5 ms·

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 E

by ggm 2y ago

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.

snarf21 2y ago
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/million-dollar-homeless-patient https://centerforhealthjournalism.org/our-work/insights/mill...
- deleted 2y ago
  [deleted]
- mikepurvis 2y ago
  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.
  - davidgay 2y ago
    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.
    - mikepurvis 2y ago
      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.
    - alluro2 2y ago
      $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).
    - tehwebguy 2y ago
      It’s like a tax scam right? Or is it like once in a blue moon they get wealthy whale without insurance?
sarchertech 2y ago
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.
- lmm 2y ago
  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 2y ago
    Is this not only reductive reasoning, but also both devils advocating, and functionally an artefact of the US health system economics?
    - lmm 2y ago
      > 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.
      - ggm 2y ago
        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.
galimalint 2y ago
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.
- ggm 2y ago
  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?
  - galimalint 2y ago
    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.
    - ketzo 2y ago
      > 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?
      - edmundsauto 2y ago
        SF budget is city and county services, fwiw. It is good to make apples to apples comparison.
Aunche 2y ago
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.
ErigmolCt 2y ago
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)

by ggm 2y ago

snarf21 2y ago

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/million-dollar-homeless-patient https://centerforhealthjournalism.org/our-work/insights/mill...

deleted 2y ago
[deleted]
mikepurvis 2y ago
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.
- davidgay 2y ago
  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.
  - mikepurvis 2y ago
    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.
  - alluro2 2y ago
    $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).
  - tehwebguy 2y ago
    It’s like a tax scam right? Or is it like once in a blue moon they get wealthy whale without insurance?

sarchertech 2y ago

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.

lmm 2y ago
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 2y ago
  Is this not only reductive reasoning, but also both devils advocating, and functionally an artefact of the US health system economics?
  - lmm 2y ago
    > 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.
    - ggm 2y ago
      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.

galimalint 2y ago

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.

ggm 2y ago
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?
- galimalint 2y ago
  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.
  - ketzo 2y ago
    > 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?
    - edmundsauto 2y ago
      SF budget is city and county services, fwiw. It is good to make apples to apples comparison.

Aunche 2y ago

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.

ErigmolCt 2y ago

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)