Opponents gear up for battle over health care | News | Palo Alto Online |


Opponents gear up for battle over health care

Measure F would put Palo Alto City Hall in charge of regulating medical costs

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On May 22, Palo Alto officials found themselves in the middle of a high-stakes battle that no one in City Hall signed up for, one that could have an impact on anyone providing or receiving health care in Palo Alto.

That's when a packet of more than 3,500 signatures arrived at the desk of City Clerk Beth Minor, ensuring that Measure F would appear on the November ballot.

Depending on whom you talk to, Measure F will either ensure quality health care in Palo Alto or force doctors, dentists and optometrists into permanent exile from the city.

It will either burden Palo Alto taxpayers with a new bureaucracy that could cost up to $2 million a year to administer or save them money by containing staggering health care costs.

Proponents say the initiative's aim is to pressure Stanford Health Care, which they claim is plagued by high infection rates, to shape up. Opponents say it seeks to pressure Stanford Health Care, one of the nation's leading medical institutions, to stand down while the measure's chief sponsor, the Service Employees International Union-United Health Workers, organizes employees at Stanford facilities throughout the Bay Area.

There is one thing that everyone agrees on: If it passes, the measure will transform both Palo Alto's local health care and City Hall, which today struggles to administer a simple business registry but which next year may find itself in charge of regulating the complex health care industry.

Formally titled the "Palo Alto Accountable and Affordable Health Care Initiative," Measure F would limit how much local hospitals, medical clinics and other health care providers can charge patients and insurers for medical care. While it would not set a flat rate on any particular service, it would limit charges to no more than 115 percent of the "reasonable cost of direct patient care."

The city would review all charges every year to ensure compliance. Hospitals that charge beyond the 115 percent "reasonable cost" threshold would be required to rebate the excess cost and pay fines.

The stated aim of the union initiative is to "provide for the orderly regulation of hospitals and other health facilities ... in the interests of public health, safety and welfare, by providing certain minimum standards and regulations regarding their operation." The measure imposes "reasonable limits on prices" and allows medical institutions to petition for exceptions during times when they absolutely need to charge beyond the 115 percent cap.

The initiative is also extremely appropriate, the union contends, given Stanford's high costs and disappointing record on infections. Stanford Health Care, they note, is ranked 71st out of 107 hospitals, according to Vizient, a company that ranks medical institutions based on quality measurements. That underwhelming ranking was cited by Stanford Health CEO David Entwistle at a November 2017 town hall.

"When you look at all the amazing things we do, there are still opportunities for improvement," Entwistle said, according to Stanford Medicine News Center.

That appears to be the only thing the two sides agree on. Sean Wherley, spokesman for SEIU-UHW, dismissed arguments from Measure F opponents that the initiative is a union bargaining chip. Stanford Health just signed a new three-year agreement with its health-workers union last December, Wherley told the Weekly, and the union is not engaged in any "active organizing" in any Stanford facility. Any arguments that this is a negotiating tactic is thus moot, he said.

Rather, he said, this measure aims to address a festering problem that the union has been trying to spotlight and solve for years: Stanford's infection rates.

The issue also came up in January 2017, when SEIU-UHW was engaged in negotiations and publicly called on Stanford to make improvements after Medicare penalized Stanford (and 768 other hospitals) for high rates of hospital-acquired infections. The penalty, which was based on 2016 data, gave Stanford a score of 7.85 on a scale of 1 to 10 (with 10 being the most severe). Among the biggest problem areas were surgical-site infections (in which Stanford scored a 10) and clostridium difficile infection, a bacteria-caused infection commonly known as "C. diff" (Stanford received a 9).

Wherley said the union has been trying to get Stanford to take care of the problem for several years, with little success.

"This is about improving patient care and preventing patients from getting gauged in the process," Wherley told the Weekly.

The cost of doing business

The union measure won't be settled until Nov. 6, but it has already achieved the seemingly impossible: It has unified Palo Alto's normally polarized City Council, which this week concluded a meeting of bitter disagreements and personal insults by unanimously voting to oppose Measure F. Though council members regularly laud the concept of "local control" and take pride in their city being a national leader in biking, solar panels and electric vehicles, no one behind the dais wants to see City Hall get into the health care business.

At the council's June 11 meeting, Vice Mayor Eric Filseth said the measure appears to constitute a "very large, unfunded mandate for the city to regulate health care in Palo Alto — a task for which we have neither the expertise nor bandwidth."

Even Mayor Liz Kniss, a retired nurse and champion of the council's 2018 "healthy city, healthy community" priority, acknowledged in June that health care is "hardly the issue we normally deal with" — and implied that she'd like to keep it that way.

"This is not something we normally do, it's not something we are staffed to do and, I think it would put a substantial burden on our city," Kniss said.

City Manager James Keene displayed the same can't-do spirit when he stated frankly at the June 11 meeting, "We're not equipped to handle this."

"We need to recognize that this has been dropped on us, really," Keene said.

City officials don't have a clear idea of how exactly Measure F would impact the city budget, but they're fairly certain that setting up a new bureaucracy won't be cheap. In June, the council directed staff to conduct an analysis of the measure's impacts on Palo Alto. This week, it received back a memo that stated the "complex implications of the measure are such that we were not able to design and undertake that detailed analysis."

One could get some idea of the potential costs, however, by looking at a study commissioned in Livermore, where a similar measure, known as Measure U, will appear on the November ballot. The analysis conducted by Henry W. Zaretsky and Associates estimated that Measure U would cost the city about $1.9 million annually, which includes $1.35 million in salaries for new staff (a program director, a health care finance director, a "finance team" of three analysts, a medical-billing specialist, an information-technology technician and legal counsel) and the rest for overhead costs.

The program would also require $750,000 to $1 million in startup costs to account for recruitment costs, software, office furniture, computers, vehicles and consulting costs, according to Zaretsky, raising the overall first-year costs to $2.8 million.

Should there be litigation, the report notes, the costs are likely to be higher.

The report notes that administering the complex program proposed in the measure "will require a highly skilled and well-paid staff of regulators."

"For the most part, such a staff will have to be recruited externally since current city employees are unlikely to have extensive backgrounds in health care," the report states.

Doctors united

Palo Alto's elected leaders aren't the only ones who find themselves unexpectedly — and unintentionally — united by the SEIU-UHW measure.

Since the measure landed on the ballot, Palo Alto's hospital executives and physicians also have joined forces to oppose Measure F through both lobbying and litigation.

Doctors from Stanford Health Care and Palo Alto Medical Foundation, as well as local dentists and others with small practices, have spoken out against the measure in recent weeks, urging the council to oppose the measure. On Sept. 10, Entwistle argued before the council that the measure, far from improving health care, will hurt the ability of health care professionals to serve patients.

"If you do your job well, this will prevent you from doing your job well and the city will have to add resources to administer this," Entwistle said. "This does nothing to impact quality of care. It actually puts patient safety at risk. It does not make patient care more accessible."

Specifically, opponents of Measure F point to the measure's definition of "reasonable costs of direct patient care," which includes salaries, wages and benefits of non-managerial personnel who provide care, pharmaceuticals and supplies, facility costs, laboratory testing and "depreciation and amortization of buildings, leasehold improvements, patient supplies, equipment and information systems." It does not, however, include such things as salaries and benefits of management and supervisors, as well as legal fees, audit fees, travel, dues, subscriptions and other expenses that hospitals need to operate, notes Duane Dauner, who spent 32 years as the head of the California Hospital Association and who now leads the "No on F" and "No on U" campaigns. By his estimation, these excluded factors constitute about 4 percent of a hospital's costs.

Dauner does not dispute the union's assertion that Stanford and other hospitals often charge patients more than the direct cost of care. He notes, however, that such a practice is necessary for them to meet their obligations, which include coverage of Medicare and Medi-Cal patients, as well as those with no insurance at all. Private payers, who typically make up about 35 percent of total patients, currently pay about 150 percent of the cost of providing care, Dauner said. However, Medicare only covers 90 percent of the health care costs, while Medi-Cal pays 70 percent. He estimated that Medicare and Medi-Cal patients make up about 60 percent of patients.

Other patients, including the uninsured, veterans and members of the military, pay about 30 percent of the health care costs.

Because Stanford and other hospitals don't get fully compensated by Medicare and Medi-Cal, they have to swallow some of the costs. Thus, even after charging private payers at 150 percent of the total cost, the revenues that the hospital takes in typically exceed costs by only about 3 percent. If Measure F passed, hospitals would have to charge private payers no more than 115 percent of the "direct costs." As a result, hospitals would see their revenues fall about 11 percent below costs.

Hospitals like Stanford Health Care don't have the option of relocating from Palo Alto, Dauner said.

"So what can they do? They'd have to reduce salaries, they have to reduce the number of employees, they have to forego buying equipment and keeping up with technology and things that are necessary to provide modern-day quality care," Dauner told the Weekly. "It pinches the hospital financially so they can't provide those services."

Unlike Stanford, small clinics and individual practitioners can move. And many will opt to do just that to avoid the onerous auditing and reporting requirements created by the measure, Dauner said. Like other opponents of Measure F, he argued that Palo Alto residents will be left with fewer medical services if the measure passes, even as more of their tax money goes toward administering the new program.

"What happens to the people who live in Palo Alto and who now have to drive to Menlo Park or Mountain View? Their access to care has been compromised because they have to go farther to get to their doctor or their dentist or their optometrist," Dauner said. "They have to drive further distance, take more time, spend more money, to get to services already available."

James Stephens, a dentist whose practice has been operating in Palo Alto for the past 36 years, concurred. If the measure is approved, he would probably have to move to Mountain View to continue to provide the type of care his patients expect, Stephens told the council this week.

"The truth is, this ballot measure will limit my ability to have a viable dental practice because of my ZIP code," Stephens said.

Chris Lee, a pediatric dentist with a practice in Palo Alto, also criticized the measure, which he argued is too broad to accommodate the real-world nuances of medical care.

"Providing quality services is complicated, and dental billing isn't as simple as drill, fill and bill," Lee told the council.

He said he occasionally encounters children who aren't entirely cooperative with a stranger trying to stick a needle or a drill in their mouths. At those times, he might have to take more time to complete the necessary procedure and incur more costs, at times well beyond what insurance would cover.

"Measure F doesn't do much to account for all these extenuating circumstances that make it so hard for us to take care of our patients and keep our doors open without having to worry about having to justifying every single cost in a black-and-white way," Lee said.

The SEIU-UHW believes the opponents' arguments vastly overstate the added burden. Wherley noted that Stanford Health Care is an organization with $234 million in operating profits and reserves for $700 million. Even despite these resources, Stanford is struggling to fix its patient-infection problem.

Furthermore, Measure F does nothing to prevent Stanford from spending more money on health care — just not charging more than 115 percent of reasonable costs, Wherley said.

"If they need to invest more in care through better staffing, newer equipment and new facilities, they can do that," Wherley told the Weekly.

It's true, as SEIU-UHW maintains, that Measure F still allows hospitals to invest more into patient care. It's also true, however, that if hospitals do that, there is little to keep patients' bills from concurrently spiking, provided the bills remain within the 115 percent threshold. Thus, while the official "Yes on Measure F" argument claims that the measure will "bring our high health care costs under control" and "ensure" that patients can't be gouged, the reality is somewhat more complex.

Things are also tricky when it comes to medical practitioners who unlike Stanford don't have swelling cash reserves. While the official argument in favor of the measure focus on Stanford Health Care's costs and infections rates, that argument has little to do with the hundreds of medical practitioners who are not affiliated with Stanford but who will also be covered by Measure F (the measure does include exceptions for various health care providers, including children's hospitals, dialysis clinics, clinics that specialize in reproductive rights and clinics operated by the federal Department of Veterans Affairs or most other public entities).

Wherley noted that the union doesn't have access to the financial records of the various medical practitioners outside Stanford. Even so, he expressed skepticism at the suggestion that doctors and dentists will skip town if Measure F passes.

"They can raise the threat of leaving, but the reality is that a 15 percent margin is still comfortable enough that you can operate efficiently and take a profit at the end," Wherley said.

The Zaretsky study draws different conclusions. If the program in Measure U is implemented in Livermore, the report states, providers would either leave the Livermore market or, if they are unable to do so, they would "likely cut costs in a manner that will lessen access and compromise the quality of patient care."

If health care providers exit from Livermore, that would "adversely impact local businesses and reduce tax revenue," the report states. It could also lower real estate values, though the report notes that this "could be welcome relief for buyers and renters."

Meanwhile, new health care providers, the report states, may be reluctant to enter the Livermore market.

For some voters, these consequences could be justifiable if the measure does what it sets out to do: lower health care costs and improve patient care. The SEIU-UHW acknowledges that implementing Measure F won't be cheap, but the union argues that some of the administrative costs would be offset with fines for violators. And if it does cost the city some money, that's a price worth paying for lower health care bills.

"Does it cause some new responsibilities for the individual providers? Yes. But in return, people in the city of Palo Alto will know that they are being charged a reasonable amount for their care," Wherley said.

Several Measure F proponents made a similar argument on June 11 to the council. Anna Toledano, a graduate student at Stanford University, said she has chronic acid reflex and has not seen a gastroenterologist in over a year because of the four-month wait for an appointment at the hospital clinic.

"The ballot measure will not harm Stanford Hospital's already lackluster ability to provide care to us, as Stanford Health Care's crafters of rhetoric claim," Toledano said. "Instead, it will serve to alleviate exorbitant patient costs that I myself had to bear numerous times in my three years in Stanford and hope not to bear in the three years to come."

Even the generally critical Zeretsky report concedes that the program could have positive benefits, with implications well beyond the two cities where it is now being considered.

"If the program proves successful and results in health care cost savings without compromising access and quality, it would obviously have a positive impact on the community and would likely be replicated in other areas," the report states.

Law and orderlies

Over the summer, Stanford Health Care, Palo Alto Medical Foundation and the California Hospital Association joined forces and filed a legal challenge with the hopes of keeping the initiative off the ballot. In letters and court filings, they argued that the measure is unconstitutional because it infringes on existing contracts, that it is overly vague, and that it is pre-empted by and federal and state regulations.

The American Medical Association, which filed an amicus brief in favor of keeping the measure off the ballot, also cited the onerous burden on Palo Alto's Administrative Services Department, which would be in charge of regulating local health care providers if Measure F passes. The department "normally deals with parking tickets and revenue collections — not complex health care issues or questions requiring expertise in hospital administration," the amicus brief states (a perhaps less-than-generous description for a department that is also charged with economic forecasting, pension reforms and the annual construction of the city budget).

The petitioners also argued that health care is already regulated by state and federal laws, including the Knox-Keene Act (which pertains to regulation of health care service plans), the California Insurance Code, the Affordable Care Act and the federal Employee Retirement and Security Act (ERISA).

These arguments failed to convince Santa Clara County Superior Court Judge Mark Pierce, who declined in an Aug. 1 ruling to keep Measure F from appearing on the ballot. In doing so, however, Pierce made it clear that his decision does not imply that the concerns from the hospitals are "inaccurate or otherwise invalid." Rather, Pierce wrote, "such contentions appear speculative and premature at a point in time before election."

"Therefore, whether the initiative will be confiscatory as applied can be determined only after the election, assuming the measure is passed by voters and thereafter implemented by the city of Palo Alto," Pierce wrote in his ruling.

Given the high stakes, the measure is highly likely to face a legal challenge from Stanford Health Care and other medical providers if it passes. Dauner noted that there's plenty of precedent for the SEIU-UHW initiatives to end up in court. In 2012, the union spearheaded Measure M in the El Camino Hospital District, which capped the salary of the hospital executives at twice the California governor's salary. The measure narrowly passed, with 51.91 percent of district voters supporting it. The following year, the Santa Clara County Superior Court deemed the measure unconstitutional, effectively killing it.

Dauner said the union also tried to push statewide measures to cap costs in 2012, 2014 and 2016, though none of these ever ended up on the ballot. In 2016, the union withdrew its measure right before the deadline after the court ordered it to do so. Then, as now, the measures were about union negotiations, Dauner said.

"The denial (in 2016) was based on the fact that they violated all of their agreements with us and that therefore it was illegal for them to try to make an end-run around the agreements," Dauner said.

But as union officials point out, cost-cutting efforts like the one at El Camino aren't the only types of measures that SEIU-UHW pursues. Wherley noted that the union had run a statewide initiative to improve dialysis clinics throughout California and filed a lawsuit to improve access for care for Medi-Cal patients. The union also has an effort underway across the country to grant expanded Medicaid access in seven states, he said. Much like those efforts, Measure F is a way to improve health care, not to attain personal gains, Wherley said.

"We do have a history in going beyond the pure interests of the union and bring forward measures to serve the interests of the wider community," Wherley said.

UPDATE: Read the Weekly's editorial on Measure F: No, no, no on Measure F (Sept. 21)

Find more coverage of Palo Alto races and measures, including upcoming election events and videos of voter-education events here.


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55 people like this
Posted by Joseph E. Davis
a resident of Woodside
on Sep 14, 2018 at 7:25 am

This is an awful idea. Palo Alto is in no way qualified to regulate medical costs. The casual nature of imposing this harmful intervention on vital medical services is breathtaking in its audacity and recklessness.

29 people like this
Posted by DTN Paul
a resident of Downtown North
on Sep 14, 2018 at 8:24 am

DTN Paul is a registered user.

Yup. I agree with Joseph, and apparently everyone else in the city that this idea is asinine. We can't even run a public pool that isnt closed for most of the year. Why would we be equipped to regulate health care?

17 people like this
Posted by TorreyaMan
a resident of Palo Verde
on Sep 14, 2018 at 10:25 am

TorreyaMan is a registered user.

A PC feel-good measure which would make it impossible to provide health care.

21 people like this
Posted by Palo Alto MD
a resident of College Terrace
on Sep 14, 2018 at 11:45 am

Having worked at Stanford Hospital for 9 months, folks flew in from the Middle East to Stanford's doorstep and had to be treated (They never paid). Many patients without insurance came in and had to be treated receiving the same care as those with good insurance. The reason hospitals charge $20 for an aspirin is to cover these costs.

Are the advocates of this bill advocating that the uninsured not be treated so that the care for an individual can be itemized to reflect the true costs?

Palo Alto should not be in the business of penalizing local hosptials

7 people like this
Posted by Brady
a resident of Barron Park
on Sep 14, 2018 at 11:55 am

Why stop will only at health care.....why can’t we limit the amount of money ALL Palo Altoans make.....my neighbor who is a VC is filthy rich and has a 12 million dollar house where mine is only a starter at 2.5 mil.....there has to something unconstitutional about this...and totally unfathomable. Where are we in a communist country?

2 people like this
Posted by Mah's Place
a resident of Barron Park
on Sep 14, 2018 at 12:17 pm

>>> folks flew in from the Middle East to Stanford's doorstep and had to be treated (They never paid).

Links to that claim?

17 people like this
Posted by Garden Gnome
a resident of Crescent Park
on Sep 14, 2018 at 1:15 pm

Ok, so maybe Palo Alto doesn't have the best track record in growing housing, telecom (remember our cable?), or infrastructure.

But I'm sure we're going to totally rock healthcare!

35 people like this
Posted by Peter Carpenter
a resident of Atherton
on Sep 14, 2018 at 1:35 pm

Peter Carpenter is a registered user.

As the former Deputy Executive Director of the US Price Commission, the former Executive Director of the Stanford University Medical Center and a former Palo Alto Planning Commissioner I can say with both experience and confidence that controlling medical pricing is something that the City of Palo Alto is totally incapable of doing regardless of how much the city spends to try to perform this task.

The Palo Alto Process would bring health care delivery in Palo Alto to a halt - at least until the courts very predictably find such a role by the city to be unconstitutional.

3 people like this
Posted by bill
a resident of Greendell/Walnut Grove
on Sep 14, 2018 at 3:36 pm

Can a clerk in a Palo Alto office approve/disapprove a medical cost with out seeing ALL the medical data on a person?
NO So there will be "tons" of paperwork to review .. time & money.

The cost of a new pill, might be less than an old pill and a real savings. Only seeing ALL the records will prove this.

What type of privacy will be GUARANTEED ? What I get shots in my back, I have to sign to allow the Doctor to talk to my wife. If not, Doctor can't talk to her. AND SHE IS MY WIFE.

20 people like this
Posted by Me 2
a resident of Old Palo Alto
on Sep 14, 2018 at 3:49 pm

How convenient that SEIU-UHW unionized employees are considered part of the cost structure in this initiative. Consequently there's no cap to the increase in salaries they can demand (and the outdated processes they want to set in stone), which can be passed on to patients..

They can continue to drive up the cost of your healthcare by constantly asking for more money because it's not capped.

If the union really cared about costs, they would also cap their own salaries. But of course they wouldn't. The SEIU-UHW only really care about their own pocketbooks at the expense of the public.

3 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 14, 2018 at 3:50 pm

Posted by Palo Alto MD, a resident of College Terrace

>> Having worked at Stanford Hospital [...] hospitals charge $20 for an aspirin is to cover these costs.

>> Are the advocates of this bill advocating that the uninsured not be treated so that the care for an individual can be itemized to reflect the true costs?

I'm not advocating for this measure to be passed, so, no to your question, but, I do think that the actual cost of providing -my- care should be available to me, the patient, and, THEN, all the overhead added to the bottom line-- cost of treating uninsured patients, cost of rebuilding to current earthquake standards, etc. I also think I should know what the actual settlement was between my insurance company and me. Unfortunately, with some types of high-deductible insurance, the patient, e.g. me, pays list price for the first $7K-$15K or whatever, and then the insurance company pays an invisible actual payment to the provider.

>> Palo Alto should not be in the business of penalizing local hosptials

I don't think this measure should be passed in its current form, no. Stanford is no different from any other hospital-- no reason to penalize it more than any other hospital.

48 people like this
Posted by Mah's Place
a resident of Barron Park
on Sep 14, 2018 at 4:20 pm

>>> They can continue to drive up the cost of your healthcare

What costs are you talking about?

The food service SEIU workers making 15 or 20 an hour?

2 people like this
Posted by Me 2
a resident of Old Palo Alto
on Sep 14, 2018 at 4:37 pm

"The food service SEIU workers making 15 or 20 an hour?"

This union represents the nurses, among other healthcare workers.

50 people like this
Posted by JR
a resident of Palo Verde
on Sep 14, 2018 at 7:34 pm

I will be voting for Measure F unless Stanford takes concrete steps to work with Palo Alto regarding their insane expansion plans. I encourage all Palo Alto residents to vote for Measure F, Stanford needs to be taken down a peg.

19 people like this
Posted by Me 2
a resident of Old Palo Alto
on Sep 14, 2018 at 9:37 pm

"I will be voting for Measure F unless Stanford takes concrete steps to work with Palo Alto regarding their insane expansion plans"

Talk about cutting off your nose to spite your face. Hope you have a spare $2M for this new department plus another few million for the litigation that's going to happen. Where is Palo Alto going to get that money?

Oh right, the residents or cut back on city services. Say goodbye to firefighters or people in the police department. All because someone wants to take Stanford "down a peg."

42 people like this
Posted by Cvvhrn
a resident of Midtown
on Sep 15, 2018 at 7:54 am

@ Me 2

SEIU does not represent the registered nurses at Stanford

4 people like this
Posted by Me 2
a resident of Old Palo Alto
on Sep 15, 2018 at 10:52 am

That's even worse. You have food service workers telling us that we need to spend millions on setting up an agency to oversee healthcare?

13 people like this
Posted by Dan
a resident of Midtown
on Sep 15, 2018 at 11:38 am

This one is really simple. Anyone using a functioning (or partially functioning) brain will vote against it. The idea of City of PA taking on a role in regulating the healthcare industry effectively is ludicrous.

40 people like this
Posted by Mah's Place
a resident of Barron Park
on Sep 15, 2018 at 11:38 am

Food service workers are not "telling" you anything, unless they happen to be registered voters, and vote.

The question was: What costs are you talking about? (driving up)

Food service workers? Really?

15 people like this
Posted by Abitarian
a resident of Downtown North
on Sep 15, 2018 at 1:54 pm

Many of us, perhaps even most of us, have experienced outrageously high bills from Stanford and other local providers for often cursory and sometimes unnecessary health services.

Even with "good" insurance, the co-pays, frequently a percentage of the "negotiated" fee, can run in the hundreds or thousands of dollars. Alas, knowing that the markup helps pay for those less fortunate does not cushion the blow of dealing with these expenses.

Accordingly, it is perfectly understandable for citizens to want the government to take a role in controlling these costs, regardless of whether or not one supports the union that conceived of the initiative to do so.

In my opinion, this function should be handled by the state or federal government, but that is not the question at hand.

The ballot concerns whether Palo Alto should be responsible for regulating the cost of health care administered within our borders.

On the one hand, cities are responsible for managing all kinds of services, including those related to medical attention.

On the other hand, our city leaders and staff seems incapable of handling activities of far less scope and complexity.

Still undecided, my hope is to be able to get sufficient objective information to guide my decision, though all signs suggest the "no" side will be overwhelming voters with propaganda.

With Liz Kniss serving as the face of the "no" campaign, my strong temptation will be to vote "yes". There is almost a 100% inverse relationship between her perspectives and my own.

9 people like this
Posted by Dr. Death
a resident of Old Palo Alto
on Sep 15, 2018 at 3:10 pm

from the article..."Proponents say the initiative's aim is to pressure Stanford Health Care, which they claim is plagued by high infection rates, to shape up"

Don't they use enough Lysol or are we talking about post-operative infections?

Going to the hospital is always a risky trip. With the recirculating AC, it's always possible to come home with the flu during the winter months.

11 people like this
Posted by J
a resident of Stanford
on Sep 15, 2018 at 10:01 pm

"I will be voting for Measure F unless Stanford takes concrete steps to work with Palo Alto regarding their insane expansion plans. I encourage all Palo Alto residents to vote for Measure F, Stanford needs to be taken down a peg."

FYI Stanford Hospital and Stanford University are different entities and organizations... The hospital has nothing to do with the university expansion plans. Neither do any of the other healthcare providers in Palo Alto (PAMF, dentists, etc...).

11 people like this
Posted by Toby
a resident of Evergreen Park
on Sep 15, 2018 at 10:29 pm

Forcing Palo Alto health care providers to limit their charges without also doing the same in neighboring cities will probably draw more people here and increase wait times even more. It also doesn't make sense how customer service will get better with less resources. Seems like the nurses and other people the union represents would be the first to go.

For routine care, I have no problem looking around. I've seen lots of doctors and Stanford is not the only place that has good primary care doctors who can diagnose a cold. But it's only a matter of time before we all get seriously sick. I have friends who live hours away who have gotten treated at Stanford because their local hospitals lacked the expertise. Part of Stanford's revenue undoubtedly go towards research and staying on the cutting edge and it's nice to have that in our back yard. If Stanford has a specialist or new treatment that might save my life one day, I would rather have that option than no option at all.

18 people like this
Posted by Bunyip
a resident of Adobe-Meadow
on Sep 16, 2018 at 2:49 pm

People, are on acid or something.

The SEIU is a union trying to force Stanfird to cow-towel to their demands. Stanford said no, so they introduced a bill to trick Palo Alto residents and threaten to cripple Stanford health care.

Residents are the absolute fools if you allow yourself to be a pawn in this one.


10 people like this
Posted by Bunyip
a resident of Adobe-Meadow
on Sep 16, 2018 at 2:52 pm

One last thing....

If you are tempted to vote yes, the bill requires the Council to regulate the costs and return a portion of revenue above an arbitrary threshold back to the payer.

That means a YES VOTE ON MEASURE F is more money going back to INSURANCE COMPANIES.

7 people like this
Posted by Debbie
a resident of Barron Park
on Sep 16, 2018 at 7:38 pm

So let me get this straight... The city tried to figure out how much this would cost and it is so complex that they can't even get an estimate. Our best guess is based off Livermore which is estimating 2mil/year to their city. Guess what? The Stanford owned hospital in Livermore has 200 beds. The Stanford main hospital has 600 and that's not including the new hospital that is being built. AND PAMF has a larger presences here based out of Palo Alto too. How much is this going to cost tax-payers and what other city services are we going to have to give up in order to afford this? It's going to be way more than 2mil. Even the city is admitting that they can't handle this. There is no other town/city in the country that has done this before. If this passes, we will only be shooting ourselves in the foot... all because we wanted better customer service from Stanford and to show them who's boss. If you hate Stanford Hospital then just go somewhere else and find other doctors. Plenty to choose from in the area. No need to strip the city of resources just to teach Stanford a lesson. It's not like our bills will actually be cheaper. The rebates just go to the insurance companies.

11 people like this
Posted by Bunyip
a resident of Adobe-Meadow
on Sep 16, 2018 at 11:26 pm


Make no mistake, this isn't the people of Palo Alto looking to improve healthcare.

This is the SEIU union wanting to control Stanford employment practices, and Stanford Healthcare said NO we won't be bullied into allowing you to collect more union dues.

To gather the signatures the union said, hey do you want to improve healthcare, and people expectedly signed their petition. Hell I'd sign that petition. But the true intent has been and continues to be withheld.

AND THATS IT! Poor residents are being used as pawns.

8 people like this
Posted by Rick
a resident of Adobe-Meadow
on Sep 17, 2018 at 10:29 am

Rick is a registered user.

What Peter Carpenter said.

9 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 17, 2018 at 10:52 am

Posted by Bunyip, a resident of Adobe-Meadow

>> Make no mistake, this isn't the people of Palo Alto looking to improve healthcare. [.] This is the SEIU union wanting to control Stanford employment practices, and Stanford Healthcare said NO we won't be bullied into allowing you to collect more union dues.

IOW, a battle between -two- bullies. With us in the middle. At the moment, I'm planning to vote "No", because I think the proposal as written is dumb, NOT because I think Stanford Healthcare is a sweet, innocent "victim".

8 people like this
Posted by No new traffic
a resident of Another Palo Alto neighborhood
on Sep 17, 2018 at 11:42 am

I can see if this passes, certain people in palo alto agreeing to health care only if it does not create any new traffic.

5 people like this
Posted by If you build it.
a resident of University South
on Sep 17, 2018 at 1:00 pm

"I can see if this passes, certain people in palo alto agreeing to health care only if it does not create any new traffic."

Just wait. This measure gives the impression that patient are going to pay less. Even though that's not the case, i can see more people flocking to Palo Alto for the "most affordable" health care in the state.

2 people like this
Posted by Chris
a resident of University South
on Sep 17, 2018 at 9:30 pm

Who is really concerned about this issue?

It will get well less than 30% of the vote.

12 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 18, 2018 at 10:20 am

Posted by Chris, a resident of University South, 12 hours ago

>> Who is really concerned about this issue? [..] It will get well less than 30% of the vote.

Yeah, sure, don't bother to vote. I mean, 537 votes out of 6 million couldn't possibly matter, right? (Florida, 2000). ( :rolleyes: )

Like this comment
Posted by chris
a resident of University South
on Sep 18, 2018 at 8:24 pm

Almost 90% of Palo Altans voted against Trump. This measure may do better, very slightly.

9 people like this
Posted by Cherie Long
a resident of Mayfield
on Sep 19, 2018 at 2:46 pm

Two comments: If the purpose is "to take Stanford down a peg", why penalize all the other health providers in the city?
2. If the purpose is to decrease Stanford Hospital's infection rate, how does this affect the infection rate AT ALL?
This measure asks the public to put a huge administrative burden on the city costing us taxpayers, return money to for profit, out of state insurers for WHAT?

8 people like this
Posted by B
a resident of Ventura
on Oct 7, 2018 at 5:21 pm

Stanford Hospital ER charges $20,000 to patch up a simple injury that only required cleaning stiches. $9,395 "GENERAL CLASSIFICATION FEE" That's almost $10,000 just to walk into the ER. You all are pretending this is somehow OK?!

Healthcare and capitalism don't mix well. You can't gouge people like this.

Like this comment
Posted by Marc
a resident of Midtown
on Oct 9, 2018 at 4:34 pm

I'm not clear why people are upset about Measure F. I think it is a great idea, but think that it stops short of solving the real problem.

I think the City of Palo Alto, since it is so smart and capable should step in an regulate all aspects of our life. They should regulate what everyone makes, what everything sells for, including property.

We can relax knowing that the capable City Council and City Manager will be using the years of skill and expertise to provide a beneficial existence for everyone that steps over the boundaries into our wonderful city.


1 person likes this
Posted by JR
a resident of Palo Verde
on Oct 9, 2018 at 7:29 pm

The "non-profit organization" known as Stanford has $24.8 billion in the bank, much of it accumulated from overcharging patients over the years. Stanford needs to be stopped from turning their hospital into a profit center to fund irrelevant things like new football stadiums.

On the other hand, there are many honest health providers in Palo Alto that are barely getting by. It's not fair to punish them, so I understand why people may vote "No". Hopefully Measure F is the first of many ballot measures that will attempt to hold Stanford accountable.

Like this comment
Posted by Marie
a resident of Midtown
on Oct 9, 2018 at 7:33 pm

Marie is a registered user.

Does anyone really think that this measure will ever be put into effect even if it passes? I thought I saw at least one such measure tossed for legal reasons. I'm tempted to vote yes as a protest vote over the lack of transparency in medical billing.

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