I've been to San Francisco twice with work.

The last time was in 2018. I caught a Muni bus, the drive drove past someone at a stop who was in a wheelchair and was signalling to be picked up, another passenger challenged the driver, and the driver shouted something like "I don't want no cripple pee pee-ing on my bus"

"by American standards" is doing a lot of lifting. On a scale of 1 to 10 I'd give SF about a 4 compared to cities like Tokyo, Paris, Berlin, London, Amsterdam, Seoul, Singapore, ...