Human Services News

The New Yorker: PRINTABLES

Why problems like homelessness may be easier to solve than to manage.

Murray Barr was a bear of a man, an ex-marine, six feet tall and heavyset, and when he fell down---which he did nearly every day---it could take two or three grown men to pick him up.

On the streets of downtown Reno, where he lived, he could buy a two-hundred-and-fifty-millilitre bottle of cheap vodka for a dollar-fifty.

If he was flush, he could go for the seven-hundred-and-fifty-millilitre bottle, and if he was broke he could always do what many of the other homeless people of Reno did, which is to walk through the casinos and finish off the half-empty glasses of liquor left at the gaming tables.

In the fall of 2003, the Reno Police Department started an initiative designed to limit panhandling in the downtown core.

He and Johns spent at least half their time dealing with people like Murray; they were as much caseworkers as police officers.

O'Bryan and Johns called someone they knew at an ambulance service and then contacted the local hospitals.

In those six months, he had accumulated a bill of a hundred thousand dollars---and that's at the smaller of the two hospitals near downtown Reno.

The first of those people was Murray Barr, and Johns and O'Bryan realized that if you totted up all his hospital bills for the ten years that he had been on the streets---as well as substance-abuse-treatment costs, doctors' fees, and other expenses---Murray Barr probably ran up a medical bill as large as anyone in the state of Nevada.

For those hard-core few who did need help, meanwhile, the medicine that helped the middle wouldn't be nearly strong enough.

It was an assumption that bred despair: if there were so many homeless, with so many problems, what could be done to help them?

Then, fifteen years ago, a young Boston College graduate student named Dennis Culhane lived in a shelter in Philadelphia for seven weeks as part of the research for his dissertation.

It's a matter of a few hard cases, and that's good news, because when a problem is that concentrated you can wrap your arms around it and think about solving it.

The bad news is that those few hard cases are hard.

They are falling-down drunks with liver disease and complex infections and mental illness.

They need time and attention and lots of money.

But enormous sums of money are already being spent on the chronically homeless, and Culhane saw that the kind of money it would take to solve the homeless problem could well be less than the kind of money it took to ignore it.

Murray Barr used more health-care dollars, after all, than almost anyone in the state of Nevada.

The leading exponent for the power-law theory of homelessness is Philip Mangano, who, since he was appointed by President Bush in 2002, has been the executive director of the U.S. Interagency Council on Homelessness, a group that oversees the programs of twenty federal agencies.

In the past two years, he has crisscrossed the United States, educating local mayors and city councils about the real shape of the homelessness curve.

So far, Mangano has convinced more than two hundred cities to radically reëvaluate their policy for dealing with the homeless.

They had a very difficult group of people they couldn't reach no matter what they offered.

So I said, Take some of your money and rent some apartments and go out to those people, and literally go out there with the key and say to them, 'This is the key to an apartment.

" Power-law homelessness policy has to do the opposite of normal-distribution social policy.

We don't give only to some poor mothers, or to a random handful of disabled veterans.

We give to everyone who meets a formal criterion, and the moral credibility of government assistance derives, in part, from this universality.

Being fair, in this case, means providing shelters and soup kitchens, and shelters and soup kitchens don't solve the problem of homelessness.

Solving problems that have power-law distributions doesn't just violate our moral intuitions; it violates our political intuitions as well.

It's hard not to conclude, in the end, that the reason we treated the homeless as one hopeless undifferentiated group for so long is not simply that we didn't know better.

Power-law solutions have little appeal to the right, because they involve special treatment for people who do not deserve special treatment; and they have little appeal to the left, because their emphasis on efficiency over fairness suggests the cold number-crunching of Chicago-school cost-benefit analysis.

There are some people who can be very successful members of society if someone monitors them.