The Sunset Connection - Perspectives from SF's Sunset Neighborhood

Can We Fix Healthcare Without Breaking Ourselves?

• Jessica J. Ho • Season 1 • Episode 6

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Hi Folks! This week’s episode has a different format, released in response to recent national changes that could reshape healthcare access for millions of Americans. With funding cuts, layoffs, and political uncertainty at the federal level, I wanted to share a timely conversation that explores what else might be possible.

My guest is Barry Hermanson, a longtime Sunset District resident, Green Party advocate, and former small business owner who has spent decades organizing around healthcare access and policy reform. Together, we unpack the real-world consequences of a profit-driven system and explore the promise — and obstacles — of single-payer healthcare in California.

💬 Why this matters to me:
Before I got into real estate and podcasting, I spent years working in healthcare policy and advocacy—including as Director of Government & Community Affairs at a local community health center. I’ve seen up close how hard it is for people to get care, even when they’re “covered.” This conversation is my attempt to unpack those experiences and ask better questions about how we move forward. 

⚠️ Disclaimer:
The guest’s appearance does not constitute an endorsement of any political party or candidate. Views expressed are those of the guest and do not necessarily reflect the views of the host.

🏡 Local Updates from the Sunset District

🌳 Sunset Dunes is now officially open — a new park celebrating the neighborhood’s natural history
🏘️ Big zoning changes are coming to San Francisco. Learn more at sfplanning.org
🧺 Outer Sunset Farmers Market: Sundays, 9 AM–3 PM | 37th Ave between Ortega & Quintara
🧠 Trivia Night at Harrington’s Bar & Grille — hosted monthly by Jessica. Email for upcoming dates!

📬 Connect with Me

📸 Instagram: @jessicaj.ho
🌐 Facebook: The Sunset Connection
✉️ Email: jessica.jasmine.ho@gmail.com
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🎶 Music Credits

“Spring Cleaning (Instrumental)” by Lunareh
“Something Else (Instrumental)” by Nu Alkemi
All tracks licensed via Soundstripe

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The Sunset Connection — exploring the stories and histories that connect us.

Jessica Ho:

Hey everyone, it's Jess. Before we jump into today's episode, I just want to take a moment to acknowledge what a strange and pivotal time it is for healthcare in America. It feels like the rules are shifting under our feet. We just feel like we're watching and waiting. It feels really unsure what will come next. Funding for community health centers is uncertain. Medicaid coverage is being scaled back potentially. There's just a lot that we don't know.

Jessica Ho:

But today I wanted to take this time to talk about something healthcare related and, as you'll hear later in the episode, I definitely have a connection to healthcare policy, and so just wanted to share a little bit about my past life and what I used to do and, yeah, how I'm connecting it with what I'm doing today. Great. So last but not least, before we start the episode, I want to also mention that there's no trivia portion at the end of this episode, and so instead I have been hosting monthly trivia night at Harrington's Bar and Grilled and downtown, and so if you are interested, please reach out. Today's episode is going to be a little different. It's just me and Barry sitting down for a relaxed, meaningful conversation about something else I care about very deeply besides the Sunset District, and that's healthcare right Like District, and that's healthcare right Because healthcare touches everyone.

Jessica Ho:

Prior to my transition to real estate for those who don't know I was the director of government community affairs at a local healthcare non-profit called Northeast Medical Services, and FQHCs are commonly known to most people as community health centers. They were established during President Lyndon Johnson's administration as part of his war on poverty back in the 60s, and I've always admired the mission of community health centers and I'm excited to kind of share that with you all, and also with Barry, and have an honest conversation about the health care system and how it's affecting us as Americans and as people who live here in the Sunset District. I'm excited to welcome our guest today, barry Hermanson. He is a passionate advocate, active Green Party member and longtime Sunset community leader. Barry's been deeply involved in local neighborhood issues for many years, not only in the Sunset but also throughout the other parts of San Francisco. So with that, you were born in New York and sort of raised in Michigan. Then you went to school or college in LA. So how did you move to the Bay Area?

Barry Hermanson:

Well, that's a yeah. That's another story. I had always intended to study for the ministry. Because of the influence of my parents, I went to seminary. And because of the influence of my parents, I went to seminary. I graduated in 1975. And by that time I tell people that I have a master of divinity, whatever that's worth.

Jessica Ho:

Yeah, that's pretty impressive. What inspired you to move from the business world into political advocacy and specifically to embrace the Green Party?

Barry Hermanson:

It was 1978. To embrace the Green Party, it was 1978, and I was working at Asian Incorporated, asian Inc and Pauline was the head of the business development side of the nonprofit and she really taught me just about everything I know. Yes, I had business school, but once you get out into the world, that's when you really learn to apply what you have. I'm forever thankful for them and for my introduction to San Francisco, because I knew nothing about the Asian American community at the time. I owned and operated a small business for 25 years, from 1980 through 2005.

Barry Hermanson:

During the mid-1990s I was very fortunate to have not focused as much time on my small business. I had a couple of staff people who were extraordinarily capable and they ran a lot of the business. While I became more politically involved in the community, I served as president of the Merchant Association there for four years in the upper market, castro area, and then I ended up chairing a committee, a coalition, the San Francisco Living Wage Coalition, which ended up passing increase in wages for about 20,000 workers, largely people who were working on city contracts. The living wage movement is a concept. Anybody who works full-time should be able to put a roof over their head and feed themselves without having to resort to public assistance.

Jessica Ho:

What a novel concept.

Barry Hermanson:

A novel concept, it's really and so it was a strong coalition of community members, organizations and the labor community and we were able to pass that. Basically, we had no supporters other than Supervisor Tom Ammiano at the time. We ultimately got everybody, including Willie Brown, mayor Willie Brown on board. A couple of years later, I ended up joining the Green Party in 2001.

Barry Hermanson:

In the Green Party I really believe that people really don't hear about us unless we have candidates, and so I took it upon myself to be a candidate a number of times over the years and always when I was, health care was a major, major issue and trying to educate voters issue, and it's trying to educate voters.

Barry Hermanson:

And I spent a lot of my time out on the west side of town in the Sunset District and the Richmond District People on the west side it is a conservative, more conservative part of town than the eastern side of town. It was my goal to spend time out here because as a Green Party candidate, I'm quite liberal, but I do enjoy sitting down and talking to Republicans over the years and I find that they have a perspective on issues that make me think about how I believe and what I'm advocating for. It's that kind of interchange we don't really have when we exclude other parties. So back in 1994, when the Universal Health Care Initiative was on the ballot, I believe San Francisco was the only county in California to actually vote for it. Every place else it did not pass because of just the huge amount of money that came out in opposition from the people who were profiting off of the existing system.

Jessica Ho:

So when you started advocacy with Don.

Barry Hermanson:

His name was Don Beckler and he had been one of the folks during the late 90s working on the San Francisco Living Wage Coalition campaign and when that victory was secured he was also a very passionate advocate for health care and actually had been very, very involved. I didn't know him then, but he really poured his heart and soul into that. So after the living wage campaign, after we achieved that victory, he went back to really full-time work on health care advocacy, focused on the California legislature and also doing advocacy at the federal level, and so he essentially recruited me and so essentially was partners with him for the next 20 years. He unfortunately passed at the beginning of the pandemic not because of COVID, I think. He just died from a broken heart of how much resistance there was in the California legislature to actually achieve something that is enjoyed by people all over the world and every other developed country of the world.

Barry Hermanson:

In America, huge numbers, hundreds of thousands of people every year go bankrupt because of medical expenses. People go hungry because they can't heat their homes, because they have medical bills. It's shocking what we do in this country.

Jessica Ho:

Well, what I think Barry and I are trying to tackle right now is a very complicated system which, you know, a lot of people don't quite understand, because I think intentionally it's hard to understand, because it's easy for people in the industry to take advantage of that lack of knowledge. So for our listeners who may not really understand the healthcare system because it's extremely complicated healthcare at its core is when you're sick you go to a professional who is supposed to diagnose you and provide care. In the past it used to be that doctors would do house visits, they would come to you, and since science has evolved very rapidly in the last century or so, we've really been able to kind of have much better pharmaceuticals to help people with different ailments, with different ailments, and as a result of the increase in pharmaceuticals and technology has also come a sort of level of business in the industry. And so what we're seeing now is that instead of just having a doctor treat a patient, we're seeing that a person needs to first get insurance if possible, and if they have insurance they see a provider in their network and then when they see that provider, they have to go through the front desk and check in and then they have the doctor and the nurse and there's all these people, and then after that they might go to a pharmacy, and all of that costs money.

Jessica Ho:

If you go to a doctor outside of your network, you might need to be paying out of pocket. If you go to a hospital in an emergency room, you may be paying out of pocket, because insurance is basically like a club, like it's a group of people that have decided that we're going to work together. You'll be the doctor, you're going to be the payer, you're going to be the nurse, you're going to be the medical analyst, and these are this is our network, right. And so if you have insurance as an individual, you have a group of people you get to see. If you don't have insurance, well then you can still see these people, but you've got to be paying out of pocket, right.

Jessica Ho:

And then for the people who are on medical, which is the government program for people who are under 138 percent of further poverty level, you are covered by the government program, where it's actually a pretty good program, where you don't have to pay, but you have to go to someone who accepts Medi-Cal, and so that is usually your FQHC, which was what I used to work for or other doctors, but it's a pretty low reimbursement for most medical providers, which is why they don't usually take Medi-Cal. And that is where a lot of the issues in terms of Medi-Cal comes in is not so much that the services aren't covered, but it's that there aren't enough people providing the services so that if you have cancer and you want to see a doctor, you might be waiting six months for a diagnosis.

Jessica Ho:

That's right, and so that's really the availability that's causing that kind of issue. And deductibles and co-pays are also confusing words to most people. Deductible essentially means what you have to pay as an individual before your insurance kicks in. So if your deductible is $5,000, that means you're paying $5,000 before your insurance even pays a dime. And then your co-pays are. When you go to a doctor, usually you have to pay a certain amount whether it's $10, $25, just to be able to see your provider.

Barry Hermanson:

When the Affordable Care Act or Obamacare was established. I think that one of the main things that that law did was to the pre-existing conditions that people had. Insurance companies could not use that as an excuse to walk away from folks. But one of the really bad things that it did was to just solidify. We're just shoveling money into the pockets of the insurance companies and the for-profit medical establishment. We're subsidizing it. The Covered California, for instance. A very large percentage, great majority of those folks all are being subsidized. They have subsidized health care premiums subsidized. They have subsidized healthcare premiums. And this is one of the things that we don't hear much about yet the cuts that Republicans will be doing. When they do those cuts, it's not just going to be Medicaid or Medi-Cal as it's known here in California or Medi-Cal as it's known here in California, but the subsidies are likely to go away, which will mean that a great many people who currently have a health insurance policy through Covered California they will not be able to afford that anymore.

Jessica Ho:

I mean, let's be very clear Covered California premium rates are not very cheap to begin with, and even now you know it is based on income, but it can still be thousands of dollars for a family.

Barry Hermanson:

And it will be even more.

Jessica Ho:

And so being subsidized. It's already not very affordable.

Barry Hermanson:

Actually there's a large number of folks that do pay virtually nothing for that. But what you get is a so-called silver plan. There's a very high deductible co-pays, and so you know, technically you have health insurance but you can't afford to use it because the co-pays and deductibles are so big. But oh hey, my premium is only $10 a month. It's a joke, it's not healthcare, so it's the same thing, they say. I'm very glad that we have Medi-Cal in California and that it has been expanded so much to folks who are undocumented.

Jessica Ho:

That's right.

Barry Hermanson:

And it's crucial to be able to provide health care, but to me it's still not really health care. It provides a baseline of services, but little more. We could do so much better and it would be cheaper if we took on the vast profits that the for-profit health industry and the insurance industry are raking in. Currently it's the stocks are. They have gone through the roof. It's just unconscionable. They have gone through the roof. It's just unconscionable. We're enriching investors while people suffer and struggle for healthcare.

Jessica Ho:

What I'm trying to say is that between the extremes of American healthcare system and what the ideal healthcare system could be, there are variations of healthcare that works better, but I think in America we've hit a point where clearly our system is so profit-driven that it no longer even feels like a service. People are not stupid. I think they understand that they aren't getting what they pay for.

Barry Hermanson:

even through their insurance.

Jessica Ho:

Right, there are people who are paying thousands of dollars a month, but, to your point, the deductible is too high, the co-pays, there's everything else, so then it's actually maybe even more cost effective to not pay insurance and then just pay the amount if they get sick. I've seen people run away from ambulances so they don't have to pay the cost. We are catching on that this system is rigged, and so, with all of that kind of energy, what can we do to push back right? Because I do feel, as an individual, pretty helpless, even as a government and community affairs director. That was the reason one of the reasons why I left, is it. It feels overwhelming. I just felt like I was just a cog in a machine, that I couldn't do anything about it, you know, even when I was talking to congress members or state assembly members, and so what advice do you have in terms of like coming out on the other side and still feeling like motivated to even fight, to even do something, and what can we be doing?

Barry Hermanson:

There are so many ways to be simplifying our system and I'm very happy to be spending time on Butch Ware's campaign for governor campaign for governor. We want to have everyone healthy and that profit should not stand in the way of anyone receiving health care. You know you go to other countries and some countries if you travel. It's a shared responsibility. I want to be able to invest in a system so that I know that you will be healthy and that I will be healthy, and that, rather than have a system that is based upon individual responsibility, that means that if I have greater resources, I get better health care, which is just fundamentally wrong, and we say single payer, but again it could be two or three payers, and so you would also have community planning for health care so that if there are very expensive medical equipment that need to be provided, how much of this do we need in a community? It doesn't need to be in every single medical facility Far, far better in terms of cost instead of having every single medical facility have one of these things and maybe it doesn't hardly ever get used, but meanwhile they've had to pay for all of that overhead for it to sit and not be used that extensively. In Sacramento, for instance, we've had universal health care bills that passed two times during the 2010s, when Governor Schwarzenegger was guaranteed to veto them.

Barry Hermanson:

As soon as Jerry Brown was elected governor, he sent a strong signal that he didn't want to see it. He said Mark Leno was carrying the bill at the time. It was extraordinarily painful for him to have to then go back to his colleagues and say you know, look, I think that we need to have somebody in the assembly carry this now. I can't carry this. The health care activists here in San Francisco we've pounded Tom Amiano, who was assemblyman at the time, and we knew Tom absolutely was a supporter of single payer. Tom absolutely was a supporter of single payer. And so Tom finally called Don Beckler and me for a meeting in his office and he said you know, look, guys, I can't, I can't do it. I want to do it but I can't Because if I introduced it, I mean essentially his career, political career in Sacramento, would be over.

Barry Hermanson:

The Democratic Party has just said no, we don't want to see this, because at the time, obamacare was just getting started and the Democratic Party wanted to focus on rolling that out Again. Some improvements, incremental improvements that's what the Democrats do. So throughout Jerry Brown's two terms there in Sacramento there were no bills, and Gavin Newsom then he campaigned on the issue. He said it was a no-brainer. We must do this Based on that statement. He did get the endorsement of the California Nurses Association. Once he won he did a complete turnaround on the issue and single-payer legislation since then just has not gone anywhere.

Jessica Ho:

Well, Aj Karra introduced it twice.

Barry Hermanson:

In 20,. What was it? 2022, Aj introduced it. In 2022, ash introduced it and Senator Scott Weiner, representing San Francisco, and Assemblyman Phil Ting and Assemblyman David Chu all from San Francisco were principal co-authors.

Barry Hermanson:

San Francisco really has been a single-payer town, and I believe that that is why we have had representatives in Sacramento who have championed single payer. We certainly have pestered them. We would go and stand on street corners and get signatures on cards that would be addressed to the legislators and then turn them in and then turn them in. It used to always make them very angry because they wanted us to just hand them a list electronically that they would be far easier to deal with, but instead we would hand them a big, big stack of postcards of their constituents who were saying please do this. And they would.

Barry Hermanson:

Of course, in order to respond to each one of their constituents, they would have to enter the data in themselves, and so, in part, I believe that's one of the reasons why, as I mentioned, that all three of our representatives in 2022 were principal co-authors. They knew San Franciscans support single-payer universal health care. I've been doing this for 20, 25 years and I believe right now we have an extraordinary moment to be able to step forward and to create some change and to draw new members to our party, people who believe that people are more important than profits.

Jessica Ho:

Great. Thank you so much, barry. Some exciting sunset news we officially have a new park, and its name is Sunset Dunes. If you've been listening to the podcast, you know we've talked a lot about sand dunes and how iconic they are to this neighborhood, so I guess the name makes sense after all. Also, big zoning news the Planning Commission just held a hearing on the city's new housing element and rezoning plan. No matter where you stand, this could change the landscape of the sunset.

Jessica Ho:

According to the San Francisco Chronicle, the plan must be approved by January of next year or San Francisco risks losing control of its approved process under state law, and so they have a few more months to go, and so, if you want to get involved, I'm going to link more information about the zoning changes in the notes. Lastly, just want to do a shout out to Outer Sunset Farmers Market Mercantile every Sunday 9 to 3 pm on 37th Avenue between Ortega and Quintara. In closing, I'm super excited about what's ahead. I've got some special guests lined up over the next few episodes People I think you're really going to love hearing from, but you won't know who it is until next time. Until next time, take care of yourself and each other, because if you won't, who will? Okay, that's all folks.

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