Save the Date! Join us to celebrate our 10-year anniversary on September 25th at The Bindery. Sign up for our newsletter to receive an invite.

Michael Stoll's blog

A Decade of Defying Downward Expectations

In February 2009, our freshly launched website featured just a handful of stories. So, we were surprised when a reporter from the Wall Street Journal called wanting to know whether the San Francisco Public Press, which was planning to officially launch in March, was going to “replace” the San Francisco Chronicle.

Facing falling revenues (it said it lost $50 million the previous year) and a protracted labor dispute, Hearst Corp. said that unless it was able to make steep staff reductions within weeks, it would sell the paper or, if no buyer emerged, close it. The threat earned national headlines, and though the Chronicle remained open for business, it lost many good reporters and editors.

While the question from the Journal reporter was absurd, the crisis that brought it to that point was real. Ten years ago, the bottom was falling out of the daily newspaper business model. Media pundits were warning that local, ad-supported journalism was an endangered species. So a group of us started the Public Press as a nonprofit, with the quixotic idea of keeping independent, professional muckraking alive through a community-support model.

One of our first big projects was an investigative reporting collaboration with the local independent publisher McSweeney’s called the San Francisco Panorama. We collaborated on producing a 10,000-word exposé detailing how the cost overruns on the new eastern span of the Bay Bridge grew over more than two decades of planning.

By 2010, we started publishing our own ad-free, quarterly newspaper. In early issues, we exposed backroom deals between developers at Treasure Island and allies of former Mayor Willie Brown, profiled real estate speculators sitting on entire neglected blocks of Market Street, and mapped a broken city transit network with data showing how poor neighborhoods got the slowest bus service.

We specialized in stories about under-covered issues and the interests of under-served audiences. We requested public records, sought out whistleblowers and used datasets to tell provocative stories.

Twenty-seven roughly-quarterly print editions and more than 3,000 articles later, we have refined our methodology and won more than a dozen journalism awards on other topics, including the resegregation of the city’s public schools, the persistence of thousands of unoccupied residential hotel rooms while neighbors languish in homelessness, the stalled efforts to enforce earthquake retrofitting in residential buildings, and widespread Bay Area waterfront development that seemed to fly in the face of new climate change warnings, with scientists saying sea levels could rise as much as 10 feet within a human lifetime.

For 2019, we plan to expand into audio, build a new website, host civic education events and delve into stories about environmental justice, affordable housing, digital privacy, education financing and more.

We are in an aggressive growth phase, thanks in part to support from about a dozen foundations. But our community of more than 550 individual supporters now cover about a third of our costs.

As we start our 10th anniversary year, we’re asking for your help to keep independent, influential and accountable local journalism growing. Consider giving online or by sending a check to 44 Page St., Suite 504, San Francisco, CA 94102.

We are grateful to all of our supporters. The Public Press wouldn’t be here without you.

Michael Stoll, Executive Director

Lila LaHood, Publisher

A version of this post was first published in Issue No. 27 — the spring 2019 print edition — of the San Francisco Public Press.

Journalism and the Arc of Social Justice

A panel of experts and stakeholders explained the state of the homelessness crisis at our January 2018 event, Solving Homelessness: a Community Workshop, an event that overlapped with our continuing print and online coverage of the issue. Photo by Garrick Wong // San Francisco Public Press/Renaissance Journalism


We honestly didn’t expect the issue of homelessness in San Francisco to find resolution anytime soon. But this fall, with November’s passage of Proposition C — the business tax that could generate as much as $300 million a year for housing and homeless services — we saw the search for solutions jump off the pages of newspapers and into the real world.

Over the last year and a half, the Public Press has returned again and again to investigating broken systems for providing housing and social services. We have explored creative ideas from community members who are bent on solving the ongoing humanitarian crisis on our streets.

Our recent efforts started in summer 2017, when we reported that lack of capacity was straining the city’s “navigation center” shelter model, which aimed to break down tent encampments and move people into permanent homes.

Then that fall, we published a package of stories exploring solutions to homelessness, in the run-up to a day-long conference in January where we gave the stage to community leaders proposing ideas for opening up more housing, improving medical treatment for people living on the streets and reconnecting people with families.

The cover story in our solutions issue revealed data about the shockingly high vacancy rate in single-room occupancy hotels, which our reporters found could — if rented and refurbished by the city — house more than 40 percent of the people sleeping on the streets. This November, that edition of the paper won awards for community reporting and graphic design from the Northern California chapter of the Society of Professional Journalists.

The investigative story, by freelance reporter Joe Eskenazi, was so widely read and influential that its findings were circulated in the June 2018 mayoral election, as candidate Mark Leno made filling those rooms the top plank in his political platform. Two other candidates echoed that idea on the campaign trail.

The problem of homelessness is multifaceted, and so we continued to report on broken systems that receive little public scrutiny over many months. Last spring we examined programs that send homeless families to apartments outside of San Francisco, and found that a lack of follow-up made it unclear whether the program had succeeded at its ambitious rehousing goals.

When we started this reporting, we never had a specific policy agenda to push, other than responding to the feedback of several hundred Public Press members, newsletter subscribers and social media fans who said homelessness and the housing affordability crisis had left them feeling disempowered. More than anything, San Franciscans want to know how they can help.

Proposition C, a grassroots initiative, was controversial to be sure. Mayor London Breed and other prominent politicians opposed it, and they were joined by vociferous tech titans suspicious of wasteful bureaucracy. But after the measure’s success at the ballot box, conversation moved quickly to how the city could get to work making the most effective, accountable use of existing and expanded funding.

The Public Press, as regular readers know, does not do advocacy journalism. We don’t make endorsements, and we don’t tell people how to vote. Yet we are encouraged that a problem that has victimized so many poor and infirm people, and scared and saddened some of those lucky enough to have homes, is finally at the forefront of public policy — and that San Francisco is no longer ignoring its most heartbreaking inequity.

Michael Stoll, Executive Director

Lila LaHood, Publisher

10 Things I Learned About Homelessness at Our Community Workshop

At the Impact Hub in the Mission District, a workshop tackled problem-solving for initiatives by the Department of Homelessness and Supportive Housing. Photo by Garrick Wong // San Francisco Public Press/Renaissance Journalism

It was a dizzying day at our Jan. 25 conference, Solving Homelessness: A Community Workshop.

With dozens of speakers and hundreds of side conversations among the 200 attendees, it was clear that the reporting we’ve done at the Public Press to gather and investigate just a few of the most intriguing ideas for solutions to the human rights crisis playing out on our streets daily has just scratched the surface.

By engaging the community, we opened ourselves up to criticism but also reaped the reward of an activated public. Many attendees — neighbors distressed by the sight of people living on the sidewalks and in marginal shelters, as well as subject experts who have devoted their lives and careers to helping stabilize people’s lives — said they learned new things and got inspired to follow up with proposals for fixes to broken systems.

I was surprised to learn a few things too. Here are 10:

  1. Mark Farrell wants to be the homelessness mayor.  That’s what Jeff Kositsky, the director of the Department of Homelessness and Supportive Housing, told me after rushing in after a series of meetings with the new mayor about his priorities Farrell — the surprising choice for a caretaker mayor after his colleagues on the Board of Supervisors ousted the board president, London Breed, from her temporary job — is very focused on making progress on homelessness, he said. But what can he possibly get done before the special election in June? 
  2. Wheels for the homeless are a sticking point. Kositsky clashed with activist Amy Farah Weiss, whose Saint Francis Homelessness Challenge advocates building temporary structures on wheels organized into ad-hoc clusters on city or donated private land. Kositsky is a fan of building a range of experimental small housing structures, including legal accessory dwelling units in backyards and basements. But anything with wheels, which are hard to get to conform to building and health codes, is a problem for a city department focused on permanent housing.
  3. Alaska is the socialist vanguard. Ken Fisher of the Economic Justice Project/Truth Be Told presented one of the more in-vogue, if quixotic, ideas — universal basic income. Granted that there aren’t many scenarios in which local and state government could provide large checks to every citizen to cover the basic cost of living here, he did provide one counterintuitive example: the Alaska Permanent Fund for decades has given checks to every resident as a dividend from oil industry royalties. Where is California’s commodity windfall to level the playing field for the poor?
  4. S.F. really is a homelessness “magnet.” The third rail of homelessness policy in San Francisco is the so-called magnet theory — the question of whether, by providing generous services and subsidized housing, City Hall is drawing homeless people here. Kositsky pointed out that in recent surveys, about half of the newly homeless in San Francisco came from somewhere else (mostly other cities in the Bay Area). That’s a different slice on the same survey that also says that about 70 percent of all  unhoused homeless were living in the city when they became homeless. I asked him if the data on churn in the newly homeless lent credence to the “magnet theory.” He said no. His point was that we need regional solutions, in which cities cooperate to help people out of homelessness where they come from. However ...
  5. We theoretically can afford to house everyone. “The reality is that we’re serving about 20,000 people a year, with about a third of our budget,” Kositsky said of his department in a talk at the close of the event. “We just cannot build our way out of this.” In fact, he could afford to do it — with a budget of about $750 million a year. That’s three times the current budget. It’s not cheap, but it’s also not technically impossible, considering the city’s budget this year is topping $10.1 billion.
  6. There are many missing persons. One of the most surprising presentations was by Kevin Adler, whose nonprofit organization, Miracle Messages, helps connect homeless people with their loved ones. Some people struggle with mental illness and thus problems doing the research themselves. Others are ashamed. The organization reunites them with family members and friends who can help support them either here or in other parts of the country.
  7. Welcome, village people. Several presenters envisioned micro-housing — tiny, private abodes that can be built for a few thousand dollars each. These are not exactly Weiss’s idea of mobile structures, but rather permanent small villages. The key to neighborhood acceptance, said architect Charles Durrett, is attractive design.
  8. Not in my parking space. You’ve probably heard the phrase “not in my backyard.” Architect/designer Richard Tsai has produced renderings of his proposed “Park Shelter”: beautifully furnished industrial shipping containers that can each fit into a standard parking space. The approach is sound, assuming the requisite political will: The streets are public property that localities can put to a public purpose, and there are more than enough parking spaces to house every homeless person in one of the steel boxes, he said. But what is lacking is the consensus that spots for cars should be sacrificed to get people out of being exposed to the elements in tents, sleeping bags, cardboard boxes (or even their own cars).
  9. Businesses, too, can help. On a panel of people who have experienced homelessness, Shanna Orona (a.k.a Couper) has quite a story to tell. She was a firefighter who lost her job and split with her domestic partner, and through the economic tumult ended up on the streets. She said that when she was living in a tent, people wouldn’t look her in the eye. It was humiliating. The Impact Hub San Francisco, a co-working space in the Mission District where the conference was held, offered her a space in their parking lot for a micro-home on wheels built by St. Francis Homelessness Challenge. In exchange, she helps out with events and logistics. More businesses could do the same, though it’s not at all clear this is a scalable solution. (Read more about Couper and her box home here.)
  10. People care. Of about 200 people who attended the event for the whole day, many were already working on solutions through their jobs or activist projects. But probably the majority were average concerned residents, looking for a way to help. The conference was a chance for them to get up to speed quickly and offer their reflections on solution ideas that were already in motion. And in afternoon workshops, nearly everyone had a chance to speak and offer their own ideas.

At separate breakout groups, participants discussed possible solutions involving mobile transitional villages and services beyond housing. Photo by Garrick Wong // San Francsco Public Press/Renaissance Journalism

At separate breakout groups, participants discussed possible solutions involving mobile transitional villages and services beyond housing. Photo by Garrick Wong // San Francisco Public Press/Renaissance Journalism

Did you attend “Solving Homelessness: A Community Workshop” on Jan. 25? Did you come away with other assessments? What made a big impression for you? What are the most promising — and most problematic — proposals for solutions? Add your thoughts in the comments below, or on our Facebook page. And sign up for our email newsletter for updates and follow-ups on the event.

Community Outreach for LPFM Radio Project Kicks Off

Thank you to the 40+ people who showed up last Thursday for our community meeting to discuss ideas for a start-up radio venture in San Francisco!

The background: The San Francisco Public Press is exploring the possibility of setting up a new low-power FM radio station after winning a permit from Federal Communications Commission to broadcast on the frequency 102.5 FM. We have 18 months (renewable for an additional 18 months) to move forward. We have a timeshare agreement with San Francisco Community Radio (formerly KUSF in Exile) for each group to get 12 hours a day on the same channel.

What happened: In two hours on Thursday, we scratched the surface of what’s possible in terms of content creation, writing a set of shared values, seeking organizational partnerships and exploring new storytelling formats. We are reaching out to individuals who are interested in participating as staff, volunteers, donors, or allies. We will provide more opportunities to brainstorm ideas for diverse public-service programming, including journalism, public events, talk shows and more. Check out this excellent summary on Medium from Samantha Clark, a journalism student at U.C. Berkeley’s Graduate School of Journalism.

What’s next: We have lots of news to share with you and are preparing a thorough report-back from the meeting. In the meantime, we are setting up a Google Group for people who want to learn more and get involved. If you’ve already provided us with your email, we’ll be sending you an invitation in the next few days. We also plan to hold additional meetings this fall. If you’d like to hear how you can get involved email radio [at]

Public Press News Editor Rich Pestorich Moves On to

Photo: News Editor Rich Pestorich, Executive Director Michael Stoll, Publisher Lila LaHood, and reporters Ambika Kandasamy and Barbara Grady.

I'm writing with some bittersweet news.

The sweet: Rich Pestorich, who’s been with us as news editor since the fall of 2010 (issue No. 2) has scored himself a prominent full-time job: online producer for! The bitter: Rich will be stepping down as news editor — though he will remain a core Public Press editorial adviser.

This opportunity came quickly. After his career of more than two decades as a news editor at the Chronicle, Rich had been working for three years part time at the Chron’s sister site, SF Gate. The new job across the hall in the newsroom opened up unexpectedly. He will be helping to shape the paper’s new online direction after the recent announcement that the site's paywall is coming down.

We’re extremely proud that Rich was able to leverage the experience he gained volunteering for a small startup nonprofit newsroom to qualify for one of the top jobs in local mainstream news. Rich used his time here productively, cross-training in new skills, specifically Web production and project editing.

We are grateful for everything Rich has done for the Public Press in the last four years. He has been an invaluable resource on questions of news ethics, San Francisco history and how to manage people in a dynamic and heterogeneous organization. We will miss his thoughtful and witty presence here in the office, as well as his patience and enthusiasm for working for cub reporters and interns. And his dedication to the ideas of in-depth nonprofit news we’re trying to propagate in this quixotic endeavor. He will be impossible to replace.


Michael Stoll, Executive Director


The Fourth Estate and You

Note from the editors, in the summer 2013 print edition of the San Francisco Public Press

Welcome to the future. Thanks to the collapse of print advertising and über-consolidation of formerly competing commercial news companies, independent journalism is becoming a threatened, if not endangered species.

In the news vacuum this trend has created, journalism entrepreneurship is accelerating. But it’s unclear which ventures will achieve influence and sustainability.

That’s where you come in. By design, the San Francisco Public Press is supported by readers, not corporate advertising. Startup nonprofit news organizations around the country are realizing the powerful and liberating potential of this approach.

If you’ve ever tuned into NPR or PBS, or any of the local noncommercial stations around the country that rely on donations, you know the “pledge” model. You may find it charming or a bit grating — but it works. Year after year it helps deliver public affairs programming you can’t find anywhere else.

Without a compelling new commercial model to flood city halls around the country with crusading public-interest muckrakers, the public broadcasting approach is an attractive alternative for media innovators.

It’s a model that might actually expand the ability of the press to do what Glen Greenwald of the U.K. Guardian calls “adversarial journalism.” Think “investigative,” “accountability” and “watchdog.”

Many news organizations have curtailed that kind of reporting when faced with declining ad revenue — the status quo economics of the news business in the 2010s.

 At the Public Press, our focus is public-interest news in a limited geography — San Francisco and the Bay Area.

We know that readers here are hungry for independent reporting on local issues, and that many will support a nonprofit news organization that addresses this need.

We’re hearing from more and more readers who voice appreciation for in-depth reporting that presents complex under-covered stories in context. But to keep the reporters on the beat, we need to build a broad base of public support.

What do you get by becoming a member? In addition to the swag, you’ll know you’re contributing directly to public policy reporting on a range of topics.

Greenwald said that reader-supported journalism holds great promise for emancipation from elite interests. The model, he wrote, “enables journalism that is truly in the public interest — and that actually engages, informs, and inspires its readers — to be primarily accountable to those readers.”

With community support, we can focus on consequential topics that spark meaningful debate. As our member roster grows, we’re prepared to bring you more powerful reporting to extend those conversations.

Don't Let the Fog Fool You

San Francisco is getting sunnier. Not in the way you might learn about from TV news or features in the daily papers; superficial stories about the warm weather at street festivals are cheap and easy to produce.

The sunshine we need is of a kind that’s harder to capture.

Journalists at the San Francisco Public Press are hard at work for you, illuminating complex and consequential policy questions in the city and across the Bay Area. In every quarterly print edition and in updates online we produce an in-depth team reporting project exposing obscure public documents that we wrest from recalcitrant city and regional agencies.

In the last year, our reporting has often led local coverage. We broke the story about a plan to reduce the minimum apartment size to 220 square feet, unleashing a national debate about urban housing standards. Our domestic violence report led Police Chief Greg Suhr and District Attorney George Gascón to launch internal probes on the handling of investigation records. And after we unearthed a list of the 3,000 buildings city inspectors think will be especially vulnerable during the next big earthquake, tenants packed a public meeting to ask why city officials neglected to tell them they were at risk. Michael Krasny of KQED’s “Forum” called on us in February to explain the city’s landmark legislation requiring apartment buildings be retrofitted.

Our upcoming summer edition shines light on California’s ambitious plans to battle the greenhouse effect. We’re scrutinizing state records that few have bothered to look at, and have found what some might call early warning signs that the state’s cap-and-trade pollution marketplace might not achieve its goals in controlling gases that add to a warming atmosphere.

But the real news is that sunshine like this isn’t free. This kind of work requires exhaustive reporting, thorough data analysis, careful writing and compelling visual presentation. To keep that going, we rely on the support of hundreds of individuals who have donated to the Public Press to support independent, nonprofit, in-depth local reporting.

Please consider making a tax-deductible donation during our Sunshine Membership Drive. If you’re already a member, thank you for your support! If you haven’t yet given, or if your membership has expired, this is a great time to start or renew. Help keep the lights on at the Public Press. Thank you for your support.

Best regards,

Michael Stoll
Executive Director

Uneven fight against human trafficking — San Francisco Public Press Issue #6



Michael Stoll, executive director

Lila LaHood, publisher

(415) 495-7377, news (AT) sfpublicpress (DOT) org


SAN FRANCISCO — The Bay Area’s battle against the scourge of human trafficking has been hampered by state inaction because of budget cuts and internal competition among an array of local law enforcement agencies and nonprofits that work on the issue. As a result, some counties arrest hundreds of traffickers and some hardly any; and victim services providers often have strained relations with the police.

Those are among the findings of a team reporting project in the Spring 2012 print edition of the San Francisco Public Press, hitting newsstands on Feb. 15. Stories will also be rolled out at over the following two weeks. This issue features a 10,000-word special section on human trafficking produced in collaboration with New America Media and the San Francisco bilingual newspaper El Tecolote.

Stories in the package, to go online through Feb. 23, explain why a 2005 California law that made trafficking illegal fell far short of the criminal punishments imposed by other states, and why a citizen initiative is trying to amend that law on the November ballot. Another story, produced by New America Media, explains why the current reform stems back 10 years to the horrific Berkeley “sex slavery” case, in which a wealthy abuser got only eight years in prison and is now free.

The Spring 2012 print issue also features stories about the Healthy San Francisco universal health care program, and how its future could be drastically changed by President Obama’s national health initiative. The issue also tackles the peril facing community gardens in the Bayview, ranked-choice voting and the transit chaos anticipated during the America’s Cup races.

In addition to its own independent, nonpartisan reporting, the Public Press brings quality reporting from other nonprofit media to new audiences. Also in the newspaper are articles and radio transcripts from more than a dozen local public-media and civic organizations, including KQED, KALW, California Watch, Bay Nature and Oakland Local.

The 16-page full-color broadsheet newspaper will be available for $1 at more than 50 retail locations throughout the Bay Area. For locations, visit Copies can be ordered online for $4 at

The San Francisco Public Press was launched online in 2009 and in print in 2010. Its mission is to enrich civic life in San Francisco by delivering public-interest journalism to broad and diverse audiences through print and interactive media not supported by advertising.

The Public Press receives major funding from the San Francisco Foundation, and has received financial support from KQED, the Center for Public Integrity, the California Endowment and more than 500 individual donors. A one-year membership starts at $35. Donations are tax-deductible to the extent allowed by law. The Public Press is fiscally sponsored by Independent Arts & Media of San Francisco, a 501(c)3 nonprofit organization.

- 30 -




Event — ‘The Future of Universal Health Care: Is San Francisco Leading the Way?’

WHEN: Wednesday, Feb. 29, 2012, 5:00-6:30 p.m.

WHERE: 330 Ellis St. (at Taylor), San Francisco


Download the 8.5" x 11" flier

Four years ago, the city launched Healthy San Francisco, a pioneering plan to bring universal health care to residents through a network of community clinics and hospitals. Though the program has earned rave reviews for the quality of care and expanding access to thousands of the uninsured, the city is not immune to the national pressures of skyrocketing health care costs.

In an election year in which health reform is on the political front burner, what lessons can the nation learn from San Francisco’s experiment? Will preventive care save or cost more money in the long run? What are the potential long-term policy implications for patients and health care providers? What other cities might have the answers?

Hear diverse perspectives from a distinguished panel of public health planners, care providers, patients and journalists — and share your own health care experiences.

Admission is free. Healthy snacks and beverages will be provided. The facility is wheelchair accessible. 

  • Moderator: Barbara Grady, reporter, San Francisco Public Press (lead author of the Winter 2011 edition special report: Healthy S.F.: Who Pays?)
  • Tangerine Brigham, director, Healthy San Francisco program
  • William Dow, researcher, UC Berkeley School of Public Health
  • Pat Dennehy, director, Glide Health Services
  • Karen Hill, clinic manager Glide Health Services
  • Abbie Yant, vice president of Mission, Advocacy and Community Health at Saint Francis Memorial Hospital... and a Healthy S.F. patient

Sponsors: The San Francisco Public Press, Glide Foundation, Glide Health Services, UC Berkeley of Public Health. 

For information:

Examining local universal care: How San Francisco took an independent -- and expensive -- approach to covering the uninsured

This is a repost of a blog item  for Reporting on Health, the website of the USC Annenberg School for Communications & Journalism California Endowment Health Journalism Fellowships, which supported the Public Press’ Healthy San Francisco reporting project this winter.

In 2007, San Francisco embarked on a rare and bold experiment, resolving to provide universal health care to its residents. The premise was simple — take an existing local safety-net system of clinics and hospitals and transform it by tracking all patients in one database and giving each patient a medical “home.” The approach, aspects of which are being rolled out in communities across the country, promises to reduce cost, increase quality of care and expand the number of uninsured people covered.

Four years later, many of the goals of the program, Healthy San Francisco, have been met. Over time, more than 100,000 previously uninsured people have been covered. The current enrollment of 54,000 people is anywhere between half and three-quarters of the estimated uninsured population in the city.

But to do so, the city’s Department of Public Health has dug deep into its general fund at a time when most of the other departments in the city have had to cut back. And it has earned less than expected from other sources — payments from low-income patients and a newly created business fee. A $27 million federal government grant expired in July, so the city will have to look for alternative funding sources. The city’s baseline safety net expenditures of about $100 million annually have been wrapped into the $177 million budgeted for the program, and with medical costs rising every year, that liability is expected to continue to grow much faster than inflation.

The big question confronting this ambitious program: can it be sustained financially?

Patient medical records are still kept on paper at the Chinatown Public Health Clinic. Photo by Jason Winshell/SF Public Press

The short answer, after a three-month investigation: yes — but only if the economy picks up, federal grants continue to flow and businesses stop fighting health care mandates.

(Left: Patient medical records are still kept on paper at the Chinatown Public Health Clinic. Photo by Jason Winshell/SF Public Press)

The San Francisco Public Press, which covers public policy in the city and across the region on its website and in a quarterly broadsheet newspaper, decided to go in depth to address this fundamental problem. Coverage of this massive health care program has been nearly absent from the mainstream media outlets. The most in-depth piece about the program was a story in San Francisco Magazine more than a year ago, discussing mostly the program’s promise, before it had much of a track record. Recent coverage in the two daily papers, two weeklies and broadcast media focused almost entirely on a current controversy about health fees levied on businesses, but not on the macroeconomic picture of the program.

With a USC Annenberg/California Endowment Health Journalism Fellowship starting last spring, we were able to focus on Healthy San Francisco’s financial sustainability. The rising cost of health care has dominated headlines for years and is one of the key points of political contention between the major parties in Washington. We wanted to examine up close a promising local initiative that could, perhaps, inform the national discussion and trim some of the billions wasted in the current medical care business model. We also wanted to explore what its services have meant to the health of city residents.

Patients vox by SF Public Press

The resulting project: “Healthy San Francisco: Who Pays?” was a special four-page section in the Winter 2011 edition of the print newspaper. Three reporters, two photographers and a graphic designer contributed to the research, interviewing the director of the program, clinic directors, technology specialists, medical staff, independent experts and dozens of patients. They visited nearly a third of the medical clinics and hospitals in the Healthy San Francisco network and discovered some compelling trends:

— While the program has succeeded at providing something like health insurance to tens of thousands of people who never had access to that level of care, without taking into account pre-existing conditions, most of the patients are poor — below 200 percent of the official poverty level. As a result their contributions are millions of dollars below the planners’ initial projections.

— The requirement that medium-size and large businesses pay for the program by giving some level of coverage to their employees, including an option for medical savings accounts and direct contributions to Healthy San Francisco, the program has brought in less money than projected.

— Some businesses are exploiting a loophole in the law to drain unused funds at the end of the year. And there is evidence that some businesses, after initially complying with the law, are lately dropping private insurance in favor of reimbursement plans that are much cheaper. They also leave patients not fully insured.

— Healthy San Francisco appears to be a big bargain, with the average cost of care calculated at $276 per person per month. That compares with an average of $402 for private insurance. But the accounting does not include millions of dollars that clinics and hospitals have had to absorb to care for the additional patient load and technology upgrades to make the system function efficiently.

— Federal grants to spur innovation in health care helped get the program off the ground but may not be renewed, especially if political winds change direction. And while the program was intended to be a bridge to national reform efforts, those programs now face challenges in Congress and the courts.

We published the stories in the print edition Nov. 16, and online later in the week. The response has been very encouraging. In the following weeks the series of four articles has received several thousand hits on the website and has contributed to a marked uptick in purchases of the newspaper, which sells for $1 at about 50 retail locations. The story has been Facebookedtweeted and retweeted more than 1,000 times. Copies were dropped off at the offices of every city supervisor, the mayor and the Department of Public Health, where we have yet to receive an official response.

We have, however gotten ideas for follow-up stories through social media. The point of this project wasnot to produce a package of stories in one lump and then move on. The reporters all say that they have deepened their understanding of health reporting and want to do more. Their laboratory will be follow-up stories on this program and its evolution over time through the Public Press. We are hoping to engage user of the program especially however they can best interact with journalists — online and offline.

See explainer graphic: reader wrote in response to a beautiful half-page graphic (left) by Tom Guffey — showing the growing costs of the program and demographic information — that mental-health spending appears to have shrunk as a proportion of the public health budget. We intend to investigate.

Also our lead reporter, Barbara Grady, got a cache of documents from the city indicating which companies had reduced their private insurance offerings. We plan to do follow-up articles on this, as well new reporting by Angela Hart on new budget information — public records that clinic directors should have shared with us months ago. We expect to find several million dollars in extra cost for technology that is not part of the official $177 million tally for the program.

We are planning a live event in in January in collaboration with the Bay Area chapter of the Association of Health Care Journalists to get responses from patients, doctors and the general public to our stories and get ideas for follow-up coverage. Reporter Kyung Jin Lee is developing a produced audio story for public broadcasting that uses the extensive recordings we did with a wide variety of sources.

The fellowship was helpful to us in three concrete ways.

First, senior fellow Frank Bass helped us break down the demographics of San Francisco by studying recent U.S. Census data. This helped not only this project but also other reporting on a wide array of stories, indicating neighborhood by neighborhood information on where we would expect to find health problems on a local level. The data show income levels by census tract. Even though one survey asks health insurance status, this information is not asked frequently enough for us to get meaningful neighborhood statistics.

Second, the fellowship helped us moderate the ambition of our project, which still took six months to assemble. We couldn’t report on the quality of care for any of the thousands of medical conditions treated through the system. We were also planning to spend a few weeks hanging out at the San Francisco General Hospital emergency room to observe and interview uninsured patients as they were admitted for non-emergency conditions. It is Healthy San Francisco’s contention that the program has significantly reduced emergency room visits by catching problems earlier and diverting them to clinics, saving money. Healthy San Francisco has produced numbers to suggest that these savings are significant, but the statistics are difficult to interpret because individual health cannot be tracked if tens of thousands of people enroll and disenroll every year.

Third, it helped us focus. Finance remained our main concern — the potential savings notwithstanding, in part because of the unique nature of San Francisco’s foray into health coverage. There are a number of localities — states, cities and counties — rolling out their own universal care programs. Massachusetts and Vermont have the most ambitious, but San Francisco’s approach of tweaking an already robust safety-net clinic system makes it the first major American city to take this route.

Third, the $2,000 stipend that came with the fellowship allowed us to pay decent freelance fees to experienced journalists who could afford to spend the time to do significant shoe leather reporting. We supplemented this with $537 in extra donations earned through a pitch to readers through the online journalism micro-funding website Spot.Us. We hope that our careful but high-impact local reporting on a complex issue, supported by the USC Annenberg California Endowment Health Journalism Fellowships, will pave the way for future funding from foundations and individuals for similar projects and even an ongoing health care beat.

See the entire package of stories:

* * *

P.S. Like all the participants in my cohort of the Health Journalism Fellowships, the San Francisco Public Press is part of an explosion of startup experimental local news organizations attempting to address shortfalls in serious news coverage as news organizations across the country cut back. The Public Press is nonprofit and noncommercial. We do not accept advertising. We relying on foundation grants (such as The California Endowment’s), syndication, micro-funding, newspaper sales ($1 retail) and the generous support of hundreds of individuals who have donated through our membership program, which is based on the public broadcasting pledge model. Basic memberships start at $35 a year, which entitles you to mailed copies of the newspaper for a year and discounted or free entry to events. Send us $50 and you also get a vermillion SF Public Press branded T-shirt. We are doing a shameless pledge drive because it is necessary to support independent, professional local reporting on topics not covered by the mainstream press. If you’re moved to help out, please contribute!

Syndicate content