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Ken Jacobs on Health Care Financing

This memo was submitted to the Health Care Committee of the San Francisco Taxi Commission on December 19, 2006 by Ken Jacobs, who is a non-voting member of the committee

To: Taxi Drivers Health Care Committee
From: Ken Jacobs, non-voting member representing private health care
Re: Committee decisions on financing and "Voluntary vs. Involuntary"
Date: December 18, 2006
I am unable to attend the meeting tomorrow. I did have several observations on
the questions asked in the memo.
(1)  It is important to distinguish between how the funds will be collected and
where the incidence falls. It is not difficult to imagine ways to pass a share
of the incidence on to cab companies and/or medallion holders without triggering
a requirement to go to the ballot. For example, if funds were collected from the
drivers, but gate fees were lowered to cover some of the cost, the incidence
would be born (sic) in part by the cab companies and medallion holders while it 
would clearly fall within the city's regulatory power. (If the color schemes are
required to contribute towards the cost of health care, it is a reasonable
assumption that part of those costs would be passed on to the medallion holders
through lower lease fees.) Conversely, as noted in your memo, if funds were
collected by the color scheme, part of the cost could be passed on in part to the
drivers through higher gate fees. It might be helpful to separate out these
questions in your decision making.
(2) It strikes me as a mischaracterization to say that medallion holders would be
"hit-twice" since they are also drivers. The medallion holders gain double income
from the cab: as a driver and as a medallion holder. They would contribute to the
plan in those two separate capacities. The medallion is a public good provided by
the city, which comes with certain obligations and responsibilities. (It is hard
to think of any public program in which people do not contribute in multiple
capacities: as workers, taxpayers, consumers, employers, etc.)
(3)  If you want to require participation of cab drivers, the cleanest way to do
that would be to make it a condition for drivers to receive their permit to drive 
a cab in San Francisco; you would want to allow drivers to opt out of the city's
health plan with proof that they have coverage through another source.
I look forward to hearing your results.

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