Supreme San Francisco values: Rights, not privileges

When the Supreme Court ruled in favor of the Affordable Care Act or “Obamacare,” top White House and federal health officials held a meeting to reflect on what that means. One striking thing they noted was that this decision confirmed that “health care is a right, not a privilege.”

And why was this so notable? That was the founding slogan of the Haight-Ashbury Free Medical Clinic in 1967.

That fabled “summer of love” was a long time ago, but some of the values of that era do not seem so radical now as they did then. The environment needs protecting from ourselves. Healthcare should not be available only to those who can pay for it. Women are equal to men and should have control over their reproductive and other health. Racism is an outdated scourge. Our diets matter, and the less meat we eat, the better for all concerned. Marijuana is not something that should lead to prison. Some illegal drugs might even, if judiciously used, help people. War is bad, meaning, peace is good. Communal living may yet be a necessary movement. And while “All You Need is Love” might be stretching things, as the second momentous Supreme Court decision last week showed, real love should not be prohibited but encouraged. As even the Pope has noted, who are we to judge?

We are not blind ’60s apologists — there were many problems then. But the mainstreaming of ideas from that era continues. The ACA is far from perfect, but “the perfect is the enemy of the good.” Getting it adopted involved many compromises. But millions of Americans now have access to care, and there are many good new ACA elements — mandated contraception, addiction treatment, preventive services and more. Overall health costs appear to be less than they would be without the ACA. Implementing and fine-tuning it is a hugely complex ongoing task — as with Medicare and Medicaid, health programs established in the ’60s out of the spirit of solidarity with those most in need.

A mentor to us both, Dr. Philip R. Lee, served as U.S. Assistant Secretary of Health and Chancellor of UC San Francisco in the 1960s. Bullets were fired through his window at UCSF while he was seeking to integrate that campus. He has repeatedly reminded us that progress often takes decades, even lifetimes. Phil is now in his 90s, but he recently reflected “We may not always be listened to, or be as influential as we might wish, but we just keep on trying.”

“San Francisco values” have been both lauded and reviled through the years. Some people will never agree with them. But compassion and equality are timeless goals enshrined in the founding documents of our nation, revived in many ways in the “City of Saint Francis” a half century ago. And when even the United States Supreme Court endorses such movements, to us it seems that, yes, in many ways, the hippies indeed got it right.

David Smith is a graduate of UCSF medical school, founder of the Haight Ashbury Free Medical Clinic, a past president of the American Society of Addiction Medicine, and recipient of the UC Berkeley Haas Public Service Award. Steve Heilig is a 33-year San Francisco resident, co-editor of the Cambridge Quarterly of Healthcare Ethics and policy director of the San Francisco Medical Society, and recipient of the California Medical Association’s Sparks award for contributions to public health.

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