. >> supervisor mar: good morning and welcome to the february 21, 2019 meeting of the government audit and oversight committee. i am gordon mar, the chair of this committee. with me is supervisor vallie brown and aaron peskin. mr. clerk, do you have any announcements? >> clerk: yes, sir. [agenda item read].

>> supervisor mar: thank you, mr. clerk. please call item one. >> clerk: item one is a re resolution authorizing the fire department to donate a fire general to the academy at john o'connell high school. >> supervisor mar: thank you. i'd like to recognize mark corsew from the san francisco fire department. >> good morning, supervisors. the health academy assists students in health sciences and exposes them to e.m.s. training and career opportunities, such as e.m.s. careers or a career in public safety. the department has donated a ambulance no longer of operational value and is out of

date. there is no equipment in the ambulance but will be used for educational purposes. i'm happy to answer any questions the committee may have. >> supervisor mar: thank you. before we go to public com, do any -- comment, do any of my colleagues have any questions for the presenter? are there any members of the public who would like to testify? if not, seeing none, public testimony is now closed. any additional comments or questions from my colleagues? can we recommend this item to the full board without objection? >> supervisor peskin: so moved. >> supervisor mar: thank you. [gavel]. >> supervisor mar: mr. clerk, please call item 2. >> clerk: item 2 is an administrative code to establish the our city, our home committee as a committee

to monitor the city's revenue garnered under the city tax code, and recommending ways to reduce barriers that prevent people from exiting homelessness. >> supervisor mar: i'd like to pass it off to supervisor brown for marks on this item. >> supervisor brown: thank you, chairman mar. and i want to thank -- i know we have some representatives in the -- in the chamber that has really helped guide this legislation and also have been really helpful in making sure we hit the points that we need to, making sure that people that need to be on this committee is there. i'd like to thank the departments of housing service and homeless -- actually, it's

homeless service and housing, controller's office, department of public health, and mayor's office of community development. in our city, our home, jennifer frebachen and others that have been working hard in this. my office has worked directly with our city, our home coalition and i thank them for this legislation. i also have heard from our community advocates to keep our promise and give this initiative what it needs, property community led oversight in a timely manner that is organized and ready to go when that 300 million is available. i am fully aware that its prop c and relates funding is tied up in our courts. this doesn't mean that our work should be stalled. we need to work hard now to build real solutions and

tackling our homeless crisis. establishing this committee is a crucial first step in the work. and i want to have a small amendment to the current ordinance, and yes, my aide, shakir is giving that now. under section 51.4, part b, i propose it to be amended so it now reads, the committee shall elect a chair, vice chair, and officers for such other positions, if any, it chooses to create. the chair or the vice chair, if the chair is unavailable, shall be responsible for developing the committees agendas and conducts conducting meetings. the committee may establish bylaws and rules for its organizing procedures. we all know that the housing affordability crisis has created a dire situation for

low-income and elderly people in this city. it's time to get our homeless off the streets. and it's time to make sure that folks don't lose their housing in the first place. i support the establishment of the committee and the amendment, and i ask my colleagues to join me in support of this project. >> supervisor mar: thank you, supervisor brown. i think we're going to move into public comment now, and there's -- i have a few speaker cards. speakers will have two minutes. please state your first and last name clearly and speak directly into the microphone. those persons who have prepared written statements are encouraged to leave a written copy with the clerk for insertion into the file. so the first speaker is jennifer fredenbach, and then,

i also have a speaker card for jordan davis. >> hi. thank you. jennifer fredenbach, coalition on homelessness. i just wanted to thank supervisor brown for introducing the legislation and her staff, shakir, as well as supervisor mar and peskin. we want to give the opportunity to thousands of impoverished san franciscans to stay in their homes and for those in their homes to be allowed to fluorish. our vision is to transform this current system that grew out of

the desperation of scarcity since san francisco experienced mass homelessness in the early 80's, where every touch stone in the system was overwhelmed by need. to as and make sure we're not only helping those most at risk, and to not just those who fit into a tiny box and had been homeless 20 years, but to go upstream and house all children, all youth, and those who had new homelessness in their lives. a system that no longer creates trauma in its very design through churning people back and forth to the streets as a regular practice, nav centers back to the street does, but that it's trauma informed and

it's designed. we need to get to a place where when the lawsuit funds are released, the system is turn key ready and that we're way out of the starter blocks and full into a sprint. so thank you again for the attention to this homeless crises and your work to ensure our city, our home. thank you. >> supervisor mar: thank you. i'd like to acknowledge supervisor yee has joined us. next speaker? >> good morning. jordan davis. didn't prepare anything like written, but i just want to stay that i'm so glad that our city, our home passed, and hopefully, this lawsuit will be resolved. but i just want to say that any time you create a committee where people were members of the public and given put into important policies, you really -- it's really a good thing to have more public input, and i just want to point out that we always -- whoever gets on this committee has a

big charge. they need to have a good equity lenses, they need to be people that think upstream. like, for example, housing, we've got to think about acquisition and going on beyond s.r.o.s. we've got to think about community solutions and not so much contact with the police. sanitary stations, we need more n navigation centers and shelters. i just hope that we can do this, and make sure our homeless our housed because as a formerly homeless person who's had to deal with mental health issues, who's had to deal with finding a safe shower. who probably would not have gotten housed were it not for the navigation center on 16th

and mission, thank you for this and let's get this going. >> supervisor mar: thank you. next speaker, please. >> good morning. my name is olivia glowacki, and i'm a member of d-1, and a supporter of our city, our home. any campaign which garners millions of dollars should have a body to oversee such massive funds, and the oversight committee would do just that. thanks for your commitment to ending homelessness, and i urge you to support this committee. >> supervisor mar: thank you. next speaker, please. [speaking spanish language]

>> good morning. my name is maria. >> my name is jason, and i'm just going to interpret. [speaking spanish language] >> so i'm here to speak in favor of prop c to help homeless people and all of the families that have sick children. and also to help people who are struggling with addiction who are here on the street and i'm here because i do work with the homeless coalition. so that's why i'm here to ask for your support graciously on proposition c, that you support

us. so i'm just asking for your support in moving forward and kind of activating prop c so children are not out on the street with other folks who are struggling with illness and addiction, and thank you so much for your attention and may you have a beautiful day. >> supervisor mar: thank you. next speaker. >> i would respectfully request a three minute interval. not only am i a black man, not only is it black history month, not only did they give us the shortest month, right now, i'm

talking about african americans, from the good black dirt, we are in a state of emergency. now if nobody in the city, the supervisor, the mayor, don't want to recognize that, i'm going to identify it and amplify it. now, happy black history month, everyone. excuse me. i'm a little emotional. i didn't take my high blood pressure medication today. but i'm a great grandfather already. i'm -- like the bible say, i'm part of the three c's, my children's children's children. any of our elected officials who don't have children, you cannot bear the responsibility that a parent has to go to. dammit, in ten years, we are going to be obsolete like the

indians, but i'm going to go up to sacramento and knock on news newsom's door. and then, i'm going to washington and telling trump what we done lost. now, this city better be responsible -- by the way, i start my new t.v. show at city hall, y'all, i'm going to tell it all. happy black history month. my name is ace, and i'm on this case. >> supervisor mar: thank you so much. next speaker, please. >> he's right. he would be a tough run to follow. my name -- one to fellow. my name is kelly cutler, and i'm an organizer with the human rights coalition on homelessness. i'm just here because everyone knows that homelessness,

homelessness policy is not simple, it's complex. we need to be going through this process, but also the process that involves the voices of people who are currently and previously experiencing homelessness because those are the true experts on homelessness. they can give more insight and really get it. so i think we all know that we need to be doing this. so it seems like just a given. okay. thanks. >> supervisor mar: thank you. and are there any additional public comments on this item? seeing none, public comment is closed. [gavel] [inaudible] >> supervisor mar: oh, yeah. and then, so now, we can move to discussion among the committee and other supervisors. supervisor brown? >> supervisor brown: oh, thank you. one person i neglected to thank

was my aide, shakira semle. sorry, shakira. she has worked on this for months and just really appreciate her working on this complicated issue. also, just the fact -- i think a lot of the speakers were talking about having the oversight committee, having the right people on there, making the decisions of this kind of funding going through, and then, also someone who has worked and dealt with funding for some years, it will take time for us to implement it before we are able to spend it. i think this is going to help that, because once we get the money, we should be ready to go, so thank you, everyone for coming out. >> supervisor mar: i also want to acknowledge supervisor ronen who's joined us for the committee meeting. any other comments from my

colleagues? great. well, i also wanted to being acknowledge and thank mayor breed and supervisor brown and also all the members of the our city, our home vision and who brought this incredibly important measure forward over the past year and thank you for your continued commitment to seeing it through and on implementation. i -- so maybe we could move -- i know there's amendments that supervisor brown has introduced. i would like to make a motion to accept the amendment. do i have a second? >> clerk: no need for a second. >> supervisor mar: okay. don't need a second. so can we move to accept the -- the amendments? and then, do i have a motion to recommend an item to the full board as amended? [gavel]. >> supervisor mar: great.

thank you, everyone. so can you call the next item, please. >> clerk: agenda item number three is a hearing to examine the unit costs set by the director of public health and subject to approval by the board of supervisors and pricing policies more generally at san francisco general hospital and other institutions under the jurisdiction of the department of public health. >> supervisor peskin: thank you, chair mar, and thank you so the -- to the cosponsors of this, supervisor brown, mandelman, and stefani. we're joined by president yee and supervisor ronen this morning. last month -- no, it was

actually in january, there was a pretty stunning indictment of the billing practices at san francisco general hospital. note i call it san francisco general hospital -- by a reporter at vox.com. and the story focused on a young woman broke her arm in a bike accident, and she ended up in the only level one trauma center, which is at san francisco general hospital, which is a remarkable facility. a few months later, this woman ended up with a bill of over $24,000 which her insurance provider, blue cross-blue shield only covered about $3,000, leaving her with a balance of over $20,000. it turns out this story is not rare, and this is in fact much

more pervaseive that any of us knew. it turns up that the reporting in the chronicle done by heather knight, and it turns out every story she uncovers miraculously ends up being settled with the patient paying the co-pay. but these are a handful of what turns out to be thousands of individuals, and we learned yesterday that our own board president unfortunately was the subject of balance billing but fortunately was the subject of great medical care at san francisco general, so we are delighted that you survived that, mr. president. and by the way, i've received scores -- i think we've all received scores of e-mails from

individuals who have undergone this financial trauma and have been retraumatized by a financial event after a physical event. there are two issues that i hope to delve into a little more detail today. first, the practice of balance billing or surprise bills, and mr. wagner you can sit down for a little bit. i don't want to wear you out, and thank you for being here and thank you for your stint as acting director of the department of public health. where, the first is balanced billing which leaves patients with thousands, tens of thousands, or in president

yee's case, hundreds of thousands of dollars. with san francisco general, the thing that has developed -- and i say this as a supervisor that is in my 12th year over 18 or 19 years, and every year when the billing rates come to the board with a pile of other things, we approve them. i don't think we've ever had an instance where we question them, but we, i think, do need to contend with the question about whether our billing rates are higher than other similarly situated institutions for the same service. and while i understand and appreciate the offline conversations that i've had with the department of public health that balanced billing is part of a larger issue to what frankly is a still screwed up patch work of health care coverage at the national level,

i think it is incumbent on us and this city and the department of public health to accommodate patients who have been stuck with enormous bills from our public health facility. fundamentally, we have to take the patients out of the middle. right now -- and not with any malice, the patients are being held hostage because this relatively small percentage of our patients are being held hostage because we want to go to the insurers. so we've got to think about that. and remember, our patient population is over 100,000 people a year, and 94% of them

approximately are medicare, medi-cal, or unininsured. so this is a subset, and interestingly, under tate law, where balanced billing cannot be done to members of h.m.o.s, it applies to even a smaller subset of about 3.8%, which you would think is only a handful of people, but it's actually over 1,000 people a year. so this is -- it's a pretty big deal. and also, people that end up needing assistance, whether it's financial assistance or assistance navigating the system are not accessing it quite possibly because they can't find it or they don't know it's available. this is a conversation i had offline with d. ph.

originally, the numbers we were told was that it was about 340 people in the calendar year of 2017. turns out that number is approximately over 1,000, somewhere between 1200 and 1700, and many of these cases are referred to our bureau of delinquent revenue. after four years, they are considered to be uncollectible, so there are actually thousands of people retroactively who need to be informed that they can avail themselves of that stance. and with that, i want to do something a little unorthodox, which is before we hear from the department of public health, i want to actually hear from the public if that is okay, mr. president, and if that is okay, mr. wagner. i've actually got a handful of

speaker cards -- yes, and i'm happy to hear from colleagues before that. we all received on january 19 or many of us received on january 19, a remarkably insightful e-mail from an individual. but that person, i will call on after i hear from our colleagues, supervisor ronen and supervisor yee, mr. chairman. >> supervisor ronen: that's okay. unfortunately, the reason why i wanted to go first is because i have to be somewhere at 11:00. i am so grateful to supervisor peskin for calling this hearing. i think it's so important. i received phone calls from many of my constituents who are in this situation, who despite being ininsured, have received

enormous bills from receiving emergency services at general. this practice has got to stop. but there's just a few comments that i wanted to make, kind of stepping back a little bit and looking at this big picture and really looking at sort of the work that i've looked at in this eight years of hospital costs. i believe that this system is designed to be this complicated, so we don't understand it, so the costs are hidden, so we don't question why we have the most expensive system in the world where costs don't correlate to outcomes. that is because there is an entire industry, middleman industry that does nothing but escalate costs, take money from

the system, exploit the -- this -- this lack of transparency and secrecy around hospital costs and drive up those costs. it's completely unneeded. sometimes, you know, i was remarking to some friends in the hallway, you know, i have a law degree. i've been studying this issue for eight years, and i still struggle to understand how that works. this shouldn't be that complicated. you go to a hospital, you get services, they cost a certain amount, you pay that amount. why is this always so opaque and complicated that even policy makers and people with advanced degrees can't understand how it works? it makes no sense, it must change, and thank goodness on the national level, we are finally having the same conversation about a medicare for all system that we absolutely must work towards in this country. i just also wanted to take a

step back and say from this awful situation that so many people have spent so much time stressing out about and having their health get worse because of these outrageous bills that at least it shed a light on this system, that these services cost this much money to begin it is absurd. we only find how much these services cost when the individual is build because when an insurance company takes care of it, we never know -- that the consumer or the patient never knows what the costs of those services are, and that's part of the transparency issue that allows this unjust system to continue. so i do want to just say, let's take this tragedy by bringing something better to the system. the other thing i want to say

is there is some irony. in the eight years i've been working in this building as a legislative aide and now as a supervisor, i've been working a lot on health care costs. i see lucy johns in the audience who is one of my mentors and leaders on this issue, why hospital costs in northern california tend to go greater than in southern california, and the role of private hospital chains in that process, but we didn't focus on costs at general. i see nato green in the audience. we created the health services master plan legislation that supervisor campos sponsored and passed to look another what are the services that we need to san francisco rather than these

high priced services that hospitals want to offer because they can make money, not provide for the health care needs of our residents. so all of these issues are issues that we've been looking at for years in san francisco, but never did i realize despite looking at all these issues, that this health care issue exists in our own general hospital. and why is that? because my focus has always been the uninsured. i'm so worried about the uninsured. how are we going to cover the uninsured. never in my right mind did i think that the insured were getting as exploited by the system as the uninsured. that's why supervisor peskin mentioned in the big packet of materials that we get, a aboute hospital costs, and we have to approve them, i'm looking out

for the medicare patients, the most vulnerable people among us. and lo and behold, some of the people with the best insurance products out there have been just as exploited by this unjust system as our uninsured patients. so let's use this absurd frustrating situation as a wake-up call. let's right this wrong at general, and then, let's redouble our efforts at both the state and federal level to change our system so that it's rational and makes sense and puts patients first and puts a cap on a system that's out of control. and with that, i'm looking forward to hearing from my colleagues and the public. >> supervisor peskin: supervisor yee? >> president yee: first of all, i want to thank supervisor peskin for bringing this issue

to a hearing and also all of my cosponsors. i also, before i get started, i want to really want to thank general hospital for the care that they gave not only me but probably hundreds of thousands of people on a yearly basis. the trauma center is the best. i can't ask for anything better. so what i received there was just excellent care, and -- but it's been -- it's taken me over a decade -- it's taken me over a decade to really want to talk about this stuff.

it was a nightmare personally, starting with when the car, you know, ran me over to trying to recover over several years and getting all these bills while -- towards the beginning of the recovery and realizing oh, my god, these are not, like, $10 bills or $100 or $1,000, it was into the multi -- $100,000 and so forth. and the first thing i thought was i don't know if i can ever work or move, and now, i have bills in which i thought we're going to go bankrupt as a family. so it -- i never used a lawyer in my life, and i realized i am

in trouble here or my family's in trouble because i don't know what to do. >> supervisor peskin: you picked a good lawyer. >> president yee: yeah. and so the reason why i think i'm glad this issue is being brought out, you know, what i had to go through shouldn't happen to people. i thought i was insured, and it took a lawyer to sort of flush everything out and figure out, you know, what i had to pay, and at the end of the day, i still don't know what i paid. so is this personal, and we need to do something about this so people don't have to go through what i went through. and i want to thank -- i want to thank my colleagues, and i

hope the hospital staff or public health staff will sit down with all the smartest people in the world and figure out what to do with this because it's got to be corrected. thank you very much. >> supervisor peskin: thank you, mr. president. so mr. chairman, if you will indulge me, and mr. wagner, i think it would be better if we heard from the public first and that might help set the context for your comments and responses and the questions that this panel asks. i'd like to start with nicky pogue, if i pronounced that correctly. that's the author of the previously stated very helpful e-mail with eight points. and before, i didn't actually know, nicky, whether you are a man or a woman. now i know you're a woman. but the one thing i do want to say -- and mr. wagner, i'm not

poking d. p.h., but there was one thing raised in nicky's first of eight points. that was an inaccurate statement made by the hospital spokesperson where in mr. andrews said we file like we have to recoup what we can from people who are insured because we're supporting people who don't have insurance. and i hope this is a misstatement of fact, but with that, i will turn it over to miss pogue, if i said that correctly. >> yes. district ten in san francisco. in september, i received a bill of $15,000. after insurance, i was left with a bill of $10,000.

after months of fighting, the good news is united health care decided to cover this balance. let me itemize six issues for you. sf general expects the privatized to subsidize uninsured care. the hospital spokesman admitted that we are covering the uninsured by asking the insured patients to subsidize to the tune of $10,000. this is not a fair or sustainable system. insurance only covers out of network facilities at the medicare rate. this leaves patients holding the bag on a huge difference. vox found cases where sf general billed up to ten times the medicare rate. during my intake, i was never informed that i would be responsible for a significant bill because i had private insurance. i would have been better off

saying that i didn't have insurance or just going elsewhere. patients deserve transparency. its prices are unreasonably high. in comparing local prices, it's indisputable that sf general far exceeds other hospitals. a level one visit is listed at 11,000, compared to 7,000 at st. mary's and 5,000 at cpmc-st. luke's. ab-72 fore bids balance billing for emergencies but only if the facility is in network. sf general is out of network for anyone with insurance. the hospital preys on this

exemption. sf general is my neighborhood hospital. i received excellent care there, but its billing practices are an embarrassment to our city. i hope no san franciscan will ever have to go through this again. thanks for making this egregious problem a priority. >> supervisor peskin: thanks. a mr. wagner, one of the points she raises, that is her designation as a level five patient compared to what arguably she should have been classified as, as a level three patient. and then, i also want to underscore before i call on the next speaker, the issue of transparency, because in the case of supervisor yee and many people that end up in our trauma one center, that's the only place that he can go in the county. and in many instances, they're not conscious. when supervisor yee was

transported to the general, he was not conscious, so that's very different than the testimony that we just heard where that individual was able to make a decision, and there, there could actually be a transparent revealing of the facts, right? so i mean, miss pogue could have gone to the general and said, you know what? forget it. i'm going to cpmc, and the irony here as supervisor ronen just told me, that in the old days, we used to beat up on cpmc for having outrageous billing practices, and it turns out, we may be as bad or worse. with that, bob ivory, followed by barbara keegan.

>> thank you, supervisors. my name is bob ivory. i'm a nurse at sf general. i've dedicated my life to taking care of people in the trauma room. i'm proud of the work that i have done to take care of the citizens of san francisco. i always felt that i took care of that fridays regardless of their -- phrase regardless of their ability to pay. obviously, i got that wrong. the vox article talked a lot about how the people that were there were dumbfounded at the amount of money that they were being billed. why are those costs so high? one of the reasons is that we follow the american college of surgeons guidelines in the trauma room. we cast a wide net. we activate people at -- as trauma activism. we upgrade them in their vitals

or -- if their vitals are bad or they're unconscious. most of them have fairly minor injuries, but their mechanism is bad, and they need to be checked out. in the article, they were saying things like i only got tapped by a cab on my bicycle, and i ended up in the hospital for four hours. i got a c.a.t. scan. no one looked at me after that, and then, i was discharged. well, we have american college of surgeons guidelines for how the nurses had to care for these trauma activations, and it is it's a fairly high bar. we give new i.c.o. care to people who are involved in fairly minor accidents, and we bill for that care. the problem comes as we heard

and as i read in the vox article, what happens when overcrowding and short staffing in the emergency department that we're not able to give this i.c.u. level of care to these trauma activations? i don't really know the answer because i never really cared about billing, i cared about my patients. but i'm wondering once the patient is cleared, and they go to the low acuity pods where they're not getting i.c.u. level of care, are we still billing them for getting that care, or would it be better to provide better staffing to the hospital emergency department and give everyone what we're telling them they should be getting? thank you very much. >> supervisor peskin: thank you. and brenda keegan, followed by aaron kramer. i just wanted to say that because six of us constitute a quorum of the board, we're

actually rotating supervisors in and out so supervisor stefani wants to join us, and we're now joined by supervisor mandelman, but we can't have more than five of us here because it's not noticed as a board of supervisors meeting. so i want to thank supervisor stefani who is here, but is about to get a tour of san francisco general hospital. miss keegan. >> thank you. my name is brenda, and i'm a nurse at san francisco general. i'm actually reading a statement on behalf of a colleague who's on medical leave. the colleague's name is sasha cutler. blue shield h.m.o. tells me my procedure and overnight stay cost sutter cpmc more than $25,000 because i had a network provider, blue shield said they saved $6,720. who benefits from that discount?

it's scary to hear that some in our community do not get any discount despite having private health care insurance. i believe that private health care companies should be required to provide the same discount to all of our patients. in fact i'd like to receive all of my care at sfgh, and for all of those dollars to go to them instead of provide health. as a nurse, i was affected by tuberculosis and have been getting care at the location where i worked. i learned that getting t.b. treatment from our own d. ph wasny protected. last year, my 94-year-old mother was brought to sf general after being struck by a

car. the truth is that shopping for hospitals makes absolutely no sense. for people who are suffering trauma, it's probably best to get to the only level one trauma center for miles around at san francisco general hospital. instead of spending money on rebranding to zuckerberg, why not use that money to offer a discount? >> aaron kramer followed by nato greene, followed by my neighbor, lucy johns. >> good afternoon. my name is aaron kramer. i'm a nurse at san francisco general, and i just want to say thank you for looking into this issue for our patient population in our community. when i read that vox article, i was quite an eye opener.

it was shocking, quite frankly, i felt disgusted to be someone that takes care of people, you know, as a nurse at the bedside, we focus on the patient. you know, i don't know about billing practice, i know about patient care, and i can tell you that when traumas come in, some of most critical that come my way, it's -- you know, these are life-changing events for people. some wake up, some don't, and to think that if they can make it out of the hospital and then for a certain amount of them, a certain percentage to get a bill at such, it's he -- as such, it's quite shocking. it's wrong, and it's very upsetting. on the hospital's eligibility and enrollment website, it says everyone is welcome here regardless of ability to pay. what it doesn't say is should you have an ability to pay or

have certain insurance, you may find out our ability to overcharge you, and that is wrong. at general hospital, we treat everyone with compassion and respect, and that should apply to all practices of the hospital. i really appreciate you looking into this, and i hope that we can correct this for all patients, whether they be residents of the city, people in the surrounding area. we are a level one trauma center, so a lot of times, you know, when you -- when something critical happens to you, you're taken where you need to go, and this is sorted out later, but to have people left to hold the bag per se on this is just wrong, so again, thank you very much. >> supervisor peskin: thank you, mr. kramer. mr. green? >> good morning, supervisors. nato green, seiu 1021.

as you know, all the up i don't knows are in negotiations this -- unions are in negotiations this year. we presented legislation for the city to correct this. it's one of the things that we would like to resolve in bargaining because our members are affected by this, too. whether they become patients, they're continuously bumping up against people in hospital administrations telling them what they can do and can't do because of the budget. so for the city to not copture the review -- capture that it could from private insurance companies, instead, nickel and diming people on the front lines is unconscionable.

it's sort of lunacy that we would have a system that requires you use your provider and then not take insurance. a hospital that used overcharging to subsidize the lower income people, every hospital does that, but they call it payer mix. that's a normal part of hospital operations. normally, when we look at cpmc or other private hospitals where they're overcharging hospitals in this manner, it's not because they're actually intending to get people to pay it, it's an accounting gimmick, where they're going to overcharge it and then write it off as a business loss to make their books look better. the last thing i wants to note is that the city may not have

the leverage it needs to negotiate with private health plans to get them to agree to be in network. our members would want to know if they get hurt, and they get sent to general, that they're not going to get stuck with a huge bill. we want to know if the city can take steps through the health service systems as a provider of health plans to pressure those plans to negotiate better rates with the city to be in network. and if the city doesn't have all it needs, tell us which office we need to occupy. we will bring in nurses to city in people's offices until they have the legislation they need. we'll go protest wherever until they're ready to negotiate with the city. thanks. >> supervisor peskin: thank you, mr. green. miss johns. and i note that