When we last visited San Francisco's Health Access Program, an appeal panel had just granted a stay in favor of the City's health tax. The Golden Gate Restaurant Association had won an initial judgment that the City's payroll tax on employers who do not provide health benefits, in order to fund a City-run health plan, violates the federal Employee Retirement Income Security Act (ERISA). The appeal panel decided to let the City levy its tax, pending a full appeal later in the year.

Recall the reason for this tax hike to fund so-called "universal" health care: uninsured patients crowd ERs, but don't pay their bills, shifting costs to the hospitals, private insurers, and taxpayers. This notion has been debunked many times in this blog, and in my recent paper on the California Health Care Deforminator, Model ABX1 1. In San Francisco, the argument is even more ridiculous.

First, the hospital which the City claims that uninsured patients are crowding is San Francisco General Hospital. But this is the County hospital, so taxpayers are already footing the bill. The City is basically increasing taxes to reduce the burden on taxpayers! Puzzle over that one.

Second, look at the Health Access Program's provider network: it consists entirely of the City's Department of Public Health clinics and members of the Community Clinic Consortium. These outfits are also already funded by taxpayers (although the community clinics might receive some private charitable funding, too). So, once again, the Health Access Program is just an excuse to raise taxes to fund organizations already wholly dependent on taxpayers.

How is this going to reduce health costs? It won't, as anyone vaguely acquainted with bureaucratic incentives to growth can immediately see.

Meanwhile, the City's Board of Supervisors is in a panic about the risk of a private hospital closing its ER. This being San Francisco, the Supes think the answer is to order the hospital to keep its ER open. Despite this command, Sutter Health cannot promise to keep St. Luke's ER open through 2009.

"Universal" health care indeed - more like universal pain, bureaucracy, and loss of jobs.