Mayor Gavin Newsom announced an ambitious proposal Tuesday that would make San Francisco the first city in the country to provide taxpayer-subsidized health care to all uninsured residents, covering services like doctor visits, surgeries and prescription drugs.

San Francisco is home to an estimated 82,000 uninsured residents, who typically go to public clinics and hospitals for treatment. The plan, dubbed San Francisco Health Access Program, would offer people the primary and preventive health care they lack and allow them to access hundreds of doctors in public and private hospitals and clinics.

Efforts to provide universal access to health care in San Francisco have been made before, but they have failed. Newsom, who is facing re-election in 2007 and has made the topic a cornerstone of his administration, is optimistic that his plan, which would need approval by the Board of Supervisors, will be implemented beginning next year.

"This is not a pipe dream," Newsom said. "This city is going to be the first city in America to achieve universal health care access."

The plan is not health insurance and therefore differs from other proposals. Those who sign up would have access to care only in San Francisco and, despite paying monthly premiums, would not be covered by the plan if they sought treatment outside the city limits.

The estimated $200 million-a-year price tag, or $2,400 per person, would be paid through a combination of sources, including tax dollars, local business contributions and individual premiums.

In April, Massachusetts became the first state in the country to require individuals to carry health insurance or face financial penalties. San Francisco's plan would not be mandatory and assumes people without other coverage will volunteer to chip in for the coverage.

"To treat chronic health issues, to treat ear infections and strep throat so they don't get really bad and end up in the emergency room ... ultimately that's what most people want," said Nathan Nayman, executive director of the business lobby group Committee on Jobs and a member of a task force created by Newsom to study and devise the health care plan.

Individuals who earn $50,000 a year, or 500 percent of the national poverty level, would pay $201.25 a month in premiums under the proposed San Francisco Health Access Plan, Newsom said. Those who make between $19,600 and $40,000 a year would pay $35 a month. The figures are comparable to what individuals pay for insurance under private providers, industry experts said.

"This is about the people in the middle," Nayman said.

The plan applies only to those people whose incomes are too high to qualify for federally subsidized health care under Medicaid.

If Newsom is successful in tackling the political hot potato that is universal health care in a city where others have tried and failed, it could have sweeping political consequences for a politician best known outside San Francisco for allowing same-sex marriages. It has the potential to catapult him back into the national spotlight and broaden his political appeal.

The Newsom health care plan is starkly different from one proposed by former Mayor Willie Brown in 1998. That proposal aimed to create a purchasing pool to give San Francisco leverage to negotiate affordable health insurance rates for city government workers and retirees, as well as the uninsured. But Brown dropped his initiative after it ran into opposition from city government workers and retirees concerned about the potential impact on their existing health insurance coverage. Public health care employee unions also opposed it over the prospect of having funds diverted from the public health care system into providing private health insurance.

Though the proposal introduced Tuesday is backed by a broad coalition of business groups, labor unions, health care providers and members of the Board of Supervisors, some business owners expressed reservations about the prospect of being forced to pay to support the plan.

Newsom proposes a voluntary program and predicts that businesses opting to join to provide their health care to their workers probably would spend about $30 million. Meanwhile, the city would chip in $104 million annually by redirecting funds that it already pays to cover the cost of treating those uninsured who visit emergency rooms and clinics. The rest would come from premium payments and other sources.

But today the Board of Supervisors is scheduled to discuss legislation introduced by Supervisor Tom Ammiano that would require every business with 20 or more employees to contribute $1.60 an hour into health care savings accounts that the city could use to in turn provide health care to the uninsured. Smaller businesses would pay $1.06 an hour under the ordinance.

Ammiano's measure could be merged with the mayor's plan, making the employer contribution mandatory rather than voluntary.

Steven Falk, president of the San Francisco Chamber of Commerce and former publisher of The Chronicle, said Ammiano's measure will hurt small businesses that collectively comprise the city's biggest private sector employers.

Laura Thomas, owner of the popular Rose Pistola restaurant in North Beach and two other city eateries, said the proposal requiring employers pay would put her out of business. "I'm not anti-health care," she said, noting that she already contributes to the health insurance of employees who work more than 28 hours per week.

"It's going to hurt business," she said. "I'm going to have to close Rose Pistola or sell it or do something."

Under Newsom's plan, all adult city residents would be eligible, regardless of employment, immigration status or pre-existing medical conditions. Children in San Francisco already have access to government subsidized health care.

Newsom said the plan is not meant to take the place of private health insurance. It would, however, offer a means of treating people without insurance so they don't rely on hospital emergency rooms for care.

The plan would be administered by the San Francisco Health Plan, which currently provides health insurance to more than 50,000 low-income city residents and who receive care at city public health clinics, city-supported private nonprofit health clinics and most city hospitals, including city-owned San Francisco General Hospital.

Participants in the new program essentially would join the existing San Francisco Health Plan. They would receive a medical card and could seek treatment from more than 400 primary care providers in the network and at nearly all private and public hospitals in the city.

Everything from emergency room stays, physical therapy and psychiatric care to radiology, allergy tests and prosthetics would be covered. Dental care and fertility and cosmetic procedures would not.

"San Francisco," Newsom said, "is moving forward to fulfill its moral obligation."

E-mail Cecilia M. Vega at cvega@sfchronicle.com.

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