zlacker

Viewed from 10,000ft it could even be cheaper in the long term, as an overall outcome. Personal attention, guidance through the system, vs constant background EMT interventions, more costly health outcomes, Policing and ultimately incarceration risks.

I don't like reductive economics logic over what is a humane response, but I do like that it may not only be nicer, but actually financially sensible.

>>ggm+(OP)
Reminds me of an article from a while ago about a homeless alcoholic that ran up over $1M in hospital and ambulance costs over the years.

https://centerforhealthjournalism.org/our-work/insights/mill...

>>ggm+(OP)
If they could get the guy with asthma regularly seeing a PCP, the money the public is spending on his constant ER trips would more than pay for housing and the time the ranger has to spend on helping him.

>>ggm+(OP)
In that case, why not move all the homeless from a park in a metropolis to a park in a cheaper/remote area? Then you can actually employ cheaper custodians in those areas to look after these homeless.

>>galima+52
See, thats why I don't like the reductive reasoning. After all, when you're moving them why bother with seat belts and comfy chairs? Just use a flatbed truck and they can hold their pathetic possessions on with string, if they have any. And you also neatly assume the resources in the remote location can cope with the burden rather than already being behind the cost curve, compared to rangers in the SF metro area with direct access to the agencies.

Wait a minute, isn't this why it "paid" for the Texan and Floridan governors to ship their problems to the sanctuary cities?

>>sarche+21
If

(Also note that if that's your general policy then you effectively allow anyone to blackmail you to get whatever they want, just by making it slightly more expensive to not give them what they want)

>>ggm+23
you might have misunderstood; if the homeless is now in a cheaper COL park, then more park custodians can be hired to take care of the homeless. And why should we assume that SF metro agencies are more apt to take care of these downtrodden than small town Nevada City? They haven't exactly done a stellar job so far for decades.

>>galima+52
Then they'll have much further distances to commute on foot to their jobs.

>>galima+52
It's a lot hard to re-enter society if you're separated from everyone and everyplace you know. Sure, it could be cheaper in some ways to ship the homeless out to bumfuck nowhere, but might be less cost-effective than you think, and certainly less humane.

>>galima+52
Park Ranges and Social Services Workers are much cheaper than Police, Paramedics, and Emergency Room Staff.

Your reductive suggestion could be implemented by busing the homeless to prisons. That's probably not what you were proposing, but it's one interpretation.

>>anadem+85
Yes it is harder, but it's also harder for society to offer you the services like free room and board, help getting a job, and the thousand other services we offer in a high cost of living area.

Since society is taking up the bulk of the work in helping you re-enter, you have to make some compromises, and potentially moving to a new place seems like a reasonable one to make. If we want a robust and strong social safety net, we cannot commit to providing all these services in the most expensive place to do so.

>>lmm+W3
Is this not only reductive reasoning, but also both devils advocating, and functionally an artefact of the US health system economics?

>>snarf2+X
Nitpick, but $1M in unpaid bills is nowhere near $1M in costs. Obviously this is still a troubling result but in all likelihood it was less than 10% of that in actual costs and the costs weren’t in fact borne by “the taxpayer” but rather by slightly inflated fees for everyone else, since US hospitals must bill according to an assumption that some percentage of bills will go unpaid, due to the relationship between themselves, the insurers, and uninsured patients.

>>galima+X3
> custodians can be hired

SF has one of the largest city budgets in the country — >$15billion — and struggles to staff park workers making $70-90k.

If the park workers only make $60k, but the city budget is 1/10th, 1/20th, 1/100th of SF’s, how does the math here ever work?

>>ketzo+wb
SF budget is city and county services, fwiw. It is good to make apples to apples comparison.

>>ketzo+wb
Park rangers make $30k-40k in small cities/towns. Not to mention big cities can help pay for some of the transition costs for these homeless, with their 15 billion budget. Also, it would be way cheaper to house these homeless once they choose to transition from park to an apartment.

>>ketzo+wb
>In fiscal year 2023–2024, San Francisco spent $690 million on homelessness, notes the San Francisco Chronicle. This is a 142% increase from five years ago.

Spending $700M/year on homelessness crisis is straight up insane. There has to be a better way that doesnt cost as much. SF is kinda fucked.

https://www.sfchronicle.com/sf/article/homeless-questions-an...

>>anadem+85
If drugs are strongly intertwined I wonder if an opportunity to voluntarily seperate from familiar drug triggers and sources might provide some balancing to the downsides.

>>Ogsyed+o4
If they could have a job they wouldn't be homeless.

>>mikepu+L7
And for useful reference: I was in hospital last year for ~2 weeks, and my insurance was sent a bill for ~$580k. The insurance actually paid $32k.

Hospital bills are clearly works of fiction.

>>ketzo+wb
SF park workers are closer to 120K from those I know. A lot of labor intensive hand weeding because the city shuns herbicide. However, this is less than the median SF city employee, which makes 150k

https://opengovpay.com/employer/ca/san-francisco

>>ggm+A7
> Is this not only reductive reasoning

Maybe. Reductive reasoning is usually a good idea.

> devils advocating

No.

> functionally an artefact of the US health system economics?

So what? If and when you manage to fix the US health system for the working poor then it might become reasonable to provide free healthcare to the disruptive homeless, sure. But until then it isn't.

>>edm0nd+uf
When there is an enormous budget somehow used up but with barely any noticeable effect (and frankly, without much of an expectation that there’s noticeable effect), you can bet there’s someone or a lot of someones siphoning from it.

Btw even $690m isn’t the full picture:

> While that amount does not include what the Department of Public Health or SF Public Works or many other departments spend related to the crisis

>>WillPo+Uf
My understanding is that there are plenty of homeless folks with jobs.

>>ty6853+Jf
Drugs & alcohol is the majority of why they are homeless from San Francisco to Grand Junction, CO (drove through & saw they have an unofficial homeless park) to Portland to Seattle to Calgary, etc, etc.

>>davidg+wg
Indeed. Those clearly-bonkers initial bills are clearly meant to a) intimidate and terrify the uninsured, and b) present a sympathetic facade to politicians and possibly the IRS about how much cost the hospital absorbs from non-paying patients.

>>davidg+wg
$580k?! As an European, I can only imagine you got 5 organ transplants, 4 titanium limb replacements, and, idk, night vision or something, while staying in a penthouse suite with masages and coconut milk treatments...

(Obviously joking and I know 2 weeks in a hospital is very unpleasant - I'm sorry for your experience and hope you're doing well).

>>aprilt+p7
Why?

>>lmm+W3
Do you have a moral objection to a homeless man with asthma getting a primary care provider paid for by the government?

>>lmm+nh
I think we have fundamentally different views on this. It's also true that disruptive homeless have to be managed in state funded healthsystems worldwide and that includes denying them service when they do bad things, I'm not naieve enough to believe somehow this is a uniquely american problem (disruptive people) but I do think the aspect of reductive health economics here is a pretty unique problem to the US health economy. And I say that living in an economy which has private emergency services alongside the public ones. We just don't have the same problem at scale, because we don't have the underlying health charge model.

>>freeon+Mp
I have a moral objection to the government providing more support to a socially disruptive person than they give to someone who is more prosocial. I'm all for a government-provided healthcare that's free for everyone, but prioritising person A because they're more disruptive than person B is morally bankrupt.

>>lmm+Qs
You've made quite a jump here from "has asthma" to "socially disruptive".

>>crooke+jt
The post I replied to was arguing from "the money the public is spending".

>>ggm+(OP)
What you're describing is universal healthcare being cheaper in the long term, which I would agree with. What is described in this article absolutely does not sound like a productive use of taxpayer money at all. Any one of the ranger's clients that gets semi-permanent shelter is someone else who doesn't. At best, we're pay a full-time salary for someone to play a zero sum game. IMO, it's actually worse than that because such housing is more efficiently allocated to those who are able and willing to navigate the bureaucracy of public housing themselves are more likely to rebound successfully.

>>tomrod+Vm
Are you asking why things have costs?

>>edmund+Xd
It’s also services for less than a million people

>>lmm+Qs
It's not about morality, it's about incentives. Under the current system in the US, if you're broke and you have no insurance:

1. The ER is free to you, because they legally cannot refuse to treat you based on your ability to pay.

2. A regular doctor's visit costs $250 and your medicine costs $5-$500/month depending on what you need, because those businesses won't give you things they don't think you'll pay for.

One need not be morally bankrupt to make choice #1. We all choose things that are more expensive for society because they are more convenient or less expensive for us - lots of regular activities of what patio11 calls the professional/managerial class have negative externalities that the rest of society pays for: air travel, personal automobiles, and lawns all come immediately to mind.

If you want people to get their medical care from a PCP and their medicine from the pharmacy, then make it cheaper for them. Health insurance companies know this; that's why many plans lets you see your PCP for a small fixed price even before your deductible is met - because they want to incentivise you to get your care in the way that's cheapest for them.

>>ggm+(OP)
Exactly. The economic argument shouldn't be the only reason to push for better solutions, but it's a compelling one (especially in a system that often prioritizes cost over compassion)

>>repire+Jz
> One need not be morally bankrupt to make choice #1

I'm talking about the people making the decisions about who gets free doctor's visits, not the people on the receiving end.

> We all choose things that are more expensive for society because they are more convenient or less expensive for us - lots of regular activities of what patio11 calls the professional/managerial class have negative externalities that the rest of society pays for: air travel, personal automobiles, and lawns all come immediately to mind.

That doesn't make it ok. Most people have at least some semblance of conscience and try to cut down on those things - of course no-one is perfect, but that doesn't mean we should allow whataboutism to get in the way of good policymaking. (FWIW I'm all for taxing those things at a fair rate that covers the costs of those externalities)

> If you want people to get their medical care from a PCP and their medicine from the pharmacy, then make it cheaper for them.

Sure. But make it cheaper for all of them. I agree that "it's about incentives" - so don't make it so that the incentive is to do the antisocial thing until the system pays you to stop. It should be easy to extrapolate where that leads.

>>paul79+8k
No, it isn’t. If that was true you’d see a much stronger correlation between drug and alcohol use and homelessness.

>>lmm+Zt
On ER care.

>>oefrha+bj
They could just take that $700M and divide it up among the ~8000 homeless in the city. That $87,500 per year would be enough to help get someone on their feet pretty quickly. Probably more effective than whatever the hell they’re spending it on today. Salaries for administrators administrating other administrators?

>>ketzo+wb
The point would be to still use SF's money to do this, I assume. The point was that SF's money would be better spent on park rangers in a smaller city than in SF itself.

Now, I think there are otherajor issues with this idea (mostly that having a 0.1% population of assisted people is much more workable than a 10% population, as would happen if SF moved every homeless person to a smaller city).

>>davidg+wg
It’s like a tax scam right? Or is it like once in a blue moon they get wealthy whale without insurance?

>>tomrod+Vm
Because you either make it where you grew up or we'll ship you to the Midwest where you're cheaper to deal with, ya fuckin' bum.

>>WillPo+Uf
Why would a job automatically mean housing? This is America, a job only means enough money for housing in some markets.

>>amanap+Wj
Identifying and assisting these people first would seem to be the thing to do.

But reducing those homeless to 0% would likely not move the needle at all on the “problematic homeless” - the type everyone complains about.

Nobody cares about Steve Wallis sleeping in a bush.

>>ryandr+TH
There’s got to be some Appalachian town that would love to get paid $700m/yr to house and care for 8,000 people.

>>genewi+se1
Genuine question: is a social darwinist society something folks (perhaps you?) feel like they would survive in? Suppose your community decide it hates people who post online and wanted to ship them to Alaska. You cool with that?

>>lazyas+0H
You do when you subset the homeless population from couch surfers and people living in their car to the people actually finding a wink of sleep under some tarps under a noisy overpass

>>Redoub+9y
No, but I could see why that is where your mind started.

You have a deep, implicit assumption of a social contract in your statement here:

> Since society is taking up the bulk of the work in helping you re-enter, you have to make some compromises, and potentially moving to a new place seems like a reasonable one to make. If we want a robust and strong social safety net, we cannot commit to providing all these services in the most expensive place to do so.

Some people can't. I know several schizophrenia sufferers who would never be able to hit an expected checklist. Some are brilliant. Some think they talk to an esoteric God and babble prophecy. None are functional.

We used to lock those folks up in sanitoriums for their safety, but due to systemic abuse this ended. Go back further, and the folks were tribal shamans, village jesters, and other elements of society which were supported by others until their (often untimely) deaths.

The latter support more or less ended when we as a species started settling down out of nomadic lives.

As a society, we dramatically underfund infrastructure (crumbling bridges and suburbs), healthcare (exploding costs without quality improvement), education (teachers salary is uncompetitive), government action (court systems aren't expedient, legislators xna be bought).

If we don't want these things, we should have the society decide so. This would be through legislation. But we haven't. We ignore these friction instead of addressing them.

Resolving friction takes effort, and effort has costs.

>>kjkjad+rN1
Then maybe the easy solution to this whole issue is to just give the homeless free cars.

>>lazyas+0H
"A survey by the United States Conference of Mayors found that 68 percent of cities reported that substance abuse was the largest cause of homelessness for single adults."

https://endhomelessness.org/resource/opioid-abuse-and-homele...

i do not have any idea how to solve housed people turning to drugs/alcohol to try and solve internal emotional pain...maybe more & more education.

>>bombca+Hm1
Maybe its facetious, but I also do not understand why they have to be accommodated in a top 5 most expensive place in the world to live in.

>>bagels+Rl2
It's half facetious but also half serious, as the amounts of money are simply staggering.

There has to be some middle ground between "homeless in a park" and "living their own life with a job" and "locked up in prison at great cost" that would be satisfactory to everyone.

>>tomrod+BN1
You have a deep implicit assumption that throwing money at the problem solves it. That's rarely true. In the case of schizophrenics, we have solved it a long time ago, but they refuse to take their meds. No amount of money in social programs will change that. It just shifts the "systemic abuse" (which I agree with you on) from (asylums abusing the ill) to the (the mentally ill abusing the general public). I think abuse is a great way to phrase it. We all get abused by the public excrement, petty crime, needles and trash, loss of use of common areas, etc. We all are being abused by that population.

>>bombca+ao2
I think it's impossible for everyone to be satisfied no matter what the solution is.

>>paul79+P62
That’s not actually what you want to ask: Drug use is an additional risk factor for becoming homeless, which tells you that the people who are homeless are likely to be drug users - but that really just sorts out who is likely to become homeless, not how many people. If drug use caused homelessness then places with higher substance abuse rates would have higher homelessness rates. But they don’t! The rate of homelessness is driven most clearly by the difference between area income and area housing cost, and does not correlate well to any measures of drug use in the area.

A nice pair of contrasting data points here is WA and West Virginia. Drug usage and addiction, as well as mental health problems, in West Virginia far outstrips Washington - see https://www.kff.org/statedata/mental-health-and-substance-us... However homelessness in Washington is far, far worse than in West Virginia. West Virginia had almost the lowest rate of homelessness in the country.

https://mountainstatespotlight.org/2024/07/16/wv-new-data-ho...

https://247wallst.com/state/how-the-homelessness-problem-in-...

>>kjkjad+rN1
No you don’t. If 50% of society uses drugs, 5% of society is homeless, and 100% of homeless people uses drugs - then you’d see that all homeless people use drugs, but most drug users are not homeless, so it’s not well correlated at all.

>>lmm+VA
It’s worth pointing out that he probably qualified for expanded Medicaid in California, so the PCP visits would be covered by that. It’s just a matter of getting him to actually go.