to the cost it leads to. i think the bigger question you want the answer to say one year an off the invest costs $40 and next year it's 42 this year. i can tell you the risk of your group drives the renewal. let's look at the increase. new and more expensive drugs, technology and building facilities for your men's and building hospitals. there's a huge number of things that drive inflation we'd love to sit down and talk about that. and what we're doing to drive down those costs. i can let the costs go up.

we're actually trying to keep the costs down but in the end you want to know how we're driving the costs down. the information is here but the offer ail inflation is a economic issue it's in every health system in america. it's interesting that the new york times about a month going ago did this study and the costs of medical care goes up. one of the things you're going to get at kaiser wherever surgeries got up we're going to

have a reasonable costs and we don't add on a huge amount if you or are one carry it costs more or less. we'll love to have a conversation about medical inflation by the answer is not in this book that is around your cost implementation >> colleagues any comments? >> thank you very much for your presentation. before we go to mr. rose report we have some health folks here commissioner scott and lynn as well and other confirmations. is there anyone else here i hope i haven't missed anyone.

do you want to read a statement i want to recognize you separately >> i'm randy scott the newest commissioner on the board and i do wish to apologize to the department and wanting i'm supposed to be in a meeting in my office at this moment. i appreciate the comments of kaiser. i was one of the two commissioner that voted against the rate renewal for a variety of reasons most of which related to the unanswered questions. however, knowing this this process needed tow moderate i stated on that occasion i felt we as a board we are left with no option but to move this

forward. i think it will be a horrible distraction to walk into a pictured of urban certainty this fall not having a contract in place. i think it can be avoided by your not regretting that. you mate not want to endorse it but i hope you'll give it the attention for the reasons that were outlined this morning to approve this. i'm not satisfied by the full representation of the kaiser hospital but i hope to be involved very close in the processes and i think the board

will be likewise. there's things that should be taken beyond the process like transparency. i thought that you have to do more than pass a resolution you need to be advocating at the state level any information that shares those goals. and you need to think partnering with california to see how we can push and require all insures to be where they're at. i think we have an opportunity to move forward aggressively with kaiser and cause them to move out of their comfort zone and i've heard their comfort

zone. 60 years of relationship should not be where you can predict where you'll be in 5 years. but there's had a mature risk here as well in terms of outlining a position that is based on trust as well as what the data has to say. my hope is we can get at the transparency we want and absolutely need in this day and age. thank you >> thank you commissioner scott. again, if i want to speak i want to make sure i give you the opportunity. and for colleagues and those in the audience as well commissioner scott, thank you for being here i know you mentioned the transparency but i want to make sure that my office

is working with the city attorney's office to explore different legislation we can do with the city that's preempted by the city law and we're exploring all options here and certainly applaud the senator at the state level >> i spoke last week and i don't think there's too much more to be said expect to adopt those rates. i was a little bit upset with the process the state board is the only one who can negotiation rates. the staff worked hard on that and with the flip of a switch we're booking back to a dealing

with the special interests changed the whole picture and it wasn't right to ignore the hard work by our staff and board with serious thought. we really in the past have adopted some rules regarding black hawk rates and benefits. there isn't any backdoor dealings and the vendors are not lout to do any dealing with anyone but the board so those transparency issues could be addressed so the dealings are proper. before the public all our meetings are before the public i encourage you to go ahead with this >> i want to thank you. for us to ask you to hold the

meetings i will say the backdoor dealings it's been for community groups raising questions. i don't want to increase cut the service board. i want we're asking a lot of the same questions. do you think it's a positive thing that kaiser is coming forward with a wellness program and the ability and a much earlier process for the 2011 is that a positive process? >> yes. >> thank you president. commissioner limb >> good morning, supervisors. i'm mr. limb the department for

the health services board. and one of the board members voted no, but having passed through the board i fully support this this is to the board for approval and i advocate for it to be passed. i see the commitment made by kooigz going back and still having the concerns and issues of the presentation given by kaiser at that time, and using a lot of the terminologies. and not really satisfied with their answers but having now because of the timelines that we have to pace and i want not to

jeopardizes the folks going through kaiser. so having said that i think the board will have to have is a commitment with kaiser and kaiser having a commitment with us to have better data going forward for next year. thank you. thank you commissioner limb. commissioner. >> i want to openly thank kaiser i've been working with them over the last 26 years they usually come around and support our members. and during the years when the

medicaid rates were pulling out the the business kaiser hung in there and stated in the medicare business. when there have been difficult times they have been more service driven but i agree with my colleagues and former colleagues we have a lot of work to do with kaiser. i'm glad they'll be more forthcoming and this will be well, for our members in the future. we do have the best rates in the state. we have very rich benefits and have 1 hundred and 8 thousand people who are relying on you and your colleagues to have the rates passes in a timely manner

and we have a staff that is working overtime. and also those negotiations have been long and hard. we don't let them get away with much we get the best rates in the state. we know we have the best rates because we have the best consults who help us negotiation to get better rates than anyone else. but we have a staff that's overworked. we have our colleagues who have worked long and hard and we appreciate it if you will support this and help your colleagues to make sure those rates are passed so all our members will have benefits on january 1st, 2014, and remember

we represent the subsequent all their employees and teachers and the class side and the community college where there's other struggles so the best thing we can do for the city excellently is to take the stress off them. so whatever you can do to urge our colleagues to pass those rates so we don't have 1 hundred and 8 thousand people without benefits. thank you for the trust to negotiate the best rates >> thank you, commissioners. at this point in time i don't see any other commissioners here so mrs. rose your report >> mr. chair i would recommend we add approval of this recommendation. >> thank you other questions.

i'm going to open up to public comment. i have a number of speakers. please line up (calling names) >> good morning let me just say i agree with commissioners scott's comments then anything i've heard over the last couple of sessions. i try to ask myself what would the members of my my own want me to say. i think we're all comfortable and familiar with the model but in all honesty, i didn't i think my members would say this is time to move this issue along. it has passed to the full board

please do that today and a end this process under the most positive way possible. i honestly believe in my heart the relationship between kaiser and the city of san francisco and all the members and employees will never be the same and moving forward it will be open a positive track. the proos process has been productive and given the consequences the seriousness of our folks and the decreases it's time to end this in the most positive fashion >> thank you. next speaker, please. >> thank you local 1001 and the former member of the health

service board i charred this the rates were regretted. if you listen thought professional staff and the health service system i appreciated my older staff member. from the kaiser presentation or even my colleagues comments just now you would think you have no choice but if you listen to the lady speaker i don't have a say. that's what's been presented here from this podium today. much of what you've heard public comment last week. however, the people of the city and county of san francisco actually decide what your

authority and power is and if you go back to the appendix of the charter it can be confirmed. in order to approve those rates it must be adopted by the a three-fourths vote by the board of supervisors. you've seen power points here i'll show you mine. the people of san francisco say 9 supervisors. a super majority must act to pass those rates. you not only have a say you actually have the final say. and whether or not it's appropriate to go 0 across the cellist it's inappropriate for kaiser not to discuss the dlilz

of what the process from 40 to $45 but fundamentally that's what t is at stake here. you should move it out of committee today but do it in a way that kaiser in the next 6 days kaiser needs to answer their questions >> thank you very much. >> thank you. next speaker, please. >> morning commissioners i'm david i'm the acting director for the union 10 to one. i fully support what the gentleman just is. i fully commend you for doing your job now there's some movement. there's some movement but not

enough. keep up the pressure and we recommend you move this out of the committee but if they haven't come back with something incrementalable we shouldn't accept. kaiser b will do this next year too. we should look at the long-range term solutions. that both kaiser and whether you shield should not been able to do this again. we compose the birth membership. we also ask you make sure that in future negotiations in 2015 we ask you pay attention to that

so there is no secrecy deal between kaiser and other providers to negotiation higher rates >> thank you. next speaker, please. >> good morning. i'm chris director of policy planning for sf u s d. i'll first say thank you so much for your work here and for the pressure that we support you for the fair rates and to minimum ize the rates. it's the most popular plan for our staff and nearly half of our retirees and families use

kaiser. so the possible diseruption is huge and this could be quite devastating. we're talking about 10 thousand people who might have to disrupt their health care and find a new care provider and dr. the second issue is costs. even if i look at the best optioned if they use the - it's a thirty periods of time increase and in some cased e cases it's a 40 percent increase. we will have a increase that's i'm sorry. i'll wrap up. our enrollment is in october and

lastly it's the potential effects to our children first year are. if you're going to effect thousands and thousands of children the effects for our children could be devastating. thank you >> thank you. next speaker, please. >> good afternoon supervisors aim ken i'm representing the united educator of san francisco. we're the professionals that keep the schools running. our members don't think kaiser but it's fair to say it they can play anything they want to. it may be that the rate increase is justified maybe the schedule doesn't allow for further inquiry but it may be that

kaiser has made thousands of dollars in profits while our professionals are making less salary because we've agreed to furlough days. on the other hand, we're encouraged that labor h ss and the city have become more involved to make sure that kaiser is more transparent and get able to the services they provided the educators of san francisco. we're also enthusiastic about moving forward with the wellness program. on the other hand, while their promising developments an english teacher would say show me your early drafts. so the previous discussion about the calendar we want to see the movement early on in the

calendar year. an english he teacher would say where are the side notes devils in the details. a government teacher says public fiscal is a good thing and the government history teacher would say their proud to be involved in the interest groups. a math teacher - i'll walk up quick. show me our work so let's move forward to a better round of health care costs in relation to what kaiser provides for us. thank you >> thank you. next speaker, please. >> jim o'brien retired fire

man's association. i'm glad about the transparency in those negotiations we urge your approval of the rates and benefits. we are more concerned or at least i am you saw the article in the new york times about the medical conditions it has to be with the agencies. so the costs are proportionately higher and not apparent to our health care services. its not just the insurance companies it's the consolidation of services that will effect everything and thank you and again, i urge you to adopt and approve those rates

>> thank you. next speaker, please . and before can you you come up i have other speaker cards (calling names) >> good morning, supervisors. i'm sal i didn't with the campaign for quality care. aigs has opened the door by putting the facts on the table and it's necessary that kaiser is being challenged on indefensible practices. kaiser has refused to back down and refuses to show it's projected costs and it's rate. kaiser it opposing transparency legislation in sacramento and they don't report the costs of

medical xevendz. we ask that those kind of practices go away we we can have integrity for the rate cigarette process and eliminates of hurting the city residents and all folks in the city and county of san francisco >> thank you. next speaker, please. >> hello jeff with the american dentists. the kaiser representative who's up here gave a list of the inflation. i think we all know this but the drivers is $9 million in profits

since 2008 and for a nonprofit to rack up those kind of figures speaks to the inflation and one of the reasons their rates are what they are over years. we've been told it kaisers rates are standard for all large and private employers and because of that they couldn't change the city and county rates is without effecting their books. in november of 2010 kaiser presented a reuntil rate to the district council 16. they represent thousands of works in california and northern

nevada. there were no discussions until 2011 and council district 167 said they'll not agree to a rate until they see the transparency. eventually, the two sides met but it's a confidentiality agreement so kaiser wouldn't reveal the details but i'd like to see the process. if they're not