Veterans of America’s recent wars left homeless; abused women and their children seeking nightly shelter; out-of-sight medical system costs; rising tides of bankruptcies. What do they have to do with each other – and America’s current health care debate?
A lot, it turns out.
By failing to guarantee a roof over every American’s head, we’ve failed the test – as Housing and Urban Development Secretary Shaun Donovan puts it – of “a civilized society.” On a typical night, 650,000 Americans have no place to call home.
We created this crisis ourselves, by the states emptying out their mental hospitals and cities demolishing thousands of low-income rental units. The result was a huge gap in affordable shelter.
Plus, by failing to restrain medical system costs or guarantee care for all Americans, we’ve forced thousands of families to go into bankruptcy. Today, alarming numbers are being forced to take to the streets where their health is even more endangered by extremes of pelting rain or stone-cold nights, unsanitary conditions and sometimes violence.
Yet as grim as all this sounds, it’s possible to see strong glimmers of light.
One positive: Fewer cities are relying on a strict “law-and-order” approach – trying to sweep the homeless off the streets or out of public parks through flashlight inspections, forbidding people to sleep on public sidewalks, or making arrests for public intoxication. So-called “getting tough” approaches just displace the problem to other neighborhoods.
Second: It’s starting to dawn on more people that the best cure for homelessness is shockingly simple: Provide the homeless with a home.
It’s a myth, says Donovan, that anyone wants to be homeless. Providing people with all manner of fragmented services – overnight shelter, substance abuse, social and mental health and emergency medical services – easily runs up massive public costs. But it’s appallingly ineffective because it doesn’t give the homeless a place to live.
Take one of the toughest groups to treat – those homeless who are chronic alcoholics, often with serious mental illnesses. Seattle is saving $4 million-plus a year with its 1811 Eastlake project, near the Space Needle. This $11 million facility has opened its doors to 75 men. There’s no sobriety test for admission; virtually all the men keep on drinking, though somewhat less. Voluntary counseling and nursing services are provided.
Is there some Seattle opposition to allowing alcoholics to drink in government-subsidized housing? Yes. But 1811 Eastlake’s residents, in the year before the facility opened, collectively spent 1,200-plus days in jail and visited the local medical center more than 1,100 times at a cost to taxpayers of $3.5 million. In their first year at 1811 Eastlake, their days in jail were cut almost in half. With a big reduction in hospital visits, medical costs dropped 40 percent.
This experiment, says Ron Sims, a former Seattle resident and now HUD deputy secretary, “flat-out works.” If widely replicated, it could deliver “hundreds of millions of savings.”
A third new positive: The Obama administration’s pledge to develop and implement, in Donovan’s words, a multifaceted “federal strategy to prevent and end homelessness in our time.”
Part of it is a special focus on veterans, who comprise 15 percent of the nationwide homeless population. There are now more homeless Vietnam-era veterans than troops who died in that war – even as Iraq and Afghanistan veterans start to join them on our streets. Recovery funds are being used to house veterans more quickly, and there’s a new targeted partnership – HUD-issued housing vouchers combined with case management by the Department of Veterans Affairs.
The new administration’s efforts get high marks from Nan Roman, president of the National Alliance to End Homelessness. “They’re serious about breaking down the cylinders between the agencies,” she notes, praising not just the HUD-VA collaboration but the housing agency’s outreach to coordinate efforts with other federal departments such as Health and Human Services on medical and welfare issues.
All the glimmers of light will remain dim, however, if the push for a comprehensive national health plan fails. Medical expenses – resulting from lack of insurance – are the top factor pushing people into personal bankruptcies, often followed by homelessness.
Then there’s the anomaly that many poor people – including non-disabled, childless adults, even those with health problems – aren’t covered by Medicaid. One study showed only 25 percent of single homeless adults covered by Medicaid. Covering these populations in the new legislation may look like an expense, but in the end, could wind up saving billions of dollars.
Yet the reverse is also true: The billions the administration began to spend in recovery stimulus funds to correct the country’s alarming shortage of low-income rental housing – and now wants to expand to house more and more of our homeless – is also essential. In Donovan’s words: “Simply put, if we want to tackle health care reform – if we want to lower costs – we must tackle homelessness. It’s that simple.”
Neal Peirce’s e-mail address is nrp@citistates.com.