The City of Palliative Care

<i>“The city is way too easy for people with nothing to get by,” she said. “That’s why I’m still here nine years later. You get by with doing drugs and suffer no consequences. I like it here.”</i><p>No doubt, chronic homelessness is a problem in San Francisco. And there&#x27;s truth in this quote, from a fentanyl-addicted homeless person.<p>But I hesitate to base my entire view on the situation from a hot take of conversation with someone deep into drug abuse. They will feed the addiction first, and only then go on to address their other needs.<p>The article leaves me wanting to hear from people in recovery. Perhaps they are harder to find. Or perhaps (even more likely) I misread the article.<p>Nevertheless, I hang on to the <i>real</i> money quote:<p><i>The bitter joke of the story is that in San Francisco, the mother works full-time, drains her savings, but still can’t make ends meet and is forced to move away.</i>

&gt; To get to this number, I averaged the number of annual homeless in San Francisco since 2013, which is 6,864, and averaged the city’s homeless budgets from 2016 through 2023 (I could not find prior budgets), which is $486 million per year. That’s $632,000 per homeless person per year<p>No, that&#x27;s $486M&#x2F;6864 = $70,800 per homeless person per year. It&#x27;s only after multiplying by the 9 years she lived in SF do you get $630k. It&#x27;s a lot, and probably poorly spent, but probably only 10x what is reasonable.

I wish this post had continued with the analogy rather than pulling the ripcord with &quot;<i>the government has inadvertently created a thing of immense cruelty: this is a system that takes in people and slowly, but surely, kills them.</i>&quot;.<p>Hard drug addiction can be seen as a terminal disease. The main cost to the city is truck rolls for EMT response. $100k&#x2F;yr is much more than it costs to feed and house an individual in basic accommodations. The main cause of overdoses is purity&#x2F;potency. Taken together, it seems like treating the situation as a public health problem with a palliative approach would save the city a lot of money as well as making life better for those trapped in it. Especially if SF could then turn around to the state and claim healthcare reimbursement for doing so.

With a spouse that works in palliative medicine, I really wish the author had chosen a different phrase. Please don’t get the idea that palliative care is only for the dying. Everything else about the article is spot on.