IF YOU HAVEN'T HEARD by now, people with disabilities are not a bunch of medical cases.

Prior to this century, disability was treated as an essentially life-ending condition that precluded people from social lives, employment and independence. Those days are long gone. Today, people with so-called ``deformities'' find employment outside the circus tent, and the elderly and infirm aren't treated as geriatrics.

Indeed, through community organizing and political participation -- particularly in the Bay Area -- people with disabilities have fought for transportation access, causing cities to cut curbs and put lifts on public transit buses, and they have passed laws, including the Americans With Disabilities Act, to ensure equal protection.

Yet, in spite of the diligence by people with disabilities in advancing what Berkeley pioneers dubbed the ``Independent Living Movement,'' San Francisco is planning to spend more than $400 million to erect the world's greatest monument to institutionalization of people with disabilities.

In their unrelenting fight to rebuild Laguna Honda, San Francisco's government leaders have gone from progressive policy- makers to public enemy No. 1 for disability advocates. The city simply refuses to let go of the oppression that is the nursing home.

Laguna Honda, the largest nursing home in the country, maintains some 1,200 beds. Proposition A on San Francisco's November 2 ballot calls for issuing as much as $299 million in bonds to finance construction of a new hospital. Interest over 20 years on the bonds would bring the project's cost to more than $600 million. A bill carried by state Sen. Jackie Speier would allow San Francisco to receive an unspecified amount in federal Medicaid reimbursements to help build the new hospital. Gov. Gray Davis has until October 10 to sign the bill into law.

To people with disabilities, Laguna Honda is a harsh reminder of a past where anyone with a physical or mental disability was branded as a cripple and sequestered from society. It is also models the injustice that occurs when the one-size-fits-all approach to personal-care assistance is used.

In a scathing 138-page report, the U.S. Health and Human Services Agency has cited Laguna Honda for failing to meet basic requirements in almost every area of its responsibility, including record keeping, nutrition, patient and employee safety, privacy and physical maintenance.

The expectation would be for San Francisco to offer a plan to rectify these injustices or explore community-care options that may prove less threatening to patients. On the contrary, San Francisco has publicly expressed its belief that bigger is better, and proposes to expand the home, to invest in it. By placing a bond measure on the ballot to rebuild this bloated facility, they eliminate financial resources that could be used for community-care options and they pour more hard-earned taxpayer dollars down the indisputably bottomless pit of institutional care. Nobody who lives in a nursing home really wants to be there, and most would tell you they are because they have no other choice. This is a shame, when we can say with factual evidence that the costs of community-based care are roughly half the costs of nursing-home care ($30,000 as compared with $80,000). Indeed, the disparity has become so great that the state has embraced new reforms. This year, Assemblyman Kevin Shelley, D-S.F., sponsored legislation to improve staffing ratios in care facilities and crack down on abuses.

Medical experts agree that from 20 to 70 percent of nursing home residents could be well cared for in assisted living or other integrated settings in the community. In the community-based scenario, the person is not a patient but rather a partner who has critical direct input on the kind of care they are receiving and to whom caregivers must listen as their direct employer.

The bottom line is that community-care options remain threatening to institutions. Yet even this is changing. The Supreme Court has summarily rejected the argument of states that they should be allowed to confine patients because of the administrative costs of vacating their large institutions. In her majority opinion on the Olmstead case, Justice Ruth Ginsberg wrote that the state of Georgia could not keep two mentally ill women confined and that ``unnecessary institutional segregation constitutes discrimination per se, which cannot be justified by a lack of funding.''

People with disabilities have had to fight tooth and nail for their rights. Today, with 13 percent of the population over age 65 and Baby Boomers approaching old age, standing up for community care and choice should be a priority for all of us.

Kathy Uhl is the director of the Independent Living Resource Center in San Francisco.