As Democratic presidential candidates unveil proposals for universal or near-universal health care for all Americans, San Franciscans already are signing up for a new program that guarantees free or sliding-scale medical care to all uninsured adults.

The program provides a network of care to city residents, regardless of existing medical conditions, immigration status or ability to pay.

For Judy Rees, a 45-year-old part-time home health aide, the program, dubbed Healthy San Francisco, will coordinate treatment for her slipped discs, borderline diabetes and anxiety.

"You never know what’s going to happen," said Frederic Tarmis, 38, an uninsured bartender in the Glide waiting room who said he was eager to sign up for the program. "I try not to think about it."

Bill Henry, 63, a part-time gardener, said he’d been navigating the city’s free health clinics and San Francisco General Hospital for years and wasn’t sure he needed the plan. Then he added, "Once I went to General and didn’t know where to ask and I ended up getting bills."

The plan began in pilot form in July. Expanding citywide this week, it is the first attempt by an American city to tackle the health-care crisis, with the assistance of state and federal funds. Unlike other universal health-care plans being proposed, Healthy San Francisco is not insurance — because health coverage doesn’t travel with the individual. Care is provided and paid for only at clinics and hospitals in San Francisco.

"What we’re seeing here is the absence of real action at the federal level," said Ken Jacobs, chairman of the University of California, Berkeley, Center for Labor Research and Education. "It certainly sends the message that this is possible."

Getting away from the ER

At the root of the program is the concept that each patient has a "medical home" at a specific city clinic so that treatment and referrals can be coordinated. The intent is to shift medical treatment for the uninsured from the emergency room to preventive care.

"It’s challenging to get a colonoscopy screening, and the waiting lists for mammography are long," said Dr. David Bangsberg, a researcher at the HIV program at San Francisco General who expects the program to ease those problems.

The other key is the Healthy San Francisco medical identification card, which features a picture of a heart and San Francisco’s skyline. The security of having a medical card is "gigantic," said Patricia Dennehy, divisional director of Glide Health Services, adding that the card gives patients information before emergencies about how much they’ll owe.

In one instance, a colon cancer patient at the clinic refused to go to General for surgery even after staff assurances that he could receive low-cost care, Dennehy said. "He had a small bank account. He said, ‘If I go, they’ll find that money.’"

The card also may appeal to middle-class patients. "It’s not a handout, it’s not a free clinic," she said. "It’s a plan."

By targeting the city’s estimated 82,000 uninsured adults age 18 to 64 instead of the entire population of 750,000, the program is able to leverage the existing infrastructure of 22 city and community-based health clinics and the resources of San Francisco General, a teaching hospital affiliated with the University of California, San Francisco. About 1,300 people have enrolled in the program so far.

As for replicating the program elsewhere, what’s needed is an established public health system, said Stephen Shortell, dean of the School of Public Health at the University of California, Berkeley.

"Chicago is a good example of another city with a strong health department and an infrastructure of city clinics," he said. "It’s one of the cities that could do this."

San Francisco already has a Cook County-style health-care system for the poor — with a big public hospital and clinics for the indigent.

But Chicago doesn’t have anything like San Francisco’s attempt to enact universal health care. In Chicago, poor people can go to the Cook County health-care system for care, but there is no guarantee of medical coverage except in life-threatening emergencies.

California Gov. Arnold Schwarzenegger’s introduction of a statewide health-care plan "clearly" was spurred by Mayor Gavin Newsom’s initiative in San Francisco, Jacobs said.

The city spends about $117 million to care for about 50,000 uninsured; the majority are working men under age 40.

Healthy San Francisco estimates it will cost $200 million to fund the program. The city received a $73 million state/federal grant spread over three years. The remainder is expected to be paid for by patients’ fees and contributions from employers.

Restaurateurs file challenge

The Golden Gate Restaurant Association has filed suit to challenge the contributions. A hearing is set for November.

Until November, enrollment is limited to adults with incomes at or below the federal poverty level of $10,210 for a single person and $20,650 for a family of four, who pay no fees.

After November, enrollment is open to individuals at all income levels with quarterly fees ranging from $60 to $675 — the amount for incomes at 500 percent of the poverty level, or $51,050 for an individual or $103,250 for a family of four.

Co-payments range from $10 to $20 per visit to a clinic and from $200 to $350 for a hospital stay.

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What the plan pays for:

*Prescriptions, office visits, hospital stays

*Specialists, lab tests, ambulance

*Establishing a primary care provider for each patient

What it doesn’t pay for:

*Dental, organ transplants, infertility

*Health care outside San Francisco

*Hospital care other than San Francisco General