A big blank check
Three clear takeaways emerged from a presentation by Supervisors Hillary Ronen and Matt Haney on their plan to offer free mental health care to all San Franciscans: It’s well intentioned, it’s going to be very expensive — and it’s a long way from being fully cooked.
In fact, it was striking how many questions the two supervisors could not answer about a measure they hope to put on the November ballot. Among the many questions that seemed to trip them up during a Monday meeting with our editorial board: Who, exactly, would qualify for the free care? What would be the residency requirement?
But the question no one could answer definitively without further detail is how much it might cost. The city’s Budget and Legislative Analyst Office predicted the annual cost would be at least $70 million, depending on how many residents take advantage of the service. However, the Department of Public Health calculated a midrange cost of nearly $450 million for a program that would create 2,547 new civil service positions.
It’s hard to argue with the supervisors’ contention that a bold vision is required to address the mental illness
issues that manifest themselves in the homelessness and despair that is so pervasive on the city’s streets. But this program goes much further; as Ronen explained, it would apply even to those with “mild to moderate” mental health conditions, and initial consultations would be available to people with or without private insurance.
The supervisors said they would like to pay for the new program, Mental Health SF, through a new gross receipts tax on businesses that pay their top executives more than 100 times the median compensation of its workers. That proposal would go to the voters in November — on the same ballot voters would be asked to commit to what amounts to a blank check for expanded mental health services. If that tax increase was rejected, the city would need to find another way to pay for the program if it passes.
Ronen and Haney said they were open to amendments to improve the plan’s workability. This rough draft — with all its complexities and uncertainties — would need to be refined into a better targeted, fiscally responsible strategy before supervisors should even consider putting it on the ballot.