The Bureaucratic Nightmare of Incrementalism

Source: Meagan Day, Jacobin, January 17, 2018

America’s patchwork system of social services makes it hard to care for ourselves. ….

….It’s actually less expensive to spend public money on shelter instead — and meanwhile, people who receive shelter see significantly better health outcomes, which can help them attain overall stability.

Some cities and states have recently acknowledged this calculus. Salt Lake City’s enormously successful Housing First initiative has reduced chronic homelessness in the city by 91 percent by providing housing to homeless people without requiring proof of employment, treatment, or counseling — the principle being that housing comes first, making other services easier to administer. Houston, too, has seen major improvement in both homeless people’s health outcomes and the city’s budget with its Integrated Care for the Chronically Homeless program, which uses Medicaid funding to provide permanent supportive housing units to homeless people who make at least three emergency room visits over two years.

These initiatives are a big step in the right direction, since they take into account the close relationship between health care and housing security — issues that are usually siloed to detrimental effect. But programs like these face serious obstacles. In particular, it’s extremely hard to coordinate among a kaleidoscope of separate federal, state, and local agencies, social program stipulations, and funding streams..;…