employment. certainly i believe we have unfilled capacity, we source capacity today and with this new budget that will sufficiently meet at least the second for one year, the second target in bill's plan. we are always chasing it. the idea of the five year plan was to get ahead. rather than to say we have a direct investment opportunity but no staff to do it. it takes a year and a half to hire staff and the opportunity is gone. we want to stay up with what we anticipate on the route we are going. >> i will move the process forward by saying i will move to adopt the budget for 2019-2020, but i want you to remember that it is in context of the future budgets, and a educational

process of city hall talking to city hall, explaining to them what we are doing, why we are doing it, how the fund works and does not impact the general fund and does impact the general fund if we lose opportunities and if, you know, contributions have to be increased. i think that we can't be painted with the same brush all of the other departments get painted with because we are different, and we are revenue but we are in a different manner, not compared to the airport or m un i. >> i will make the motion to adopt the budget based on that context what we did at the committee over the two month period. >> the mayor's office asked me

to document how the budget -- we have given to support the mayor's main initiatives. the initiatives are homelessness and housing. and public safety and health. so we don't have a direct responsibility. what we did is we used presentation to basically say by the fact that they, city hall supported investing in the investment staff over the last five years had we made median returns of public pension plans we saved the city over $275 million in contributions. they know those numbers in front of them. with them investing and supporting us because they did. the mayor's office had to improve the increase in staff and sign off on the pay structure that we are able to now recruit folks to these investment positions. i want to put in front of them

that had they not done that and had we made median results, they would have had to pay over the last five years an additional $275 million in employer contributions. we hope they will give us credit that we saved them that money and the investment they made in increasing the resources has paid off more than 100 fold. >> okay. there was a motion on the floor. >> i will second it. i want to make a comment. we talked about this is the change not so much -- it is a change in the way we do our business, and with your plan for the next year. it is something that my experience with the city is we are going to pass the budget, hope we don't stick it in the drawer because you guys have a

lot of education upping what you do and how you do it and look at the positives. i don't think all of the positives are getting out so i encourage that we all keep our eye on this ball. next budget cycle starts coming right in october. it is an election sitting there. >> exactly. >> on that note. >> i am going to ask if this is a one-year. the impact of what you are doing now, my understanding, this is the next budget cycle things could totally change based on the initiatives you outlined. >> we load to the budget system the two year budget last year and now we are making significant changes on that budget.

we will do our ask and justification. we talked with president stansberry we want the material available after the election to make sure that city hall and the mayor's office and board of supervisors who have to approve the budget understand we are doing a good job and need the resources or they will end up having to pay for the lack of us to keep ahead of a $40 million pension liability in less than 10 years. >> that is the key. you just said it. >> we are trying to package it into three slides. i don't know if we will make it to three slides. >> it is the right strategy. >> after the last board meeting we all started talking about next steps in process. what i said is myself and

mr. hughes would meet offline and talk about how to move forward. we did that. we met week before last. there is some other things we need to do. as part of what we did is ask ththeedjanette to look at the rs this is 2012. have we continued to be average over the last several years how much more money would the city have had to contribute. mathmatically correct calculations plugged in the numbers in the model so we know exactly how much money the city would have had to contribute had we not increased investment returns from average to where we are today and that number is over $270 million. next year it will save us -- it

will save the city $150 million. that is incredible. there is a lot of other things that we have to do and we will meet around talk about it again and keep the board updated. we have a motion, a second and any discussion on this item before i call for public comment? >> this $98 million including deferred comp, correct? >> yes. >> we know that is dealt with separately. the details in this budget has to do with management fees $54 million plus. there is a problem how accurate that is. i believe we use assumed expense ratio of .45.

>> .46. >> that is greater than the budget because there are fees we are responsible for paying that do not show up in the budget. >> it was raised to .46 when we right around 2009 and 2010 when the value of the pension was less than $12 million in order to support the acual. they look at the normal assumption is less than 45 or 46 basis points. the change was made in the 20 basis point level until the reality of our operation and our commitments were exceeding that and so they had to adjust that by board approval to increase administrative fee raise. it ask the highest i have ever seen for a public plan. i don't think that is our limit. from the actuary's perspective

we are be low administration costs. to your first point our budget including retiree healthcare trust fund budget. that is not printed to this board. it is presented to their board. we are now submitting three separate budgets. deferred comp, retiree healthcare and this. >> the things about the .45 that goes to the total cost we collect on which the city and the active employees pay o. >> exactly. >> watching the costs improve the platform to maintain the 7.4 or better. >> what we actually spend. we have had new board members why aren't we budgeting more closely. we drew up a list as of june 30 of who we were investing with because our process started in

september and october. we don't spend. i think we probably are lucky to spend two-thirds much the budget on the investment management side and so it is significantly less than the 46 basis points. >> if you look at it as opposed to collar by manager -- dollar by manager. >> when this education process works make sure there are two people from the office. >> the board of supervisors and the mayor's office does not review or touch that part of the budget. they do not touch the administrative expenses of investing the money other than to approve staff salaries and money to pay staff. all of the management fees and research is at the discretion of this board and they will not change it, they never have

changed it. they don't review it or suggest changes to it. that is the one carve out that we have that i don't believe any other department has. >> thank you. >> thank you very much for the presentation. we have a motion, second. we will call for public comment. any members of the public to address the commission on this item? >> if he wants more office space is buy a san francisco office building. where are you going to get the money? if you took the investment advice and just invested in stocks, bonds and real estate, it would double in 10 years. the office building more than likely would have 100% return on your investment. the money for that, you have got to spend hundreds of millions of

the hedge funds, equity and in 10 years just the money you spend on performance fees, management fees would more than pay for the office building. it would also lease out the space that you don't use to other agencies. >> thank you very much. any other members of the public that would like to address the commission on this item? seeing none, i will close public comment. can we take this without objection? >> item passes. why don't we go back to item 11, please. >> chief investment report. >> we were up 1.2% in the month of november. excuse me the month of april. led by the public equity

portfolio in the u.s. up almost 3%. i do want to draw your attention on page 2 on the right side. our unstanded commitments the te obligations totals $7.5 billion in liquid -- excuse me private credit is slowest growing. the current wait is 2.5% versus a policy of 10. the way to think about this is that a fully funded private credit strategy including unfunded commitments would be $2.5 billion. looking at that from a $3.3 billion is where it is halfway there, not a quarter of the way there.

the commitments have not yet been called. turning to the narrative starting on page one, we have had a really amazing four months. the s&p 500 is up 20% in the first four months of the year. that is the best start to a year since 1987. i don't want to repeat what happened in october of 1987. it has really been due to two factors. easing of the trade tensions with china, although those have been renewed the last couple of days, and the jobs market has continued to be quite strong. the pmg, we meet at least twice each month and we did approve the recommendations that the board saw this month. on page 2 of the narrative. great news.

delighted to convey that chris chained ward have been promoted as director of natural resources and director of rural assets. they co-lead the assets program and work together. they both have 12 years total experience. chris has been here three years and ed for four. our natural resources program outperformed by 8.76% for the past what is it? three years. that is a remarkable stunning outperform answer and is due to chris as well as tanya. hon has been here almost five years. she brings north of 20 years

total experience to her position as director of public equity. she also has a distinguished educational background as do both ed and chris, and we do have several positions, two positions we have completed recruitment for three. two of those will start next week. those are for real a assets and interim for private equity. anna had an offer extended to help her man age asset allocation. by may 27th we will have only one position i am aware of that will be open. we have come a long ways to fill out our analyst group. i am delighted with the career track for chris, ed and hon. i have a number of closings.

>> we will take those as submitted if you want to go to item 13. >> if you need to make a report on the closing. if you could do it quickly that would be better. >> why? it is in the public record? why verbally? >> it is not all in the public record. we need to make it. >> this is a public document, right? it is in the public record. why don't we put it in the minutes rather than going through it. can we please put it in the minutes going forward so we don't have to read all of them? i don't understand why we have to read them out every single time. >> because he is required to make a report of the closings at the next board meeting. >> it is submitted.

>> they are reflected in that level of detail in the minutes. >> in the minutes, okay. thank you, mr. bryant. >> we have three additional closings which we will furnish to the board as well. >> thank you. very good. >> page 6 regarding absolute return. a couple of keys here. inception today is that we have outperformed the index over 1.2%. we outperformed the barklays aggregate bond index by 3.4%. the investment committee the highlights are as we talked about, we are $25 billion a un and $28 billion in liabilities. they will grow to $60 billion. we are going to become a very

large plan. we will become much more mature even if we hit our return objectives, our net cash outflows will grow from 2.0% plan assets to 2.8 and 3.3% in 20 years. if we don't hit the return objectives they can be north of 4%. to prepare for becoming a very large plan, we have had good success emphasizing the specialist strategies that we think we have terrific partnerships. we do need to begin to make changes how we manage going forward as we become a much larger plan. we don't want to just index and invest in larger platforms that offer lower returns. we want to retain what we have done well.

we need to modify that in four ways. develop operations group, develop a career track, increase co-investments by 4 to 8x so they become 10 to 20% plan assets in 10 years and fourth increase the total between investment and operations staff from 26 to 33. about the next three years to 40, six years from now. we think this gives us the best chance to extract more value out of existing relationships and unearth new specialist strategies. this is our recommendation. we talked about this extensively at the ic. this is a recap to the board. that is it. >> thank you for the presentation. any questions, comments, discussion from the board?

>> there is a piece that triggered the report. why you recapped the ic that was your choice i am not sure why. the fiscal year numbers in this stuff that you presented with kaiser was done in the calendar year. i suggest we change it to fiscal year. the contribution is calendar year. this is based on fiscal year. when things line up it is easier to keep track. just a suggestion. >> very good. we may need to modify the calender. happy to do that. it is a work in progress. >> seeing nothing else from the board i will open it to public comment. any members of the public that would like to address the commission. >> i just read in the book that it said you have had an annual return on theming funds -- huge funds.

4.79%. that is ridiculous. to get 7.4% return you want you have to get 10% to get you 7.4. that should tell you that you should divest from hedge funds two years ago. it is the most ridiculous investment you have ever made. >> any members of the public that would like to address the commission regarding this. thank you for the reports. why don't we go to item 14, please. >> item 14. discussion item. travel expense report for the quarter ended march 31, 2019. >> we take it as submitted. any members of the public to address the commission regarding the travel expense report? i will close public comment. anything from the board? great.

item number 15. >> discussion item number 16. executive director's report. the city and county of san francisco versus retirement board and executive director we expect a ruling from the court of appeals within 90 days, that would be by the end of july. i will report to protect benef benefits filed a brief and they were supportive in their filings of the retirement board's position in determining to pay the pre-1996 folks that was to pay the cola. >> anything from the board? we will open up to public comment.

any members of the public to address the commission regarding the executive director's report? we close public comment. item 17, please. 17. discussion item. retirement board member good of the order. >> anything from the board? we technically have to call for public comment. calling for public comment on this item. no members of the public wishing to address the commission we close public comment. everyone thank you for your time. meeting adjourned.

>> my name is alan schumer. i am a fourth generation san

franciscan. in december, this building will be 103 years of age. it is an incredibly rich, rich history. [♪] >> my core responsibility as city hall historian is to keep the history of this building alive. i am also the tour program manager, and i chair the city advisory commission. i have two ways of looking at my life. i want it to be -- i wanted to be a fashion designer for the movies, and the other one, a

political figure because i had some force from family members, so it was a constant battle between both. i ended up, for many years, doing the fashion, not for the movies, but for for san franciscan his and then in turn, big changes, and now i am here. the work that i do at city hall makes my life a broader, a richer, more fulfilling than if i was doing something in the garment industry. i had the opportunity to develop relationships with my docents. it is almost like an extended family. i have formed incredible relationships with them, and also some of the people that come to take a tour.

she was a dressmaker of the first order. i would go visit her, and it was a special treat. i was a tiny little girl. i would go with my wool coat on and my special little dress because at that period in time, girls did not wear pants. the garment industry had the -- at the time that i was in it and i was a retailer, as well as the designer, was not particularly favourable to women. you will see the predominant designers, owners of huge complexes are huge stores were all male. women were sort of relegated to a lesser position, so that, you reached a point where it was a difficult to survive and survive

financially. there was a woman by the name of diana. she was editor of the bazaar, and evoke, and went on and she was a miraculous individual, but she had something that was a very unique. she classified it as a third i. will lewis brown junior, who was mayor of san francisco, and was the champion of reopening this building on january 5th of 1999. i believe he has not a third eye , but some kind of antenna attached to his head because he had the ability to go through this building almost on a daily basis during the restoration and corrects everything so that it would appear as it was when it opened in december of 1915.

>> the board of supervisors approved that, i signed it into law. jeffrey heller, the city and county of san francisco oh, and and your band of architects a great thing, just a great thing. >> to impart to the history of this building is remarkable. to see a person who comes in with a gloomy look on their face , and all of a sudden you start talking about this building, the gloomy look disappears and a smile registers across their face. with children, and i do mainly all of the children's tours, that is a totally different feeling because you are imparting knowledge that they have no idea where it came from, how it was developed, and you can start talking about how

things were before we had computer screens, cell phones, lake in 1915, the mayor of san francisco used to answer the telephone and he would say, good morning, this is the mayor. >> at times, my clothes make me feel powerful. powerful in a different sense. i am not the biggest person in the world, so therefore, i have to have something that would draw your eye to me. usually i do that through color, or just the simplicity of the look, or sometimes the complication of the look. i have had people say, do those shoes really match that outfit?

retirement to me is a very strange words. i don't really ever want to retire because i would like to be able to impart the knowledge that i have, the knowledge that i have learned and the ongoing honor of working in the people's palace. you want a long-term career, and you truly want to give something to do whatever you do, so long as you know that you are giving to someone or something you're then yourself. follow your passion and learn how to enrich the feelings along the way.

>> hi, everybody. welcome to laguna honda. [cheering] >> and before we get started, my grandmother spent almost 14 years here at laguna honda, and so many of you took incredible care of miss camelia brown. i want to give a special shout out to denise and so many people here who day in and day out take care of some of our most vulnerable folks that rely on us to care for them every day. we are so grateful to be here with our governor, gavin newsom. [cheers and applause] >> he has already hit the ground running, and we know from experience of being a former mayor of san francisco, he understands intimately all the challenges that we as a city

face, which really is going to be so incredible for our city and cities across the state of california for all the things we know we need to do to change california for the better. laguna honda is a key part of san francisco's health network, which cares for one in eight san franciscans. primarily people who are uninsured, low income, or for -- from our immigrant communities. and includes not only laguna honda, but san francisco general , and smaller clinics across our city, and health services in our county jail. here at laguna honda, more than 1,000 patients each year receive care for complex conditions like h.i.v. and alzheimer's and dementia, and other mental illnesses and disorders, and we have, for patients who are suffering from strokes or brain injuries, or spinal injuries, or

other trauma. these treatments require long-term and specialized care, as so many of you here know, and they commonly include medications as part of the treatment plan. however, it is a well-known fact that these medications are expensive, and can drive up the cost of healthcare for millions of people who need these drugs to survive. the san francisco health network is constantly working to find ways to save money on drug costs for uninsured patients. we work with federal programs like the 340 b. program that provides drugs at a discounted rate for some of our facilities, but facilities like laguna honda , or our county jail, our behavioral health clinic, they don't qualify for those federal discounts. not to mention the medications used in treatment plans at these

facilities are some of the most expensive medications. the health network purchases more than 3,000 drugs for patients who don't qualify for 340 b. discounts, and just the 25 most expensive drugs, of those costs, it because our city more than $17 million each year. when we have people struggling on the streets of san francisco, with mental health challenges and substance use disorders, or people spending thousands of dollars on life-saving medication for h.i.v. and aids, or people fighting a battle with cancer, we need to be focused on helping them recover and heal, not whether or not they can afford to pay for the medication this is the same case at many healthcare facilities, not only in san francisco, but across the

entire state of california and the nation, and this is why i am so thrilled to be joining governor gavin newsom here today to announce a san francisco will be joining the efforts to bring down medication costs in our city. [applause] >> we will work hard to bring down the cost of those medications. we have worked hard over the years, but we know there is so much more that we can do, and by joining forces with other counties across the state, we know that we can make a difference in the lives of millions of patients. we are joined here today by two other bay area counties in making this commitment, alameda and santa clara county, and please join me in acknowledging our new department of public health director, dr. grant koufax who is here with us today

[applause] >> at this time, i would like to call to the podium colleen who has spent about 13 years working for the department of public health in san francisco. she is an incredible health care advocate, now heading up alameda county department of public health. [applause] >> good morning, everyone. it makes me so happy to see so many familiar faces here, and to be able to bring my new county in partnership with my old city and county in this really exciting endeavor. alameda county is pleased to stand with governor newsom to leverage the collective garb -- bargaining power as a state in its counties to lower the cost of prescription drugs for all californians. i would like to thank the governor for his leadership on this important issue. alameda county's vision 2026 is in alignment with the health

forward agenda. vision 2026 is our comprehensive effort to set a course for a decade that anticipates community challenges and maximizes our ability to meet residents's needs in this rapidly changing world. vision 2026 foresees a thriving and resilient population where individuals and communities are empowered to overcome adversity and be supported so they can grow, flourish and be self-sufficient. essential to achieving this vision is our ten goal of healthcare for all, which seeks to ensure that every person in alameda county has access to the care and services they need to live their healthiest lives. governor newsom's collaborative approach to obtaining prescription drug costs will put us closer to a comprehensive solution for affordable and accessible healthcare for all. collectively, public healthcare providers and other safety net

providers in alameda county, spends tens of millions of dollars each year on prescription drugs for our county's most vulnerable residents. while many of these drugs are acquired through the federal 343 b. program which may or breed referenced, drugs purchased for individuals accessing our behavioral health services or our inmates and our jails do not this means that we are surely paying more than we need to for these medications, diverting valuable resources from other safety net programs and services this presents an important opportunity for our county and others to partner with the governor's healthcare team to explore how we can make drugs more affordable in our safety net healthcare system. additionally, this approach will foster regional collaboration through the sharing of information and protocols and best practices. alameda county is looking forward to partnering with the governor's office, and our county colleagues to explore the promise of this timely endeavor. at this point, i would like to

welcome miguel marques, marquez, the chief operating officer for the county of santa clara. [applause] >> thank you, colleen, and thank you governor newsom for inviting slight -- santa clara county to participate in this event and in this work, and thank you mayor breed for hosting this event today. over the years, santa clara county has implement it programs to expand coverage and affordable options that move us closer to providing healthcare for all. indeed, our board of supervisors has officially supported a single payer healthcare system. and santa clara county, we are proud to operate three hospitals , and a dozen clinics located throughout the county. each of which provides high-quality, integrated healthcare to the 2 million members of our community. like the governor, we know that innovation through the healthcare system, including a path to single payer systems

will help us reach our shared vision of better health for all. that is why we are excited by the opportunity to work with the governor and with so many other partners throughout the state to take on the high cost of prescription drugs. year after year, pharmaceutical companies continue to increase the price of brand-name drugs. we all need to ask the question, do prescription drugs really have to be that expensive? wild drug purchasing practices are complex, we must look for and implement innovative solutions to reduce these costs. federal policies have not done enough to control drug prices. in the absence of federal leadership, local and state government need to partner and need to think creatively about how to leverage our collective buying power to negotiate better prices for our residents. last year, santa clara county valley medical center spent more

than $120 million on pharmaceuticals. giving the extrude nearly high cost of prescription drugs, we have been looking for opportunities for savings. we welcome the chance to work with the state and with other partners to explore options to reduce these costs. as you know, public helps it -- health systems play an especially important and unique role in delivering care, services, and treatment to the patient's in the communities we serve, especially the uninsured and the underinsured. we are a safety net healthcare system that is proud to offer top-notch care to all who need it, but to do that, we need to explore all opportunities to reduce costs whenever possible so that our limited resources can better be spent to help the homeless, the mentally ill, and other vulnerable members of our community. a number of years ago, the county of santa clara was the first county in the nation to

ensure that every child, regardless of immigration status , could get healthcare services. we are especially proud to support the governor's efforts to become the first state in the country to provide coverage to young, undocumented adults. thank you, governor for leading the way for these young adults. santa clara county and the state of california have aggressively implemented the affordable care act. it has been a huge success. just a couple of numbers. in santa clara county alone, more than 100,000 -- 140,000 residents gained coverage through this expansion. another 45,000 plus have subsidized coverage through coverage california, that is just in santa clara county. and most important, the bottom line number, the uninsured rate in santa clara county has dropped by 50 3%. so the time is now to take the

next step. we are fortunate to have a governor who is a champion for these important issues. we look forward to working with the governor to make better health for all, california's highest priority. thank you very much. [applause] >> thank you, miguel. i also would like to take this opportunity to introduce someone who has been a champion for laguna honda, our supervisor for district two, catherine stefani is joining us here today. thank you so much. [applause] >> and now i would like to introduce our governor, who we all know was a former mayor of san francisco, someone who led innovative programs, pushed to really change san francisco and california for the better, same-sex marriage, he was the one who put forth the idea and opened the doors for so many people to get married at city hall, when so many people

attacked them on this issue, and now it is gone global and has been recognized throughout the united states, 311 was just his brainchild, this innovative resource that we use to call to deal with a number of challenges in the city, so many incredible resources that we use today, and now, is a governor in his budget , he will continue to provide the support and the resources that we need to address many of the challenges that exist in san francisco. we also should know that he really led the charge on the rebuild on the hospital to the new facility that we see today. the governor of the state of california, gavin newsom. [applause] >> thank you, thank you. this is fun coming back. the couple of you were showing

me photos ten years ago, pregrey hair, and this is remarkable that this place opened. i remember standing here during the ribbon-cutting, and i think i used a line, which i am now reminded of, at the time we were doing something with a skilled nursing facility. also ten years ago, that was novel and no one was investing in this place. people so the county couldn't afford it and we had to move in a different direction. we get it when it comes to skilled nursing facilities and keeping people in place. we are on the leading and cutting edge and doing something no one else is willing to do. i remember saying that the mayor of athens said, he says, we do not imitate, for we are a model to others. i say that then, nine plus years ago, i will say it again today in the context in the spirit

that brings us here together around the issue of prescription drugs. we do not imitate because we are a model to others what we are advancing here today is new, what we are advancing here today matters what we're doing today is what i expect others to be doing tomorrow, not just other counties joining california's purchasing pole, but other states joining california's purchasing pool. leveraging our resources, big buyers mean lower costs. the fact is, in the state of california, 13 plus billion dollars a year, your tax dollars are currently being spent on prescription drugs. i will repeat that, 13 plus billion dollars a year. the problem is, we were isolating the purchasing. we had jails doing their

purchasing, we had the state hospitals doing their purchasing , we had our retirement system doing their purchasing, we had the va doing their purchasing, we had our medi-cal system, which is 13 million strong, we were only leveraging 2 million of those 13 million in our purchasing pool. just combining the medi-cal system alone, taking the 2 billion and leveraging the purchasing now with 13 billion is going to drive hundreds of millions of dollars of savings on an annual basis. we project in our budget that we just submitted a few weeks back, or a week or so ago, that we will save conservatively $393 million because of this purchasing effort. that's just on an annual basis, $400 million of money that we otherwise would spend that would allow us to provide discounts, to provide additional subsidies

to reduce those costs each to each and every one of you. if we are not curious about these drugs, we are not curious about addressing the cost as it relates to the issue of healthcare inflation. this is one of the principal drivers. we have seen close to doubling of our costs in the state, doubling of our cost in the state, just in the last nine years. this cannot continue. with all due respect to big pharma, i have no problem, no gripe with people being successful, i don't begrudge success, i appreciate competition, i appreciate research, i appreciate the kind of innovation that we pride ourselves on, but i don't like people taking advantage of other people. i don't like gouging, i don't like windfalls, i don't like folks, you know, getting massive bonuses and, you know, at the expense of folks that are struggling on the streets and

the sidewalks. this is a foundational principle , it is a value i know laguna honda community shares. it is a value that san franciscans share, it is of value the mayor shares, it is shared broadly throughout this state and substantial of lee, around this region in santa clara, in alameda, that value now is being brought to the forward in terms of counties joining the state purchasing pool. we had hoped this would happen in a year or two, maybe three, but here we are, just weeks after announcing l.a. county joining our purchasing pool, no three additional counties are joining the purchasing pool. this is remarkable. the momentum is real, and this is exciting because we are actually making progress in realtime. this is not just platitudes, this is not just a tweet, this is not just a promotion, it is not just a promise, we are seeing things happen in realtime

, so i just want to thank the enlightened leadership that you heard from today. they didn't need to do this, it was wise to do it, but they didn't need to do it, but the fact that they are doing it, and they are doing it on the front end, is an extraordinary testament to mayor breed's commitment not passing interest to bring down the cost of prescription drugs and the cost of healthcare in this county. colleen's commitment and miguel 's commitment to do the same is a big deal, so i don't want to undersell this moment. i want to appropriately sell it. i want to overhyped -- i don't want to overhyped it, but this is significant. we have governors calling this state wanting to join our efforts. we believe this is the beginning of a different frame of momentum not top-down, god bless watching congress, pretzels trying to deal with big pharma, this is bottom up. it is a new frame.

i will tell you, a california, we just reached at $3 trillion year mar. we punch above our rate, and there are only four nations on planet earth that carry more wait then the state of california. we are truly a nationstate, the fifth largest economy in the world, the united states is one of those economies ahead of us, only a few others that have the capacity to do what we are doing as a state. now the second largest purchaser outside the v.a. and the united states itself in the country. this is important. i want to express and acknowledge the hard work of our team in sacramento that is working overtime to get this right, to make sure we do it right. i want to thank the counties for building that momentum, and i want you all to know that we are inviting the private sector to join our purchasing pools. we want to see companies large and small also join in and take

advantage of our ability to leverage and to sit at that table as one purchaser, not just aggregated as thousands of purchasers. we are formed -- where pharma has the power, now we are taking back that power and we are leveraging that power over the table. hugh merrow costs 96% more in the united states than it does in the u.k. some medications are 100% more then the folks in the u.k. give me a break. with all due respect, it is not just about well, we do the research on the development, we have to pay for that, the people who do the most research and the development are people like you. through our grants, through our tax dollars. they leverage those, they supplement those, and we are proud of that research. but give me a break. they do it because they can. they do it because no one is pushing back. they do it because they leverage influence of the people like me.

they come in with a lot of money and they come into leverage their point of view and they usually scare folks instead of doing the right thing, but they can't scare the leaders assembled behind me, and the cannot change the trajectory of a state that says, we have had enough. we are better than this. we will do more and we are going to leverage our voice in a way that respects the people of this state that we represent, so thank you all for coming out. thank you for being part of this announcement and all this extraordinary momentum and know this, in closing, this is just one of many things the state of california is doing to expand healthcare in this state. our budget, briefly, is going to expand coverage regardless of your immigration status. our budget will double substantially and increase by doubling our annual contribution and our medi-cal system through proposition 56.

forgive me for boring you on that, but we will increase our reimbursement rates, more trauma screenings, more early screenings to address issues before they manifest, we are going to deepen subsidies for low income families on the health exchange, and expand subsidies into the middle class. the only state in america that is expanding subsidies for families earning up to $150,000 a year. we are very proud of these efforts. our goal is universal. our goal is to get this done through a single parent financing system, but until we advance those ideals, we will build pragmatic steps, make progress each and every week until we ultimately get to those goals. thank you, san francisco, thank you to mother nature for adding a little energy, thank you mayor breed for hosting us here today. [applause]. >> thank you.

>> i don't know if there are questions, how do you want to do this? i will let the electives go, and supervisor, very wonderful you are here as well. any questions, we will do it out here. we will let you all go. thank you, guys, very much. [applause] [♪] >> coming to san francisco on june 11th, the earthquake safety his fair from 10:00 a.m. until 4:00 p.m. as the auditorium at 99 grove street. meet with contractors, design

professionals professionals, engineers and architects, along with city agencies and hundreds of booths on the main floor. attend one of the workshops at 11:00 a.m. the seismic safety strategies study. what you need to know is the city strengthens buildings 240 feet high and higher, and to get ready to the next -- for the next big one. 12:00 p.m., changes in the updated citywide vacant commercial storefront ordinance. 1:00 p.m., comply with the accessible business entrance program to enable everyone to enter your business. 2:00 p.m., home modelling process made stress-free, meet the experts and understand the permit review issuance and inspections process. 3:00 p.m., making the best use of the accessory dwelling unit and legalization program to at affordable housing. learn from these three workshops at the june 11th d.b.i. earthquake safety fair, and begin to get ready for the big one by taking immediate steps to protect both family and property

we hope to see you there, so register now. [♪]

>> good afternoon and welcome to the land use and transportation committee of the san francisco board of supervisors for today, monday may 20th, 2019. i am the chair. joined to the left, matt haney, and vice chair supervisor who will be sitting to my right. our clerk is erica major. do you have any announcements? >> please make sure to silence all cell phones and electronic