SAN FRANCISCO -- Forget the driver's license and credit cards. The most important piece of plastic in Cheng Wang's wallet is his new medical identification card featuring a picture of a heart and this city's signature skyline.
Wang, who has diabetes and other ailments, says the Healthy San Francisco program saved his life.
When he immigrated here in May to be closer to his elderly mother, the 64-year-old Taiwan native brought enough pills to last seven months. When those ran out, he didn't know what to do. He had no medical insurance. And it scared him.
Then he learned about a groundbreaking city health plan that provides a network of care to residents regardless of their ability to pay, immigration status or existing medical conditions. Wang, a proud man, said it's important to him that the program is not purely a handout. It's a bona fide medical plan offering care free of charge to those who can't pay and on a sliding scale to those who can afford to contribute to their care. When he finds work, he'll pay, he said.
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"It's precious," the retired printer said, holding out his card. "It gives me peace of mind."
The city's initiative is a first-of-its-kind local solution to what has become a pressing issue nationwide: how to provide the poor and middle class with affordable health care.
Americans spend more than $2 trillion a year on health care, nearly a fifth of the national economy, according to federal statistics. Still, more than 60 million people remain uninsured or under-insured.
"We struggle every day to see that the poor do not fall into a chasm without medical care," said Linda Bien, president of North East Medical Services, a participant in the program.
She said, "Across the country, even people with medical insurance have trouble receiving care. The system is broken. And new models have to be put out there so we can reconsider: What does work?"
Launched in July at two pilot clinics in Chinatown, Healthy San Francisco now has 14 city health clinics and eight affiliated community clinics. More than 82,000 San Franciscans are without health care. Program managers hope to have all of them enrolled over the next two years by advertising the service in three languages at clinics and social service agencies.
Officials stress that their universal health care plan is not insurance. The program does not travel with members, who are only covered for visits to par-ticipating clinics and the public hospital in San Francisco. It does not cover dental or eye care. Those below the federal poverty level of $10,210 in annual income for a single person and $20,650 for a family of four pay no fees.
Starting next month, the plan will be open to individuals with incomes up to 500 percent of the poverty level. Quarterly fees on the sliding scale range from $60 to $675. Co-payments for those who don't qualify for free care range from $10 to $20 for clinic visits and $200 to $350 for a hospital stay.
The goal of Healthy San Francisco is simple: Get involved early in preventive care before chronic illnesses become serious enough to require hospital care at the county's expense.
Giving them their own Marcus Welby
"Our system didn't serve the population," said Tangerine Brigham, program director. "It was easy for people to do episodic care or seek no care at all.
"The idea was, 'Well, if I don't have my own Marcus Welby, I might wait for trauma care.' We're trying to give everyone their own Marcus Welby," Brigham added, referring to the fictional family doctor in a 1970s television drama.
The program's inception dates to 1998, when voters in a citywide referendum endorsed universal access to health care. But the next step did not come until Mayor Gavin Newsom took office in 2004.
He began studying the matter. City officials estimated that they were spending $111 million annually to treat the uninsured at San Francisco General Hospital. Why not, Newsom and his staff asked, take some of that money and invest in prevention so that underprivileged residents would not have to resort to hospital visits to treat ill- nesses?
"We simply asked a profoundly different question," Newsom said.
"For years, people here beat their head against the wall figuring out how to provide universal health insurance to the uninsured. Then we asked an- other question: How do we provide universal health care? That made all the difference."
Brigham said the program should cost $200 million the first year, and officials expect to finance it without a tax increase. They also will receive a fed-eral grant of $24 million a year. In ad- dition to membership fees and co- payments, the city will 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.
Dr. Mitchell Katz, the city's health director, said many of the 2,800 Healthy San Francisco enrolled members consider it important that the city is doing what the state and federal government have not done.
"People like the fact that they're not on the dole; they belong to a plan," he said. "With the people I have talked to, that is the key. It's not labeled charity care -- you're a poor person, come here. Sure, the poorest of the poor will receive free care, but for the others, they pay what they can afford to pay."
Officials said they hope the new program catches on with needy San Franciscans. The fact that the plan is not portable will discourage people from dropping existing plans -- and Healthy San Francisco will be there for people who need it most, they say.