 million a year. In addition to membership fees and co-payments, the city will also receive money for the program from employers with more than 20 employees, who, starting in 2008, will be required to contribute a set amount to health care. [VIA The Cincinnati Post]

Of course, the bit about employers contributing has been controversial- for those interested in that debate opposing views were printed in today’s San Francisco Chronicle. See the supporting editorial here and opposing one here.

Could this work in Richmond? I can’t even pretend to make an authoritative statement about that. But I’m thrilled that a city is attempting a truly innovative approach to solving this perennial moral problem in American society.

And beyond the social justice aspect, could offering health care to all Richmond residents stem the tide of population loss? Would folks choose to stay in the city when their children reached school age if their medical bills were lower?

Would we see increased entrepreneurship and small business start-ups as the crushing financial burden of providing for your own health care was lifted?

Or would this exacerbate the problems created by our independent city form of government by giving another incentive to businesses to locate in the counties (assuming that the counties would not participate in a program like this)?

I’m sure the country will be watching San Francisco to see how this plays out. I’m hoping it becomes a model for the rest of the country.