next speaker, please. as a low-income family of six, i am very concerned about the hospital sturgeon higher rates. my concern is also the concern of most residents. the plan of constructing a hospital and the neighborhood will not solve the problem. given the fact that they are here addressing the issues being raised by the community. they own a one-third of the market share. it is considered the largest hospital in the city. it is 44%, a virtual monopoly.

we know that monopoly is equal to control and dominance. who will stop them from hiking. they charge 37% more than the state average while they operate st. francis and st. mary's in san francisco. i think we believe the health care is not a commodity that can be traded. what san francisco residents and workers need is access to affordable health care. they're showing a willingness to communicate and to have not said they will make their hospitals accessible. we in the community association

are asking our government officials to stand behind the people. supervisor campos: i appreciate you taking the time. next speaker. >> i lived at 1711 of the bill. -- oakdale. we plan the daily routine for the whole month. given where we accept the nation's, we also save some money for senior programs. my concern is the cost of health care.

which is too much. i have a medication of five different ones for preventive medicine. it cost me about a dollar and 10 cents for 90 pieces. the pricing is shown, i have an eyedropper. it used to cost me $11.99. once they came, it was increased to 4099. -- $14.99. then again to $16.99.

probably it will not be army alone. a lot of people also that are like me. supervisor campos: i know there were a number of seniors that had to leave. we appreciate you. >> think you very much for having this hearing and listening to public comment. i find it quite shocking that the ceo had a 59% increase in his salary in 2009 and another

when he was promoted to vice president. all employees including nurses and health care workers have their wages frozen in 2009. there was a hiring freeze put in place and all departments were asked to cut their budgets by 10%. this resulted in layoffs and services that directly affects our patients as well as the nurses that provide that care. we lost to the consultants that helped premature berries -- babies. we lost the translators. they basically lost the full time positions. they do all of the staff and supply and of stocks that are needed for nurses to do their job.

all of these fell on to the remaining nurses. it increased our workload. nurses have observed practices that management has never fully explained and could call into question how billing is done. and practices that have nothing to do with recent allegations regarding false anesthesia billings. supervisor campos: don't be shy. >> the experience that my family has had with services for very young children, my daughter was born premature. we looked at the facility. every aspect of the care that they need is essential.

losing a specialist is something that can really put a family in jeopardy of losing a life. it is the critical and they are so young and so small. they want to provide the high quality care. they rely on the care to live more peaceably with what the outcomes will be about. it is really unfortunate that these of the conditions being forced upon you. i think we can do better as a society. >> and the evening, supervisors. my name is donald armstrong. by working with a lot of the populations, i am seeing the effects of the high cost of the health-care field. some are going without procedures because of the high cost.

they either can't afford it. some of the other things i am saying as far as identical vision, they can't even get glasses now or even get dental care. it is getting a little ridiculous. i hope that we can work together and the supervisors can have some type of oversight that is going on. and to make health care more available to a lot of the demographics we're working with. it is quite disturbing when you go to a home and you can't get a certain procedure. i see a lot of things going on. maybe a year ago. those facilities are very important.

that is all i have to say. >> both of my parents are retired and both have chronic health problems. i am the only child currently working to support them. sometimes we have to choose between their medical care and essentials because medical costs are so high. a mom would rather suffer back pain because we simply can't afford it. that is not fair at all. there is a 70% difference that one gentleman mentioned earlier. because the health care providers are more consolidated in the biggest health care provider has the power to charge higher premiums. and what they don't expect me

and my family to move just to get medical care. listening to the presentations, i heard a 3 million of executive pay. how much can they serve the community? they are basically a nonprofit, but why are they concerned about making the most profit on their care? shouldn't they give more back to the community? it is actually very low. some of francisco should not approve any development until they meet the needs of the community and residence including medical costs. >> we have been joined by president chiu. president chiu: i wanted to

apologize to folks. typically our meetings last around a couple of hours and we didn't realize a couple of us has scheduled something at noon. i appreciate all the members of the public that are here and commenting on this important issue. >> i am a direct care registered nurse as well as president of the california nurses association. thank you, supervisors for convening this important hearing. we believe is important to know there is a cost like the previous speaker has mentioned between northern and southern california. various factors might play a role in the disparity. we believe the the market

dominance does play a bigger role. secondly, the assertion that labor costs are largely responsible for the higher cost of health care are quite frankly preposterous. the only grain of truth to that assertion can be found in the salaries. as an example, and the ceo is now the highest paid and ceo of the sacramento valley. that is because after a wage increase of 43%, there are over two dozen corporate officials just in the sacramento area that earned over a million dollars apiece. here in san francisco, the wage increases for officials have

surged dramatically in the past several years. the latest available data shows that the corporate salaries jumped from anywhere from 40% to 50% a year. i want to make it very clear that no registered nurse, housekeeper, a nurse's aide, a dietary worker, or any other management hospital employee has ever nor will ever in the future have their salaries of words in the same manner. supervisor campos: next speaker. mr. smith, thank you for waiting to speak. >> thank you for this very interesting hearing. we take it as a very sincere question of how we can cut costs.

one way that we can tell you is cutting $40 million of the city costs by doing one then. but you asked for an economic figure. i called my office and they brought it over. what do i do, but this sunday -- i want to make clear that these are zero well-deserved wages. we have an effect of work force. the hospitals in northern california, particularly in the bay area are the most effective anywhere in the country. that is because of our incredibly effective work force.

here is the information you have asked for. nurses received about -- ken dollars more an hour. i want to look forward to working with you on reducing costs. supervisor campos: is there any member of the public that would like to speak? >> of what to say thank you for organizing this hearing. it comes at a very timely point in the city's development. i was blown away by some of these statistics. quality doesn't change. it is a factor of looking at the

market. then made a statement that what we need is more transparency. an understanding how it is charging consumers and looking and thinking creatively. we should be asking to see what the rates of success are in terms of the health care services. and we need to know that in order to provide health care to our residents in san francisco employees. i think what this all shows, it shows community residents that in light of what we have seen today, they are making huge profits this year and they are providing only 10% of their services to medical patients.

they are getting pushed to sf general. i think it is just another sign that it is not about labor costs. a lot of the evidence shows that they are looking at not just providing the best affordable care, but looking at the bottom line to change services. [chime] supervisor campos: any other member of the public that would like to speak on this item? public comment is close. colleagues, let me make a couple of brief remarks about this hearing. i started hearing by noting that one of the most difficult issues facing the city and county of san francisco is the fact that as we are facing a pretty difficult budget year a

city, for the incoming fiscal year, the protection is $491 million,. it is a very serious issue. these are truly some of the most knowledgeable people on this issue. we heard from them about different factors, there is

market consolidation by hospitals. we heard from experts today that since francisco is among the most consolidated if not the most consolidated market in the state. in trying to understand why it is that it costs a patient $7,349 a day, why it costs a patient other places 3931, consolidation is an issue. we heard from the doctor today that testified that consolidation and it definitely drives the prices. even when taking into account higher labor costs, even when factoring in the cost of living, you still have a very significant difference.

it is an issue and it is something that we have to deal with. it is something that is not going to be resolved in the near future. i thought was important for us to have this discussion. there is a lot of discussion going on around pension reform. it is directly tied to health care costs. we need to make sure that we have a better understanding of why we are where we are. this is not happening in a vacuum, which is a larger regional state context. this gives us a better sense of that. how to think the city officials have been working. kathryn testified and talked about some of the measures that have been taken by the health services system to address these issues. live heard from representatives that they have also taken some very important steps including

the issue of narrowing the hospital network that they utilize. those are all things that have to be considered. the final thing that is very disturbing is that some of the allegations that are found in the lawsuit and and was recently joined by the california insurance commissioner points to possible fraudulent practices, those are very serious allegations. in the complaint, they also point to an alleged practice of working with insurers and having provisions in their contracts were their billing will not be questioned. that leaves patients throughout the region very vulnerable. i of know of my colleagues want to add anything to the hearing. president chiu: a couple of

quick things as the chair just said. a lot of our pension and health care benefit costs, the fact that they're going up as directly related to the topic of today's discussion. we really need all the difference stakeholders to think as hard as possible. there was an announcement this year by various health care providers about efforts that would be made to contain the costs. a lot to applaud that and encourage its. we still have a long ways to go. hopefully this hearing is a step in that direction to really understand what the cost drivers are, in getting a handle on that. i think it is important to have all of the partners, all of the people, all of the players involved. which is why i think it was important for us to hear not

only from these experts, but from labor and the hospital council. i think everyone's voice needs to be heard. supervisor campos: 5 would ask my colleagues to continue this item to the color of the chair in the event that we have the opportunity to come back have lived in these issues? is there any other business before the committee? hong >> there are no items. supervisor campos: the meeting is now adjourned.

>> welcome to "culture wire." i'm here with james lee, and exhibiting artist, and we will have a chat today about the body of work you are presenting. after you left the military, what prompted you to go back to a place where the u.s. is engaged in military action? >> it is interesting. the population of afghanistan

is around 29 million, and there's probably no more than 80,000 u.s. soldiers serving in afghanistan right now, but if you look at the stories that come out, you think the numbers are completely reversed. all the stories are about americans, and you see almost no images of stories about the afghan people themselves, so if you look at the dominant representational paradigm uc today, it is all about foreign soldiers. my idea was to try incurred counted to that a popularized narrative and focus on images and stories that really reflect that lived experience of conflict through the eyes of the afghan people. >> you are exhibiting with three other photographers. it is true all three of them have really focused in the areas where a lot of u.s. and allied forces are seeing action, are actually involved in combat, so

your story is different than theirs. what does it mean to show your body of work along side of the stories that probably are more familiar? what kind of juxtaposition does that create for you as an artist? >> i think the strength of bringing the two different stories together is i think there is a real danger in focusing only on surface similarities between conflicts. when people look at a body of work and say that they see in this conflict photography, and it reminds them of somalia or iraq, i think that is dangerous because i think there are very unique elements to each conflict, and if you do not focus on the distinctions, you start to create a broader, watered-down topic, which is armed conflict, so i think it is important that when we focus on conflict, we make sure we do not just generalize, but we allow specific places and voices and people to be heard and we do not make these generalized assumptions about what conflict is like. >> the other photographers in

the show, what is local, and the others are from new york and new delhi. what do you like about some of their work? >> in a big fan of the fact that he approaches photography from a non-traditional point of view. he also cunner has a mixed view of cameras themselves. he calls them toys. >> he uses these cameras that one might assume our toys, but he also says all the toy cameras are cameras, so it does not really matter to him what he is using to take the images as long as he is getting the images he wants. and because they are taken with these film cameras, they have a very different feel than the other pictures in the show. one of the things i want to talk about is that lindsey's body of work is running down one side of the hall, and it is all about

women in afghanistan and how they serve and their special interactions with civilian women and communities, which is the special role that women soldiers play in afghanistan. across from eric copeland's work, which is extremely masculine and black and white and very aggressive -- what do you think about that juxtaposition between their two bodies of work? >> i like lindsey's contribution to the exhibit. she shoots in color, like i do, so it is great to see more color. she has a gift for capturing distinct moments that balance the conflict that these women are facing did today, but also very intimate, very feminine moments. she has one where a female soldier is shaving her legs at the beginning of her day, and it is kind of an odd thing to consider, but, obviously, it happens every day, but most people do not think about the challenges that face women in these types of environments

where they continue to be feminine, continue to be women, but they also serve a vital role in afghanistan. she allows viewers to come in and see those kinds of intimate moments you might not normally think about. >> to our viewers, and actually the curator of the show. one of the things i was interested in with your work and with the other bodies of work i selected was that you are presenting a real human perspective. each of you zeroes in on individuals, and the kind of sensitive, intimate, or private moments. >> if you look at most people's lives today and the way they spend their lives, it is probably not that different from what goes on on some of these larger for an operating basis. they have cafeterias. they have internet cafes. they have laundromats. they have their own spaces where they read, play video games. it is really like a small, microcosm of what they might find back in the united states. >> what do you hope