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America’s Largest Health Insurer Is Giving Apartments to Homeless People (www.bloomberg.com)
167 points by SQL2219 6 months ago | hide | past | web | 180 comments | favorite

Wait why are so many people shitting on this idea. This seems to me to be exactly what people are always comparing about, "big companies only care about the bottom line they don't care at all about suffering." Right here there is a private company trying to help ease the homeless problem and everyone is just shitting on them for not doing the way they think they should or are getting angry at them for making a profit on it.

If we constantly dump on every person and company who makes any attempt to help address a social problem simply because it doesn't solve the whole problem or because they don't do it in the way we want or think is effecient, people are going to stop trying to do anything.

Sure maybe this program didn't solve homelessness in Phoenix and maybe it didn't help significantly reduce the percentage of people that are homeless but you know whose life it did significantly help? Steve and every other person who got a home, so sure maybe this didn't change homelessness in America radically but it did radically change homelessness for those people.

I think this is a positive development, but to me it highlights how sad it is that so much of America sees investment in its own people as "wasteful spending."

Protecting the most vulnerable people and ensuring people don't fall into the trap of poverty is an investment that should occur at the governmental level. There are many such governmental investments that would alleviate serious long-term problems.

My biggest frustration with the American government and American business-oriented culture in general is a lack of long-term thinking. We know that "a stitch in time saves nine," but instead we decide to go the nine stitches route. Put more nerdily, people do not properly respect the implications of exponential growth.

“A society grows great when old men plant trees in whose shade they know they shall never sit”

-- Greek proverb

> Protecting the most vulnerable people and ensuring people don't fall into the trap of poverty is an investment that should occur at the governmental level. There are many such governmental investments that would alleviate serious long-term problems.

The United States spends 38% of GDP “investing in people.” https://en.wikipedia.org/wiki/Government_spending_in_the_Uni.... Even if you exclude the much maligned defense spending (where a lot of our science and technology investment goes), that’s $6.5 trillion that goes to investing in people or managing people who invest in people.

I’m amenable to the notion that we should invest more. For example healthcare and guaranteed meals for everyone under age 18.

But the idea that “America sees investment in its own people as wasteful spending” is just false. It’s a statement that’s so disconnected from reality that it makes me question the point that is really being made. Are people really saying spending a third of every dollar on welfare is nothing? Or is it a way to deflect from any efforts to criticize how that money is being used? Because if you keep telling people “America invests almost nothing in its people” that makes folks very defensive about the programs we do spend money on, and willing to overlook mismanagement of those programs.

These statistics don’t take into account things like the disproportionately high cost of healthcare in the US, so percentage of dollars spent isn’t an especially meaningful measure. Social Security payments maybe, but you would have to compare relative age of populations and account for how the wealthy escape paying into the system at anything like a progressive level.

As this article demonstrates, Americans are great at paying out lots of money into private systems without receiving good material returns on these investments. By contrast, for example, my great grandmother in the UK paid into various state taxes regimes all her life. In return, she received very good quality healthcare, home care and long term care in old age, and social housing after the death of her husband. She was a working class person who suffered a lot of hardship, but lived to be 99. In the US, she probably would’ve ended up bankrupt and dead on the street much earlier.

> These statistics don’t take into account things like the disproportionately high cost of healthcare in the US, so percentage of dollars spent isn’t an especially meaningful measure

Yep. The US spends more than double what countries with universal coverage spend on healthcare[1]. Those countries also have better health outcomes on nearly every metric[2] and manage to cover all of their citizens.

[1] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

[2] https://www.healthsystemtracker.org/chart-collection/quality...

Doctors in the US are also grossly overpaid compared to other countries: https://www.medscape.com/slideshow/2019-international-compen...

We will need to reduce doctors salaries by atleast 50% if we want to tackle high healthcare costs..

> These statistics don’t take into account things like the disproportionately high cost of healthcare in the US, so percentage of dollars spent isn’t an especially meaningful measure.

It depends what you're measuring. OP is talking about Americans' willingness to "invest in their own people." That's an issue of "money in" not "results out." On healthcare, for example, U.S. governments spend 8% of GDP. That's on the middle-high side compared to the rest of the OECD: https://www.oecd.org/els/health-systems/Country-Note-GERMANY.... We just manage to cover a fraction of the population for similar levels of spending. The same is true for our public education--we spend more get less.

That suggests a very different narrative than what OP was saying. "We spend so much on education, why are our kids falling behind?" Versus: "Why aren't Americans willing to invest in education?"

The problem isn't that America isn't "willing to invest in its own people." It's that Americans get far less in the way of public services for the amount of money they spend. It's a problem of efficiency, not generosity.

> Social Security payments maybe, but you would have to ... account for how the wealthy escape paying into the system at anything like a progressive level.

The earnings cap for Social Security is common in OECD countries, and our cap is higher than most: https://www.forbes.com/sites/ebauer/2018/04/28/so-hey-why-no.... (Comparisons are a bit difficult. France, for example, has a cap on Social Security taxes, but no cap on healthcare payroll taxes. But the U.S. has no cap on Medicare taxes, and we pay Medicaid out of income tax, which is highly progressive.)

It's also funny you use the U.K. as an example. The maximum state pension in the U.K. amounts to about $10,000/year. The average U.S. Social Security payment amounts to $17,500 per year.

> As this article demonstrates, Americans are great at paying out lots of money into private systems without receiving good material returns on these investments.

Except health insurance, the U.S. is generally behind Europe in terms of privatizing public services. For example, not even Republicans are talking about privitizing Social Security, but some level of privitization of retirement accounts is common in other countries: https://www.ssa.gov/policy/docs/ssb/v66n1/v66n1p31.html. Australia, Denmark, and Sweden are examples of countries that have partially privitized their Social Security by imposing mandatory participation in private pension systems as part of the overall retirement system.

Transit systems in Europe are often privately operated, while in the U.S. they're almost all publicly operated.

91% of American students attend publicly managed schools, below the OECD average of 82%: http://www.oecd.org/pisa/50110750.pdf. Spain, South Korea, Belgium, Ireland, the Netherlands, and Australia are countries where 1/3 or more (70% in Belgium) of students attend private schools. In the OECD, it's common for private schools to receive government funding (via voucher-like systems). Sweden, Finland, Germany, the Netherlands, Ireland, and Spain, are examples of countries where private schools receive more than 60% of their funding from the government.

The EU is undertaking a vast reform that would require opening up local utilities to competition: https://europa.eu/rapid/press-release_MEMO-14-19_en.htm. Among other things, it could speed up the privatization of water systems in Europe (private water systems are already fairly common there, but basically unheard of in the U.S.)

USA seems to be around 26th in the world with that ratio.


The USA has a unique situation with its defense spending though, which skews that ratio in a sort of unfair way. On that same data you linked, if you look at dollars per capita instead of %GDP, the US is actually 11th and ahead of Germany, Iceland, and the UK, etc.

Now really, the stats you linked probably aren't even all that correlated with social spending. It's more likely a measure of the scope of bureaucracy.

Not only that, most of those countries have socialized medicine -- but socialized medicine isn't exactly an anti-poverty program. When the government takes an extra $1 from someone at the mean income and then provides them with $1 in health coverage, it shows up as $1 in government spending, but that's not redistributive. If the program didn't exist they could have taken the $1 and used it to buy $1 in health insurance, which is what happens in the US. Socialized medicine is only redistributive to the extent that the money comes from someone other than who receives the benefit. For healthcare spending probably 80% of the money isn't that, because it's mostly going to insure the same people who are paying the taxes.

The US couldn't raise taxes by an equivalent amount unless the money specifically went to healthcare in an equivalent way (because otherwise taxpayers would still need to have that money to buy healthcare), so you couldn't use it to solve homelessness.

The problem is that Social Security and Medicare in the US completely dominate social spending, and they're also the same thing. Or worse, since Social Security even gives bigger payouts to wealthier people who had higher incomes before retirement -- the least it could do is give everyone the same amount.

So we end up in a situation where we are at the same time spending too much on government programs and not spending enough on government programs, not because the amount of tax revenue is too low, but because the money we currently spend mostly isn't actually going to anti-poverty programs or public infrastructure or scientific research etc.

Yes, we’re ahead of places we think of as first world countries (Australia, South Korea, Ireland, and Switzerland. And we’re pretty close to Japan, the U.K., Israel, etc. We are closer to Germany than Germany is to France. The clustering in the OECD is pretty close.

America makes more sense when you consider that Civil Society (as in the third sector) is mostly dead, and what is left is extremely fragmented. There is no cohesion, very little shared culture, and a lot of outright animosity between groups. They aren't countrymen, they just happen to live in the same legal boundaries.

When people in this mindset see homeless they don't think "This is a member of my society that is suffering", they see an Other. Put another way, plenty of old men want to plant trees, they just only want their own group using the shade.

I think a lot of this mindset is also driven by the fact that the loudest members of society aren’t generally reflective of society as a whole.

The Trump supporters at rallies, and the cancel/call out culture on Twitter are two examples that come to mind which bias an individual towards large groups of people who mostly aren’t such caricatures.

It’s like the whole LatinX thing, where no Latinos really identify as LatinX but it’s this narrative pushed forward by an extremely vocal super minority.

Or that whole uproar about white women wearing Japanese clothing that happened.

At the end of the day, I think most Americans are more connected than we think culturally and it’s a bit of a shame but we mostly don’t hear the opinions of the people who’re working, taking care of children, and otherwise enjoying life by partaking in hobbies, social events, and cultural activities.

What we do hear are the people so invested in X or Y as to be extremely strongly opinionated enough about and invested in it that they may drive culture one way or the other without the contributions of most individuals.

Of course there is xenophobia, and strong prejudices and biases out there, but I’m hardpressed to describe Americans as being that way as a whole and in general I think we mostly move forward on social issues even if we take a couple steps back.

We’re seeing one of the most unequal periods of American history come to a head right now, exacerbated by tax cuts for the wealthiest, globalization, unfettered money in politics, and a whole slew of other factors.

But I have a feeling we’re going to come out of it okay, and I’m especially hopeful for Generation Z which seems to be all about achieving universal healthcare, affordable education, the freedom to be yourself in nondiscriminatory ways, and tackling climate change.

This is your opinion, and a bit insulting considering you have taken a broad brush stroke across a country of 300+ million people, including myself. Perhaps you should get off the twitter bubble and go get involved in your community.

A few issues with your argument:

1) "plenty of old men" is almost certainty referring to the common portrayal of "old white men" and more broadly speaking all White Americans.

Let's just pick this one apart. I cannot speak for all the various religions in the US and their relative charity work, but I know that every church I have ever been apart of has done a tremendous amount of charity work not just in their local community but across the globe, mainly in third world countries - of not "white people". I will make the responsible assumption that other religions do the same. Considering more than 40% of US citizens attend some religious congregation weekly, that means more than 150 million Americans are contributing physically, and likely economically, to global organizations that have shared culture and do "goodwill" in the US and abroad... most often for the "suffering", and a large % of this group of Americans are white, many of which are old - as it's well known that religious observation is significantly greater among pre-Millennial generations.

2) Speaking to the remaining 60% of the United States, more than 62 million Americans volunteer, it's growing every year, and more than half of American's contribute to charity. Again, even assuming 50% overlap with the active-observant religion 40% of the population, we can assume almost every American contributes to an organization either through labor or charity to help those who suffer, and the delta of those who are likely not contributing physically or economically are probably those receiving said charity, and not a huge swath of millions of racist anti-American "countrymen".

3) To your point about a "disconnected society of mostly old white men", I have lived in South Florida for most of my life, where there is a HUGE influx of immigrants and refugees such as Cubans, Haitians, Central Americans, and most recently South Americans, i.e. Venezuelans - where these communities often represent double digit % of the population, and majority of the population in certain large geographic areas. You cannot "drive around" without seeing a car displaying a flag of their country of origin. From the tone of your comment it sounds like YOU have a problem with that behavior? You are essentially calling them un-American.

Frankly speaking as someone who has gone to public school with the children of these people, most of which the children were born outside the US, many of which are "Dreamers" - I know many might "long for their homeland". I know many have immense pride of their heritage. But these people that I know most often have joined the military, police, or other government service - because that is more often then not a stable, often guaranteed, step up in society both economically and I believe from a respect perspective which by your argument they apparently still have to earn. I assume you do respect those vital national and local services, regardless of the "Americanism" of those carrying out the services.

4) American Culture is defined by "shared culture", it is unique compared to every other country in the world BECAUSE OF THAT, not in spite of that. It is constantly changing and evolving. And the fringe that you speak to is simply ignorant of that fluidity that makes this country so unique and grand. I won't make the assumption of generalizing you and putting you into that fringe, but you certainly are amplifying that group by accusing all others of being apart of it without any evidence or scientific fact.

Racism. It's mostly driven by racism but we're not allowed to call it that.

Not allowed to call it that since when? It seems to me that we’re allowed to call everything racism these days. E.g. Warren talking about “environmental racism, economic racism, criminal-justice racism, health-care racism.”

I don’t disagree with your point in a certain sense, but your framing is fluffy and unsatisfying. America is one of the least racist countries in the world. For example, 82% of French support banning Islamic head coverings, versus just 28% of Americans: https://www.pewresearch.org/fact-tank/2010/07/14/french-supp.... I’m a Bangladeshi married to an Oregonian. (Not like Portland, like rural Oregon coast.) I’ve lived in red states, visited rural parts of the country, and currently live in a precinct that voted for Trump. The degree to which Americans are willing to accept you into their communities, given minimal attempts to conform, never ceases to amaze me. (And when I hear about how “profoundly racist” America is, I can’t help but think sheepishly: “man, what would they say about Bangladesh?”)

So how much explanatory power does leveling charges of racism really have? Clearly racism exists and is a bad thing and produces many problems. But racism is also a structural problem endemic to humans, not anything unique to Americans. How much can you really rely on racism alone to explain the level of division within American society?

A lot of divisions in America are driven by generations of policy based on racism - from redlining, white flight and zoning policies that changed the structure of cities and are now used as weapons against newcomers and change, to the very existence of many cities and governments that were created in order to be a separate white space from the larger cities nearby, and the use of these boundaries to avoid funding the basics of society for everyone (school districts, libraries, roads, etc).

The vast majority of Americans are not racist in the sense that they are personally antagonistic to an individual of another race. But many of them are racist in the sense that they think black people on average are poorer because they have shitty culture, not because white people historically prevented them from buying land, prevented them from being educated, prevented them from using opportunities like the GI bill, etc.

Hey rayiner, love your contributions to HN. I think you're missing a big piece here that I have very recently started to see myself. I would be delighted to share with you.

Are you aware of Dr. Ibram X. Kendi's book "Stamped from the Beginning: The Definitive History of Racist Ideas in America"? I am just about done reading it. Before I may have side-eyed "criminal-justice racism" "health-care racism", etc. After, it is clear as day how racism in America should be a first-order question when examining any social issue/problem.

I really hope you check out the book!


As for "health-care racism" I even caught that in the news recently. "Racial bias in a medical algorithm favors white patients over sicker black patients"


> Not allowed to call it that since when?

It's not politically correct to call it racism. According to the powers that be, we should call it "economic anxiety"


Throwaway account of sorts here. I too am a South Asian who has been in the US for quite a while, and have lived in both red and blue states. I used to live in South Asia and the Middle East.

In my experience, Americans (of all races, including whites), are a ton more welcoming than I've seen anywhere else (well, except Canada of course). In fact, the most welcoming community I lived in was in a red state.

In contrast, people in the countries I lived in are much, much more overtly prejudiced. Here in the US I have no problem having a conversation with pretty much anyone - be they of another race or wealthy or in poverty. In South Asia those who were of a different social class were simply invisible. You don't get to interact much with those higher than you, and everyone pretends the poor simply don't exist.

And so much is dictated by your ethnicity/tribe.

I remember the situation in the US after 9/11. There were bad things happening across the country against people of Muslims or those suspected of being Muslims. But the majority were supportive. I remember my Saudi friend remarking "You know, if white people had done something like this in our country, it would not be safe for them to leave their home. And here I am not worrying at all about being outside. I know the majority has my back."

In over 20 years of living in the US, I've never had someone overtly treat me in a racist manner. Yet back home being treated in a prejudicial fashion was the expectation. Life's simply a lot better in the US.

Clearly, the US has lots of prejudism/racism issues. And it's visible. And you can see it in the statistics. And in my experience it has gotten worse in the last few years. We're not saying the US is alright. But when I look globally, the US is definitely in the better half, and probably pretty high in the better half.

Oh, and if you want an idea of how bad things can be even in Western Europe, I strongly encourage you to listen to Epsiode 684 of This American Life ("Burn it Down"): https://www.thisamericanlife.org/684/burn-it-down

You can see the transcript on the site.

Some of the stuff described there would be pretty outrageous/scandalous in the US. The difference isn't that sutff like this doesn't happen in the US (it probably does), but how the public reacts to it when it becomes mainstream news in a major city.

Oh, and just on the side: We South Asians are not really any better. I can't tell you how many times a fellow South Asian in the US complains about racist white people, and then has no problem making racist remarks about Chinese and African Americans. And when called out on it simply dismiss it with "Well that's just the reality!"

You are crushing this thread with sensibility. Thanks.

In my experience the case is exactly the opposite. The term "racism" is so overloaded at this point that you can call someone a racist if they've mentioned anything even tangentially related to race. It's an insult more than a descriptor.

How so? Do you mean that people "would" help if they weren't racist? San Francisco, which has one of the largest homeless populations per capita, has a homeless population that is 35% caucasian (the largest represented racial group).

(Edited to add: Caucasians make up 40.2% of the city population)

https://sf.curbed.com/2017/6/16/15818104/homeless-sf-count-2... https://datausa.io/profile/geo/san-francisco-ca

Across the West (where I travel the most) see that most homeless is white. I would say too, that, even in places with much higher Mexican or migrant populations, such as Tucson, AZ - the homeless population is also mostly white. At least visibly. Homelessness doesn't seem to be related to racism, it seems to be a very white specific thing (at least in these western states - CA, WA, OR, MT, CO, UT, NV, AZ, NM, WY).

While probably part of it, I don't personally believe that to be a primary cause. America is probably at or near the least racist it has been in its history. I think the entities driving narratives that make people believe racism is rampant, and cause people to make flippant accusations of racism, have more to do with it.

  Right here there is a private company trying to 
  help ease the homeless problem
That's not true: they are making an investment in housing, based on economical considerations, that they expect to cover by reducing the health liabilities of the covered individuals.

I don't think this means that they should be shit on, or that the situation is bad. On the contrary: it looks like health externalities (homelessness) have been appropriately internalized, and it is enabling correct match-up between resources and needs.

But it just sounds silly when you say they are "trying to help ease the homeless problem"

Sure maybe their motive is economic rather than altruistic but to quote my mother "if it's stupid and it works it isn't that stupid"

I mean Steve Jobs didn't care about anything but the profits when launching the iPhone but it was arguably a significant factor in getting us to the state where we are at today where pretty much everyone has an internet enabled smart phone.

It just sometimes there is the group think on HN that all companies and big corporations are always evil and are some sort of malevolent force and so we can't give them credit for any good they do because they don't meet our moral standard. I mean that's like saying Lincoln's role in freeing the slaves was fundamentally evil because he didn't also extend everyone the same protections enshrined in the Civil Rights act.

Ultimately in my years of software engineering I have become convinced that big huge grand programs are almost always bloated ineffective and full of bugs whereas most real value derives from incremental improvements.

It isn't about good or evil, it's about the fact that relying on large corporations' profit interests to solve public ills is a fools errand. So, sure, the public might get some good from a corporation's program, but as soon as the profit dries up, the corporation will move on. This isn't a moral thing, it's just a thing profit-driven organizations do.

People don't want welfare infrastructure to be contingent on a corporations ability to profit, because in the end it will be a fickle thing.

Will this effort make it harder to build public infrastructure in the future?

I'm sympathetic to the argument you're making, and I've even used it a couple of times when talking about stuff like browser standards, Facebook Basic Internet, etc... It's not a dumb argument.

But at the same time, homeless people don't care about your theoretical utopia. They need help right now, and there's a very real cost to saying, "nobody should help this person suffering until we can do it right."

There's a balancing act here. Unless private care is going to make it harder to solve homelessness in the future, we should embrace it as a band-aide solution while we work on public infrastructure. Because let's be honest, public solutions like guaranteed housing are likely pretty far in the future -- I don't see a lot of evidence that there is enough political momentum right now to make that happen. The evidence I see suggests Medicaid has a decent chance of even getting worse in the immediate future.

We need band-aide solutions right now.

To be clear, I mostly agree with you. But:

> Will this effort make it harder to build public infrastructure in the future?

It might. Things like this are frequently invoked in policy arguments to claim public efforts are unnecessary or ideologically suspect.

Again, that's not to say this is a wrong-headed effort, but not being clear-eyed about the role of patchwork private efforts in public policy arguments is unhelpfully naive.

> Will this effort make it harder to build public infrastructure in the future?

Yes, most likely.

> But at the same time, homeless people don't care about your theoretical utopia. They need help right now, and there's a very real cost to saying, "nobody should help this person suffering until we can do it right."

I don't know who you are arguing against here. I never said any of these things. I'm not advocating we prevent corporations from doing things that help people, I am only pointing out that they are fickle friends, and we shouldn't count on them to be reliable providers of aid.

Will it be more fickle than a politician's ability to get votes?

The answer here is probably "yes". But the question is worth asking. If we can construct some system where the profit motive does motivate ongoing maintenance of welfare infrastructure, thats a win.

Not only will it be more fickle, there is 0 accountability from the public, and the corporation has unilateral control over the programs existence.

Contrast that with entrenched public goods like schools, libraries, police and fire departments. Most politicians don't have the ability to suspend those programs if the quarterly numbers are low.

So yes, private welfare infrastructure is inherently less stable than public.

> If we can construct some system where the profit motive does motivate ongoing maintenance of welfare infrastructure, thats a win.

There are some things that just aren't profitable, and never will be, like rural mail delivery.

Not to be dramatic or anything, but I think if the last 30 years have taught us anything, it is that the more we try to solve problems with profit driven organizations the more anemic our society will become.

>It isn't about good or evil, it's about the fact that relying on large corporations' profit interests to solve public ills is a fools errand.

Why? Are corporations going to make more from dead consumers than healthy, happy and live ones?

Again where is this pervasive attitude that anything "large corporations" do is immediately suspect or presumed evil? It just doesn't make sense.

>So, sure, the public might get some good from a corporation's program, but as soon as the profit dries up, the corporation will move on. This isn't a moral thing, it's just a thing profit-driven organizations do.

So your saying at some point people won't need health care?

>People don't want welfare infrastructure to be contingent on a corporations ability to profit, because in the end it will be a fickle thing.

Yes, because uncountable bureaucrats aren't fickle. Since we are talking about healthcare just look at the way the US treats it's veterans in the VA. In Washington DC, look how poorly the Metro system is run compared to other similar systems.

I have zero faith in the governmental complexes, in the US at least, to be more effective than properly motivated private industries. If you removed restrictions on selling insurance across state lines, allowed the creation of non-profit insurance corporations similar to credit unions or electrical cooperatives and made some changes to the sue-happy culture (tort reform) the vast majority of the US healthcare "issues" would balance out rather quickly. And far more effectively than layering on more bureaucracy.

Even without the above you are still seeing trends like: http://selfpaypatient.com/selfpayhealthcaremarket/

But for some reason in the US we seem to think health insurance = health care. That's pretty daffy! Health care is when I get to see a doctor. Running to insurance every time you have a sniffle is what is driving up costs - bureaucratic overhead and complexity (bureaucracies live in any large human powered organizations - not just governments!) in health care is truly bizarre. I watch my mother who has a background in healthcare dissect and destroy bills from hospitals for care given to my family members - often she gets the final bill down over %50 - but how many people have the expertise to do that? We've outsourced all knowledge about our healthcare to others and we are confused when the price and quality goes down? People spend more time researching a good deal on the latest electronic gizmo but have got the first clue about what it should really cost to get an X-ray or other medical procedure done?

Who's really at fault here?

> I mean Steve Jobs didn't care about anything but the profits when launching the iPhone

I have many, many, many criticisms of Steve Jobs as a human being, and as a leader, but I have literally never before read anyone claiming “he didn’t care about anything but profits”.

If by this you mean Steve Jobs killed a bunch of unprofitable products, and generally Apple as a company on his watch didn’t sell anything without a sizable markup above the marginal cost of production, I would trivially agree.

But your formulation basically reduces a complicated contentious figure down to an absurdly inaccurate caricature. He clearly cared very deeply about a lot of different things.

No need for a group think that corporations are evil. HN just likes to tear apart any premise presented to it. There are plenty of instances where they tear into the argument that corporations are evil and argue instead that capitalism is best-no regulation or taxes needed.

The argument that helping others will lead both to reduced social costs and improved economic participation is ripe to be made. These companies may be stumbling onto it through trial and error, but the economic world where people are not dying on the street will be more productive for us all. Whatever path gets us there gets us there.

> That's not true: they are making an investment in housing, based on economical considerations, that they expect to cover by reducing the health liabilities of the covered individuals.

And why, exactly, is that a problem?

Not sure what planet you live on, but here in the real world economics is the primary motivating factor for all societies.

> But it just sounds silly when you say they are "trying to help ease the homeless problem"

Why is it silly to say that? It's EXACTLY what they are trying to do since it directly affects their bottom line. They have contracts with the state to provide medicare - this let's them do it far more efficiently. If they can also do it while dramatically improving the lives of those they serve why shouldn't they get credit for that too?

It just boggles my mind that the Automatic assumption in this country is that all corporations or profit motives are immediate evil/immoral. Talk about real silly ideas...

Why does a health insurer have more money than what they know what to do with? How were they able to extract so much wealth if they were providing a competitive service?

Why don’t they just lower premiums so that more people can afford to see a doctor? Or provide better coverage so fewer people would go bankrupt when diagnosed with an “expensive” condition?

Why is buying real estate a better investment than saving lives?

>... providing a competitive service

They are not providing a competitive service. When I get my health coverage from work, I only have one or two options. And the prices are already set.

>...just lower premiums

In effect, that's what Medicaid does.

>...provide better coverage... expensive condition

This program is preventing the expensive conditions. That's better for everyone. I'd much rather not get sick than have enough money to pay for treating the sickness.

> Why is buying real estate a better investment than saving lives?

Because you get the same outcome (healthier people) for less money. It's win-win.

Why do you believe that they are only working on real estate?

Why do you think they are idiots?

> Right here there is a private company trying to help ease the homeless problem and everyone is just shitting on them for not doing the way they think they should or are getting angry at them for making a profit on it.

They aren't doing this because they care about the homeless.

They are doing it simply because they promised 13% to 15% annual returns and that Wall Street is unhappy with their Medicaid margins. They said it themselves.

They ran some numbers and realized that housing people made their shareholders money.

This is not the incentive you want to solve homelessness.

At some point you have to accept that the best is the enemy of the good. If housing the homeless makes shareholders money, then I say that's an acceptable tradeoff to give people homes. It's not a permanent solution, and it's not an ideal solution, but if it's putting roofs over peoples' heads, it's a move in the positive direction.

Except, this not a move in any direction. Leaving people living in the streets have been profitable so we left people living in the streets, now is more profitable to provide housing, if tomorrow is no longer profitable to leave them on the streets again, we will do so, because we maintained the same posture of just chasing profit.

And despite what GP might think, I welcome this as a nice way to ease people suffering, and I don't think "all corporations are evil". I just believe that people having a roof should not be tied to profit, and I disagree with the ideology pushed to our throats about how corporations chasing profit is good for everyone.

I mean even here it’s only profitable to provide housing for the most expensive people. They deliberately only Provide housing for people who cost >=2.5x mean because otherwise it’s not cost effective for them.

Even if long term it will get them off the streets, and potentially lower costs, the short term incentives don’t align.

Right... they found a way to economically optimize their product, which is to make/keep people healthy. The result is that the people mentioned are in better health, and that costs are lower.

Of course the company gets to keep some profit as a reward for figuring this out. That's how a market economy works!

If it helps the homeless and is cost effective, who cares what their motivations are?

The idea is not bad and some good will result from it. I think people may object to this as little more than a PR campaign ( I am not sure if you noticed, but insurance companies fare only a little better than the body of congress when it comes to public opinion ).

In short, they do some tax deductible charity from money I paid them ( or saved from not paying my claim ). Yay. All of a sudden, I feel so much more predisposed to not dislike healthcare industry.

But to your point, few people think not dealing with homelessness is good. I would just feel better if healthcare industry tended to my needs first..especially since I pay them to do just that.

edit. added anti-industry rant, changed some spelling

Income redistribution. Your health care premiums, deductibles are paying for this.

This is profitable goodness. This is what we should strive for as a society. I imagine it was quite a battle for the people who suggested this strategy against the naysayers. Listen to them here in this thread.

I hear envy. Envy of the good.

I applaud the insurance company and the employees.

It's so hard to do good things in the world today and they found a way in this capitalist mess we have created.

> This is profitable goodness. This is what we should strive for as a society.

Many people, including myself, would like society to take action because it's the right thing to do in of itself, not because it's profitable. We shouldn#t be having to find a profit motive for what should be a charitable act.

But if there is a profit motive towards what would be an act of charity then we should be relieved because profit means this will exist without the need to rile up public morality which is way more fickle than profit.

First, just to get this out of the way, I feel that taking action due to a profit motive is better than not taking action at all. Do we at least agree on that?

Second, getting people to take action is all about incentives. Those incentives might be profit motive, internal motivation (e.g. feeling righteous), etc, etc. It seems like our job, as a society, is to construct incentives that lead to the actions we want to see. There are various ways of doing that, and profit is definitely one of them that has the nontrivial benefit of being broadly applicable: lots of people are at least somewhat incentivized by money.

Now there are all sorts of ways incentives can go awry, and that includes profit incentives, so we do need to watch out of that. But apart from that it doesn't seem like there's anything inherently wrong with using a profit incentive to produce the action we want.

I don't dispute that action due to profit is much better than no action at all.

The sentiment in the post I replied to seemed to be that our society should be striving towards "profitable goodness". I think a good action should be taken because it is the good and right thing to do.

Not every good act or charity can be profitable, so if we pick "profitable goodness" as our society's goal then what happens to all the actions that aren't profitable?

I agree that not every good act or charity can be profitable.

I guess my take on it is that _if_, all else being equal, we can make charitable acts profitable, we should do that, because that's a more reliable incentive than relying on people to do the good and right thing, unfortunately.

In practice, "all else being equal" is often a very strong constraint!

This whole situation is just really messed up. What’s happening with this company is great, but we should not be in a position as a society where a homeless person can’t get housing until living on the street has made them so sick that it’s profitable for an insurance company to buy them an apartment. This particular solution is definitely a positive thing, it’s just a small bandage over a massive wound.

The end stage of neoliberal technocracy is this kind of Rube Goldberg management of suffering.

Homelessness is not going to be fixed till it is addressed at the federal level.

There are difficulties: there are different homeless population types characterized by Mental health, substance abuse, cost of living, unemployment, etc.

Also because of a reaction to heavy handed policies of the past, it’s difficult to institutionalize those who need mental health intervention.

That said we could at least tackle the easier population whose issue is an economic one.

I’m back in SF after a few years away. I had developed some thoughts about the homelessness challenges that Reno was facing, but when I landed in SF/Oakland it was immediately overwhelming, occurring on such a different scale and with such visibility.

I have no solid ideas of what “we need to do” but I know that in the European cities I frequent, it’s not like this. Other comments in this discussion touch on the social infrastructure that we’ve forsaken... the things that cost money, require continuity and depth in the community, and which... in other cultures, seem reasonable and required for their humans.

That said, I wonder about what the infrastructure looks like that helps people months before they hit the homeless force functions. There’s a funnel in the descent of resources... the homelessness activists can’t fix the infrastructure of social support and the economic cliff son many people teeter on.

I just spent a couple of months traveling, living in quarters not my own. Had a very minor health issue that was difficult to treat outside of my home base. It was inconvenient, then challenging, then debilitating, and ultimately pretty deflating. I had the resources to fix things, but if I had been financially constrained, my confidence and autonomy and self-esteem could have plummeted to hard-to-recover levels. I could feel how vulnerable other people probably would have been. And I know my friends in other countries would’ve shaken their head and muttered something about our system here in the US.

When you consider that it costs over $3000/month for a single bedroom apartment, the local government prevents the building of high-rise buildings, and the climate is comfortable outdoors year-round, it makes sense. It will continue to be this way as long as high density low income apartment high rises are not allowed to be built in large numbers in west SF.

I don't think this is a hot take, but if the market wants to build fancy apartments, let them build fancy apartments.

The reason there aren't less fancy, affordable apartments is people weren't allowed to build new apartments 20 years ago, which would have aged into affordable housing this decade.

Sounds good to me. Just let developers build.

I'm not sure I follow this line of thinking. The price is what it is, and everyone knows what it is. How can I feel sorry for folks that live there and just shrug and say "can't afford it". It's one of the most expensive cities on Earth. There is so much land in the US, so many cities with reasonable cost of living, etc etc. It feels like instead of doing the logical thing, we're building some class of caviar homeless. We can't just dictate that because people want to live there, we must provide them cheap or free housing in popular coastal cities.

Though the above does touch on what I think is really missing - a social safety net. I can see how high cost of living could lead to homelessness when you're trying to cling on after losing a job and can't find something to replace it right away. I fully believe we should help such folks, give them a safety net, just -not- in SF. There's tons of inland cities that are begging for people, let's solve two things at once. After they are back on their feet, if they want to move back - so be it.

The price is what it is because of excessive governmental regulations that have artificially driven up the cost of housing to astronomical levels.

At the end of the day, the homelessness problem in SF and other west coast cities is the result of the government looking the other way (i.e. not enforcing the law) combined with the fact that you can live outside most of the year.

> There is so much land in the US

The bay area isn't close to capacity. Even SF has 10,000 fewer people per square mile than NYC.

You're slightly misunderstanding me. I'm not saying we must provide people with cheap housing. I'm saying developers should be allowed to build it. For a profit. The government is preventing the free market from building more housing in SF, and it is making the problem much worse than it would be otherwise.

SF doesn't have to be a city just for the top 1%. But that is what it is becoming, directly because of restrictions on building too much housing.

But SF hasn't always had these prices, what if someone was born there and has their "social network"? Do they have to fuck off when that VC-funded Node.js programmer show up? So they move to a cheaper place, try to rebuild their life, but what if that's the next hot town for Porsche-driving Saudi-funded bros? "Sorry poor man, you need to leave yet again!".

It sounds harsh, but I'm not sure what the answer is. Think of it, if housing were completely free everywhere in the US, for everyone, most people would flock to the west coast. It has the best weather in the US, and San Diego in particular even the best in the world perhaps. You have an ocean nearby, rarely gets too hot or too cold, etc. The only way to prevent the absolute cluster-f that would be is with scarcity and thereby pricing. I don't live there, so I'm not being elitist...I'm being realistic. A major factor in why I don't live there is the cost. A rational person deals with such things, instead of shouting from the a tent in the street.

Edit to add - I don't think the situation of 'keep moving' is realistic. Of all the thousands of cities in the US, only a handful have really had a price explosion, and the reasons are obvious - coastal, nice weather, and limited space. I can't see that ever happening in say, Olathe, or Tuscaloosa, etc. Austin for example has had an explosion, but generally has the room to grow outwards in a reasonable way in my opinion.

So by your thinking, a lot of people when faced with the choice of 'Would I rather be homeless in San Francisco, or have a house but have to get on a train for an hour to see my friends' would choose the former?


But guess what, it works the other way too.

I grew up poor. Lucky to have a roof over my head. In a town where the local pasttime is hanging out in the Walmart parking lot and doing heroin.

Then I got a job at a big tech company. I had to beg and borrow just to move out here because it's so expensive to relocate. If I didn't have a friend out here, I would have had to sleep in the office until my first pay check (yeah it's fucked up).

Now my life and family are in a massively better place.

So what's the solution to homelessness? Relocate and/or retrain. It takes a lot of effort, but it's the only thing that works in a capitalistic country.

Can we declare a "war" on homelessness and redirect some military spending? Maybe instead of another fighter jets, nuclear aircraft carrier, or nuclear missiles, we can help our citizens instead.

I would be a lot happier paying taxes if the spending ratios were reversed.

Why do you think it's a money thing? Major cities already spend a lot of money on homelessness, and the richest cities are often struggling the most. It's not obvious to me that they'll succeed if they just get a bit more funding.

Remember that the most financially cost-effective solution to homelessness is death, and the next most cost-effective solution is exile.

Economics (and math) is only useful to life insofar as its axioms model reality well.

If you put a value on human life and model flux across borders, the metrics look different than purely $ spent for # of homeless present.

Absolutely. It'd be terrible to decide that we won't help the homeless because it's too expensive. What I'm questioning is whether modern homelessness programs could actually solve homelessness if we tossed a bunch more money at them.

Also, remember that in Government-speak, “spending money on Problem” often means: hiring a Administrator Of Problem, having them hire a Deputy Administrator Of Problem, hiring a 20-person staff who will run a Task Force On Problem, then paying all of them $200K+ plus a pension, and the outcome is a PowerPoint presentation on Problem that can be used to justify hiring more Administration Staff For Problem to do more studies.

See Also: where most public school funding goes.

That's because a large portion of homeless people have drug addiction and/or have mental disease. Just giving them a place to stay doesn't cure the root problem.

Most homeless folks do not have drug addictions or serious mental disorders. The majority of them just recently lost jobs or were evicted for not paying rent and live in their car for some time in between shelters and figuring out how to get housing. These transient or temporarily homeless make up the majority of the homeless population (~75%) and can definitely be helped out with temporary housing and other measures.

Chronically homeless folks make up only ~25% of the homeless population and of them less than half have mental illness or addiction issues. So, most chronically homeless people can be helped with housing and other measures.

My point is just that the crazy yelling homeless guy you see on the street in SF is a minority when it comes to the homeless population. You are just much more likely to see him because he is yelling on the street in SF. However, for every crazy homeless guy yelling, there are >5 people living in their cars who just need some temporary help to get back on their feet.

Homeless people, like everybody else, usually have many problems. You can fix their problem of not having a home by giving them a home. Once somebody has an address and a little more stability, your chances of dealing with other issues goes up.

Yeah the issue is that housing them together puts the woman down on her luck next to the guy with a violent drug addiction and then you have to kick him out when he starts attacking people.

>Just giving them a place to stay doesn't cure the root problem. reply

I suspect that this is because the 'place to stay' usually comes with various strings attached. I doubt there are many homeless people who would choose to sleep under a bridge rather than in a bed (though not doubt there are a minority who would).

The strings attached generally ensure the place meets a minimum standard of tolerability. For example, while drug abuse certainly can't be cured at a snap of your fingers, it can't be tolerated in communal housing situations either; any sane person would rather sleep under a bridge than a bed in a crack house.

> It's not obvious to me that they'll succeed if they just get a bit more funding.

So the options are to cut social programs, leave them as they are now, or expand them. Which option would you guess has the best chances of helping more people?

The fourth option, and the one that seems most promising to me, is to laterally shift social programs. Change the way they work in ways that aren't about the amount of money they can spend.

People might be surprised to discover how many of the homeless are veterans of one of the actual wars, possibly with injuries or PTSD.

> Homelessness is not going to be fixed till it is addressed at the federal level.

lol - it can't even be fixed at local levels where there is very close and local pressure and you expect it to be fixed at the totally remote and abstracted federal level?

Want to fix homelessness and many other problems? Let go of this "two party" BS and stop voting people back in who change nothing or allow problems to continually worsen.

It's really that simple. Until politicians are going to be held accountable and know that just because they have a D or R behind their name they can't take your vote for granted, why should they worry or care about opinions expressed in threads like this one?

People might actually have to pay attention to what's going on around them, though. People currently not in "the game" might have to get out of their comfort zone and get involved. Perish the thought.

Insanity - doing the same thing over and over while expecting a different result. As the old comic strip Pogo once opined: "We have met the enemy and He is Us".

Enough blaming other people or expecting some other fair godmother in the sky (ie. "federal level") to wave a magic wand and solve all our problems. It isn't going to happen and to expect otherwise is truly irrational.

What leads you to conclude it won't be fixed till it's done at the federal level?

Nitpick: Title should read "America's Largest Private Health Insurer." America's largest health insurer is the government, via Medicare, Medicaid, and similar programs.

I'm interested in seeing how this corporate-funded/corporate-managed program compares to the many housing assistance programs that are funded by public funds or private donations.

I'm sure there are plenty of businesses out there that already help fund such programs indirectly by donating to charities that run affordable-housing programs.

But it will be interesting to see what happens when the businesses are running the programs directly, cutting out the nonprofits as a middleman.

My somewhat pessimistic take is that any efficiencies that might be gained by applying more rigorous business methods will be offset by lack of domain knowledge and for-profit perspective -- seeing a homeless person as a problem to be solved rather than a person to be served.

That said, I'm all for large corporations trying their best to address homelessness and housing insecurity, even if they do so imperfectly.

To nitpick your nitpick - this "private" insurer is actually a government contractor, administering Medicaid for individual states.

> The research and development lab for this experiment is a pair of apartment complexes in a down-at-the-heels corner of Phoenix called Maryvale. Here, Brenner is using UnitedHealth’s money to pay for housing and support services for roughly 60 formerly homeless recipients of Medicaid, the safety-net insurance program for low-income people. Most states outsource their Medicaid programs to private companies such as UnitedHealth, paying the insurer a per-head monthly fee—typically $500 to $1,000—to manage members’ care. The company’s 6 million Medicaid members produced $43 billion in 2018, almost 20% of total revenue.


> To keep down costs and avoid the difficulty of running a health-care system, most states contract with UnitedHealth and its competitors to establish what are called Medicaid managed-care programs. In 2017, $264 billion, almost 50¢ of every Medicaid dollar, went toward care for the 54 million people on private Medicaid plans.

> This is just sad. This is just stupid,” Brenner says. “Why do we let this go on?”

Because this is practically textbook definition of a perverse incentive.

What about healthy homeless people? Do they get homes? We are encouraging people to be sick and to a abuse the ER. And what about all of the working poor who are doing the right thing, but still have to pay half of their income in rent?

The reason we don't provide homes is you can never just provide homes to the ones who'would have abused the ER' but instead have to provide them to all homeless.

Also, as sad as it is to admit, there is a portion of homeless who you could literally buy a house for, and they will still end up homeless.

I hope I am wrong and this program works out.

On the contrary, a lot of homeless people’s primary impediment is the fact that they don’t have their own living space. There‘s a lot of evidence that “housing first” is an effective way of combatting homelessness [1].

More broadly, unless a system is truly overwhelmed by bad actors, I’m inclined to not worry about them at all. Is it really that important that we only help anyone who “truly” need it — and burn the whole system down to that end?

[1] https://en.wikipedia.org/wiki/Housing_First

> More broadly, unless a system is truly overwhelmed by bad actors, I’m inclined to not worry about them at all.

It's more expensive to means test many of these programmes than to just hand the money/benefits out.

But it's a common human bias that cheating must be prevented, even when it doesn't make sense in the aggregate.

It's a cognitive limitation we have to get beyond.

This is why americans don't have universal healthcare, because they are obsessed with making sure that no one gets care who doesn't 'deserve' it as much as they do, even though it would actually benefit them in the aggregate if everyone in society was cared for.

> Is it really that important that we only help anyone who “truly” need it — and burn the whole system down to that end?

The welfare queen has been replaced by means testing.

This shouldn't be a new thing; it was understood in greater detail as "hierarchy of needs" in the 1940s.


The reason that we can and should do housing first is for two reasons.

First, it's cheaper than any of the alternatives. From the NEAH, a paragraph describing those savings:

> Finally, permanent supportive housing has been found to be cost efficient. Providing access to housing generally results in cost savings for communities because housed people are less likely to use emergency services, including hospitals, jails, and emergency shelter, than those who are homeless. One study found an average cost savings on emergency services of $31,545 per person housed in a Housing First program over the course of two years.xii Another study showed that a Housing First program could cost up to $23,000 less per consumer per year than a shelter program.

Next, it's just extremely effective. Being homeless over any period of time negatively affects mental well-being. The longer that you are homeless, the worse this gets, and the harder it is to get out. Housing first isn't just the cheapest solution, it actually solves the problem of homelessness directly and helps people to heal their mental state. You can find this information all over the place.

Ultimately, we should have rapid housing-first policies for everyone who ends up homeless, but that will require the American public to give up our normally punitive cultural attitudes so that the data can win, but we haven't done the best job ending other punitive systems despite their total failure, like the war on drugs.

Quote is from: http://endhomelessness.org/wp-content/uploads/2016/04/housin...

I really, genuinely hope I am wrong and that this program works out. I am 100% on board for expanding it if the trials works.

First, you risk creating formerly-homeless slums. Any landlord that accepts homeless ends up upsetting paying tenants. As much as we love to help homeless--there is a NIMBYism here. Most of us are all for helping the homeless until we are finding needles in bushes and our kids are accosted by drunkards.

I hate to be so harsh, but the bleeding hearts would be a lot more skeptical of housing the homeless if they started moving into their neighborhoods.

Second, municipalities that offer generous support for homeless may end up with a greater homeless population because of immigration from other cities/towns. There isn't much of a solution for this so long as homelessness is tackled on a local basis.

> I hate to be so harsh, but the bleeding hearts would be a lot more skeptical of housing the homeless if they started moving into their neighborhoods.

I absolutely agree with this, and we can find data that supports this concept quite aggressively throughout US history, with one example being that racial integration in schools stopped when it came to northern cities. It was fine as long as we pretended it was a southern problem, but today the most racially segregated schools can be found in major urban centers.

Ultimately, most decisions are made emotionally, and in order to move human society to the next stage of ethical development, we will need to combine an ethical baseline of human welfare (Singer style reverse utilitarianism comes to mind) with the application of data and statistics. Unfortunately, thinking statistically is difficult, and the human mind is capable of rationalizing emotional decision making before the thought it complete.

Ultimately the problem of homelessness is easily solvable from some pure mathematical/economic standpoint, but fails for the same reason that supply/demand is not a law of human society: it all depends on rational actors, a unicorn-like construct.

It doesn't mean that we cannot apply data to our decision making, but it _does_ mean that we need to work our hardest to defend decisions based on high quality data, high quality data analysis, and well-replicated science. Housing first is an idea where all of the early analysis has been extremely promising, and the NIMBY-ism that surrounds it should be called out for what it is: emotional decision making that disregards data and science resulting in a lack of compassion for people. I will say it's unethical, but it's also completely and totally human.

> The reason we don't provide homes is you can never just provide homes to the ones who would have abused the ER' but instead have to provide them to all homeless.

This is the exact reason more sensible systems do, in fact, try to provide homes to everyone. And various sorts of topup payments to those unable to afford their rent.

it is not sensible to provide homes to everyone, the silent homeless, the ones you don't see, are the ones that are more easily helped. just identifying those with small children would go a long way

it is the homeless with mental issues that you do see that we cannot just "give them a home" because it won't help them and you likely cannot even get them to stay in one anyway.

States are stuck behind the issue of having to prove someone is a danger to themselves or others just to confine someone and it may be required to do so to treat, see O'Connor vs Donaldson for most of it . yet you will find organizations tripping over themselves to block this on case by case basis which makes the cost untenable to nearly everyone meaning in the end they don't get help.

So it is up to Congress to define how it is determined that someone is a danger to themselves or other so it can withstand a court test and even then you are bound to have suit after suit using cherry picked cases. There is too much money to be made in the legal profession to let mental health cases be treated.

Courts have made stripping a person of rights harder. Typically, I'm not inclined toward slippery slope arguments. But this is a case where erring on the side of caution seems warranted.

> more sensible systems

Can you give me an example of one of these systems?

Salt Lake City had that policy for a while, but funding is running out.


> what about all of the working poor who are doing the right thing, but still have to pay half of their income in rent?

I thought that the claim was that everybody got free housing to correct for perverse incentive structures. The SLC program required homelessness and disability- thus having a perverse incentive structure.

I can see now that I misread the context- specifically referring to ER abusers- which makes this a very good example.

I am the one who posted the comment you quoted.

I'm not sure if you're agreeing or disagreeing with me. But I had heard of the Salt lake City program years ago, and expressed doubts about it online (unsurprisingly my opinions were not very popular).

While I hope it works out, there are always externalities to doing the right thing (and housing homeless definitely is the right thing).

Residents hate living in buildings with homeless neighbours. As sympathetic as we should be, once paying tenants start finding needles in bushes or drunkards stumbling around at night, they are not so enthused. There is a degree of hypocrisy in that the liberals who want to house-first are seldom the ones who want to house-next door.

Second, municipalities that offer generous support for homeless may end up with a greater homeless population because of immigration. There isn't much of a solution for this so long as homelessness is tackled on a local basis.

Social housing in the rest of the developed world? It’s more or less the norm relative to the US’ punitive deprivation.

Theoretically in the UK local councils have an obligation to house anyone who has a "demonstrated connection with the area". There is also a "housing benefit" system which pays rent for those who cannot afford it.

I say "theoretically" because it doesn't entirely work and there are still a gradually increasing number of rough sleepers, but it does at least keep children from living on the street.


> In 2015 there were 4.8 million families in receipt of Housing Benefit. Most families –2.7 million – claiming Housing Benefit are workless and living in the social rented sector (this includes pensioner recipients). Some 1 million were workless and living in the private rented sector. The remaining 1.1 million were in working families, half in private rented and half in social rented housing.

The UK has been testing the reverse strategy to that described in the article. As well as the forty year war on public housing [1], the last decade has seen cuts to safety nets, social services, social care for the elderly and other 'soft' forms of care. The burden inevitably falls on the emergency services and the NHS and this is not only an ineffective way of caring for people but also, as the article notes, a very expensive way to fail.

[1] https://www.lrb.co.uk/v36/n01/james-meek/where-will-we-live

topup payments (in the absence of rent control) don't work because they are just past-throuhgs to landlords.

As terminology, "homeless" is technically useless. Whenever and wherever it's used, someone can strawman "homeless" onto people with a different set of circumstances than those being talked about.

The population in the program is not homeless in the sense of "I call this town home." ER frequent flyers are frequent flyers because they live near a particular ER.

Yes, there are people who provided an apartment will leave to sleep in the bushes. "Homeless" lumps them together with people who won't. It lumps them together with people living in their cars. Squatting in buildings. Couch surfing among relatives. "Homeless" tags people lacking shelter security with the mental illness, panhandling, substance abuse.

The problem with "homeless" is it lumps people with intractable circumstances with people with very tractable problems. "Homeless" pretends there is a universal problem and therefore demands universal solutions. But the spectrum goes from passed out on the sidewalk to $200/night RV parks. So does the need for resources and services.

This program is not for everyone. It won't meet everyone's needs. That doesn't make it a moral hazard.

>The reason we don't provide homes is you can never just provide homes to the ones who would have abused the ER' but instead have to provide them to all homeless.

The reason we don’t provide homes to the homeless is they it’s a direct challenge to Capital’s control and capture of land rents and undermines the ideology used to pull the higher-earning segments of labor into alliance with them. Homelessness functions as both an implicit threat against the “middle class,” should they step out of line, and likewise as evidence of their moral superiority and judiciousness relative to their “lessers.”

This is the sort of thing Tim Faust talks about in the concept of health justice. If we move people into a single payer system that takes care of them long term, it will suddenly be obvious that we need to do more stuff like this as it's more expensive and stupid not to.

"In 1986, Congress enacted a law to bar hospitals from turning away patients who are unable to pay. Any hospital with an emergency room that participates in federal health programs must evaluate and stabilize every patient who comes through the door, including those who are uninsured, indigent, addicted to drugs, or mentally ill."

That's part of what pushed the price of health care up - huge numbers of people going to fully equipped emergency rooms for problems that could be handled by a GP or a nurse-practitioner. It's free health care for all, done all wrong.

I want all the insurance companies to get together and go a calculation and see if banding together and opening a nationwide series of no questions asked homeless shelters with meals would bring down their costs at all. They could each contribute an amount that was proportional to their market share or something similar. Off the top of my head I want to say it wouldn't be worth it, but if this article is accurate, and the costs for insurance companies are actually going down, then who knows.

Conversely, if this helps one portion of the economy that greatly then it will surely benefit the entire economy even more - or at least equally.

Precisely why I would say this should be a governmental system of bare essentials living and housing. Every dollar spent on people with nothing will be spent by those people and increase aggregate demand, economically, and health, at a societal level.

Dr.: "Hello, Mr. Smith, here's your Rx: one home."

If that's the reframe it takes, more power to ya.

It's uneconomical to let the homeless remain homeless. Such a blindingly simple fact.

Im going to go against the grain here but I think it might be good to be able to get good data on homeless populations. Much data now is not accurate. At the very least this will provide key data points that could help resolve and better serve these populations

One major issue with counting the number of people who are homeless is that most of them are not on the street, but are instead relying on friends and family for shelter. The people who live on the street are the spear tip of a much larger and broader group of people who are facing various degrees of crisis in finding housing. It is difficult to come up with a method that captures data about all the people who, for example, were evicted and spent several months living on couches and in their car.

Right, this is because the homelessness industry needs to justify its existence with ever inflated numbers. Someone down on their luck and staying with parents or siblings is not homeless and does not need intervention for shelter. In general, we should encourage extended family living as its economically easy and socially good. These 'homeless' need economic help, not shelter, and its likely that, due to their proximity to family or friends, this help can be provided in large part by the private sector as long as government policy encouraged the creation of jobs. Really, when civilians say homeless they mean what researchers call unsheltered, the subset of homeless living on the street. This group has much higher needs, typically around mental health and drugs

Why is that a major issue? The regular Census can capture information like "did you provide transient housing in the past year" , and "if you hae had a transient resident living with you, please contact XXXXX so we can directly include that person in the Census"

There's a small portion of chronically homeless that don't want to be in any systems though; whether it's because they are paranoid, have a criminal history, have a debt or potential of, etc.

I could have guessed it was UnitedHealthcare before I clicked the link. Maybe instead of buying apartments they could spend a little money on their billing system, which has literally fucked up every single medical expense I've ever had.

How long before getting one of these requires accepting smart home monitoring of things like your medication compliance?

"Our cameras caught you smoking, we're revoking your housing and your health insurance for lying about being a non-smoker."

Quite likely. People are very keen on this kind of thing for punitive reasons - being on the street will of course kill someone far quicker than smoking. "You have to give up smoking for the good of your health or we'll hasten your death" is the sort of thing Kafkaesque systems are built from.

Here’s hoping that’s not how it goes. But maybe blow back from that sort of homeless fleecing and privacy invasion would result in proper governmental homeless assistance. (But people currently have a high tolerance for privacy invasion so...)

There's definitely a faction demanding more cruelty to the homeless; they routinely have their property taken and destroyed as a sort of extra-legal punishment for being homeless in the "wrong" place.

"We're willing to help the homeless, but only if we're allowed to control them to satisfy our own mistaken notions of what helps people (and more subliminally, our egos)."

This actually makes a lot of sense. A large insurer is in a position to actually see the end-to-end costs and since they are regulated in such a way as to have to pay them, this turns out to be the best way to run their company.

What a brilliant idea - focus on prevention and not just putting the fire out.

It makes far too much sense to ever gain popularity - and whoops, I just looked at the majority of comments in this thread and am not disappointed :(

Smart idea, that actually saves them money.

> Brenner shows me data on a patient named Steve, a 54-year-old with multiple sclerosis, cerebral palsy, heart disease, and diabetes.

No patient confidentiality?

I'm not sure why you're downvoted, this was a PHI breach.

Good question. I usually see highly upvoted articles about the evils of widespread data collection but apparently it's totally fine to publish confidential medical information on the news and make examples out of patients.

Names are usually changed in these circumstances.

When they change names, they usually write something like:

> Some names and identifying details have been changed to protect the privacy of individuals.

The author did not write that. I don't see any evidence the patient consented to have his case published either.

Even disregarding the name, there's almost certainly enough info to identify the person here.

Steve who? No PII has been compromised here.

One would hope that "Steve" is a pseudonym but I wouldn't count on Bloomberg to do the responsible thing in this case.

The combination of homelessness, first name, age, insurer, rough location, and a laundry list of major diseases is absolutely PII.


> It was found that 87% (216 million of 248 million) of the population in the United States had reported characteristics that likely made them unique based only on {5-digit ZIP, gender, date of birth}. About half of the U.S. population (132 million of 248 million or 53%) are likely to be uniquely identified by only {place, gender, date of birth}, where place is basically the city, town, or municipality in which the person resides. And even at the county level, {county, gender, date of birth} are likely to uniquely identify 18% of the U.S. population. In general, few characteristics are needed to uniquely identify a person.

How many 54-year-old Steves exist? How many of those have multiple sclerosis, cerebral palsy, heart disease, and diabetes at the same time? How many were homeless?

I've seen people identify patients using far less information than that. It's a small world.

Doesn't MS cause the rest of those?

UHC still made 12.68 billion net income in 2018.


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