however, we have very strong reservations about doing that in a regimented planning structure. we believe, especially given that we have just seen in this year a dramatic piece of legislation that has come through the united states in reforming our health care system. to put something that sets in stone, even historically in stone types of medical procedures, ways of delivering services, that will be changed and that we will be stuck in a plan that is three years out that we need to wait to go back to. deliveries of services will change dramatically. doctors will be probably going into pod there. will be a whole new structure about how medical services are provided, which this plan will be outdated before it even gets started. so we have concerns about that. if you look at that as a gap analysis we don't think that will be the same case.

there are roles and we've heard some tonight. access, cultural access, those sorts of things are important. but based on geography, most likely health services will not be delivered primarily around geography, especially for specialty services. we've done a very good job of using clinics in san francisco and we should continue to do that and build that out. but for specialty services, that's probably not going to be the model. it also doesn't look as regional care. san francisco is an economic driver around the medical industry. we bring people -- people come here for medical services. it doesn't talk about that at all. we need to be dealing with those issues. so we would love that this get -- [inaudible] so we have more time to discuss shoots with you. president chiu: thank you. next speaker, please. -- discuss the issues with you. president chiu: thank you. next speaker, please. we also have randy and abby. and any member of the public who would like to speak. >> good evening. jerry crowly.

i'm as tired as you are, sitting here all afternoon. and -- however i'm representing the neighborhood network and refer you back to three years ago, i think you would remember when there was an appeal at the board of supervisors involved in an institution and some plans in the triangle area. the board of supervisors sent the institution back to develop an institutional master plan. which in as i sat here this afternoon thinking about health care

services, i thought, why have we waited this long. we have great respect for your leadership. >> thank you. next speaker please. >> i am here to say kaiser permanent stasupports planning r health care.

kaiser permanente is opposed to this as it was written. we believe it will limit access to health care, causing delays. san francisco is already one of the top cities to build a hospital, and it could limit the ability to continue providing services to residents, including those in healthy san francisco that we care for. the determination from planning department would place an undue weight on geography. the ordinance could push health- care services and their quality of life out of the city.

we attract patients from all over northern california, which brings a concentration of medical services to the city and the quality paying jobs to the city would not have if we have smaller political centers. >> you have done a great job at hospitals. since you do understand the importance of what we are

saying, have you figured out -- are there things we can do? this only makes sense -- we are about to be the real medical hub of the west coast. we are very proud of that. we have to plan, because without planning, there is chaos. you need to help us figure out, so i need you to write it down and show mae how it is going to have the affect and what we can do to change that.

you will plan for years. we need to do the same thing. >> what we are asking is for more time. we would love to describe how this would best work. what i was describing is how the kaiser permanent model is based on integration of care, and that requires a medical center campus, and that is what has developed in the northern sector of the city. we need a certain level of scale, because the specialty services are part of a network of services. if you have an oncology department, there are other functional -- >> if we do of planning exercise, people could

understand. we do not understand, and we do not have a clear view. if we have a plan, it is clear to navigate the. we have to understand how to bring the best health care. >> we are definitely in support of planning. goo>> we do not have a lot of t. we have things so we can get something done.

>> i am also trying to understand how it is legislation that requires planning would get in the way of all the things you talked about. have you had specific changes you have incorporated through the hospital council? we have been getting feedback from them, and we have not seen anything specific. is there something specific but was not included. >> there is some alternative language. >> we are very much on the same page in all this. thank you for your leadership.

i think what we're trying to describe as a very complex planning process. it took 18 months to come up with the health bill for a reason. it is pretty complex. we need to table to figure this out forever. and we have not taken the time to sit down and the fine. there are several ideas as to how this could be done. i know our organization has many individuals dedicated full time to doing strategic planning on an ongoing basis, because it is constantly changing.

the challenge will be for our health department, who is accustomed for planning for 20% of the population to engage in private providers and how we can really looked at this. health care reform is asking us to do accountable care. we all do it a little differently, so the charge of how we are going to do everything from dental care to providing services is very complex. it is not like a board game where we are going to know all this in short order, because a lot of is going to change over time. we are doing lots of outpatient care. to be able to put this together will take a concerted effort by

a partnership of all private and public providers. >> i welcome those comments, but the frustration i have is that we have been talking to this industry and talking to people for at least six months, and we have been opened to change after change and getting specific language from them, so of some point we have to act, because the planning commission is being asked to take positions that have health care implications without the tools they need. note toolboxes going to be perfect, but at some point we have to take action. it has been six months. >> the planning department past 1 through 5.

that means they feel something needs to happen to them. we have got to be a model. >> i totally agree. i know some of the frustration comes from the health committee itself. one of the suggestions i have made most recently was related -- was looking at the charge they have. i understand the concerns the planning department put forward. i have been in private health care for 30 years. we have to try to figure this

out. there are opportunities to work together better. i know we are concerned it will drive up costs at the time we are being asked to drive down costs by increasing delays. i am not sure the supervisors fully appreciate the statewide planning process we have to go through >> if you were here you

heard us talking about the planning department. maybe we can figure something out. that is what we are trying to do. >> next speaker please.

>> my name is elizabeth. i want to say thank you for bringing of the health care issue and really listening to the people. planning is important but health care is an urgent need. i believe as a youth program manager who listens and here's the use gunmen -- the youth come in, that we support this, because we need to take the blindfold off the city process. the city does not have a comprehensive understanding of our needs.

the city cannot adjust investigates based on each particular need. we need a big picture approach. we believe the monster plan will provide the big picture approach by making recommendations. the decisions made impact the services we are able to receive. we have to make sure the families you serve will hold of voice in the process. >> next speaker please. >> i want to thank you for taking the time to listen to public testimony i am here to

support the master plan. health care is one of the top priorities. many are not insured by their employers and depend on the safety net to stay healthy. they can determine what are the health care needs. they should also prioritize the need of san franciscans. currently they are drawn to specialized care to be competitive on a regional, international, and national basis. it places an increased burden on the department of health. thank you for your time. >> next speaker please. >> i am with the chinese grants student association, and we work

with a lot of community residents in the southeast. one impact of not having a master plan is that in the southeast where the members bear the biggest brunt of pollution from the freeways, whether the community has the highest asthma rate, the highest hospitalization, there is also the least access to health care resources. that is part of not having the tools for your -- having the tools. everyone supports the plan, but not everyone wants to go along

with it. and when i hear the planning processes could but the determination is bad, i hear that it is great to have something on important new -- on paper, but it is not important. it is not necessary for institutions to go along with the. i have a problem, because we need to hold health care development responsible for providing health care to an entire community. i think it is important that we continue to move ahead with the process. the industry could have been

provided -- involved as well. >> good evening. >> we have been working for many months, but we have been working on this issue for many years. they are facing the brunt of health disparities and air pollution in that area. it is not anything new, but the fact there is an objection now to start planning is outrageous. there have been many opportunities to way in on the process.

a lot of amendments have been changed. they have been nothing but flexible and have helped the community. we wanted to restate that the process has been very good. there have been many opportunities to weigh in on this, to have testimony taken into account this is an urgent issue, and i believe they need to weigh in on it. we need to have a plan by the time national health care starts to come down. we do not have -- need to have

anything shoved down our throats. hopefully you do not delay this plan, because it is sorely needed. >> i am with the coalition. i want to read a statement from our staff person. she coordinates for the housing developments throughout the city. she says the health care- related developments should be based on the needs of all residents. residents need health care. it is important in addressing the needs of all san franciscans. some residents have to travel across the city.

they would have a difficult time if they had to travel and wait 10 or 20 minutes. healthcare services will remain in the areas where they live, and seniors can access services much more conveniently. this will determine that it is equitably distributed throughout the city. large corporations do not like to be held accountable. but is why there is resistance. thank you for your leadership, and thank you for what you did. you have been working on this

for a long time. >> next speaker, thank you. it is not working for anyone. the community comes out and says, we are not so happy about this. it is high time we have a master plan for the city. it is not a pitched battle, and

we actually have zero road map, a guiding light that provides increased productivity and -- we actually have a road map, a guiding light and provide increased productivity. >> thank you very much. next speaker, please. >> i sat on an effort to plan health care killed by the reagan administration. when we were doing the project review, there were people from the community and the hospitals and the business community, and the business community always said the sky was falling.

we have to deal with this. this was loud and clear. the focus should be on how to provide the care for underserved communities, which is not only geographic but also population, and those are the people said basically fall out of this. you represent this, and part of district 3. the southeast, you have hospitals for your -- you have hospitals. we have needs because of the hills. no one wants to deal with primary care.

it falls into the health department. i do not see the for-profit institutions that emphasize tertiary care saying our mission is to provide primary care throughout the city. women have babies. they do not always have access to good primary-care through the city of. people have asthma. they do not always have assistance through what the public provides. >> any further public comment on this item? if not, --, not if you would like to. >> thank you. i would like to thank you for your effort and also for the

committee to express anything. i am proud to be able to coordinate about the importance of health care service. i always want to thank you for the committee members, because this is the day before the election. the union members want to work on that. they are also taking some time to actually alive someone accountable who actually makes this