
America’s Largest Health Insurer Is Giving Apartments to Homeless People - SQL2219
https://www.bloomberg.com/news/features/2019-11-05/unitedhealth-s-myconnections-houses-the-homeless-through-medicaid
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hpoe
Wait why are so many people shitting on this idea. This seems to me to be
exactly what people are always comparing about, "big companies only care about
the bottom line they don't care at all about suffering." Right here there is a
private company trying to help ease the homeless problem and everyone is just
shitting on them for not doing the way they think they should or are getting
angry at them for making a profit on it.

If we constantly dump on every person and company who makes any attempt to
help address a social problem simply because it doesn't solve the whole
problem or because they don't do it in the way we want or think is effecient,
people are going to stop trying to do anything.

Sure maybe this program didn't solve homelessness in Phoenix and maybe it
didn't help significantly reduce the percentage of people that are homeless
but you know whose life it did significantly help? Steve and every other
person who got a home, so sure maybe this didn't change homelessness in
America radically but it did radically change homelessness for those people.

~~~
asdfman123
I think this is a positive development, but to me it highlights how sad it is
that so much of America sees investment in its own people as "wasteful
spending."

Protecting the most vulnerable people and ensuring people don't fall into the
trap of poverty is an _investment_ that should occur at the governmental
level. There are many such governmental investments that would alleviate
serious long-term problems.

My biggest frustration with the American government and American business-
oriented culture in general is a lack of long-term thinking. We know that "a
stitch in time saves nine," but instead we decide to go the nine stitches
route. Put more nerdily, people do not properly respect the implications of
exponential growth.

“A society grows great when old men plant trees in whose shade they know they
shall never sit”

\-- Greek proverb

~~~
AlexB138
America makes more sense when you consider that Civil Society (as in the third
sector) is mostly dead, and what is left is extremely fragmented. There is no
cohesion, very little shared culture, and a lot of outright animosity between
groups. They aren't countrymen, they just happen to live in the same legal
boundaries.

When people in this mindset see homeless they don't think "This is a member of
my society that is suffering", they see an Other. Put another way, plenty of
old men want to plant trees, they just only want their own group using the
shade.

~~~
asdfman123
Racism. It's mostly driven by racism but we're not allowed to call it that.

~~~
rayiner
Not allowed to call it that since when? It seems to me that we’re allowed to
call everything racism these days. E.g. Warren talking about “environmental
racism, economic racism, criminal-justice racism, health-care racism.”

I don’t disagree with your point in a certain sense, but your framing is
fluffy and unsatisfying. America is one of the least racist countries in the
world. For example, 82% of French support banning Islamic head coverings,
versus just 28% of Americans: [https://www.pewresearch.org/fact-
tank/2010/07/14/french-supp...](https://www.pewresearch.org/fact-
tank/2010/07/14/french-support-for-ban-on-full-islamic-veil). I’m a
Bangladeshi married to an Oregonian. (Not like Portland, like rural Oregon
coast.) I’ve lived in red states, visited rural parts of the country, and
currently live in a precinct that voted for Trump. The degree to which
Americans are willing to accept you into their communities, given minimal
attempts to conform, never ceases to amaze me. (And when I hear about how
“profoundly racist” America is, I can’t help but think sheepishly: “man, what
would they say about Bangladesh?”)

So how much explanatory power does leveling charges of racism really have?
Clearly racism exists and is a bad thing and produces many problems. But
racism is also a structural problem endemic to humans, not anything unique to
Americans. How much can you really rely on racism alone to explain the level
of division within American society?

~~~
lazyasciiart
A lot of divisions in America are driven by generations of policy based on
racism - from redlining, white flight and zoning policies that changed the
structure of cities and are now used as weapons against newcomers and change,
to the very existence of many cities and governments that were created in
order to be a separate white space from the larger cities nearby, and the use
of these boundaries to avoid funding the basics of society for everyone
(school districts, libraries, roads, etc).

The vast majority of Americans are not racist in the sense that they are
personally antagonistic to an individual of another race. But many of them are
racist in the sense that they think black people on average are poorer because
they have shitty culture, not because white people historically prevented them
from buying land, prevented them from being educated, prevented them from
using opportunities like the GI bill, etc.

~~~
sol_remmy2
> A lot of divisions in America are driven by generations of policy based on
> racism - from redlining, white flight and zoning policies that changed the
> structure of cities and are now used as weapons against newcomers and
> change, to the very existence of many cities and governments that were
> created in order to be a separate white space from the larger cities nearby,
> and the use of these boundaries to avoid funding the basics of society for
> everyone (school districts, libraries, roads, etc)

I've got some bad news: when you solve racism, these problems will still
exist. Because the elites will never want to live nearby poor people and
zoning laws ensure they don't have to

~~~
tptacek
If you "solve racism", then redlining and white flight still exist? I mean,
that's true in the sense that even after the next generation stops being
overtly racist, there will still be a systemic bias against black people by
dint of their parents and grandparents having been confined to disinvested
neighborhoods. Other than that, I don't see how your rebuttal makes sense.

~~~
nurspouse
> If you "solve racism", then redlining and white flight still exist?

I think he means that it will be replaced by something else and the _end
results_ will be the same. A lot of problems we attribute to racism will be
there due to some other cause. Problems have multiple sources, and solving one
will not solve the problem. A common debate in society is precisely about how
much of a given problem is due to racism. Some people assume it's very high,
and others say it is just one amongst many.

~~~
tptacek
Right, but the comment above addressed that directly, and was met with a
dismissive response. In fact: the roughest neighborhoods in cities like
Chicago are a direct result of racism. It's not controversial or even
disputable: you can look at a crime map, superimpose the redline boundaries,
and see the correspondence immediately.

Is _everything_ a result of racism? I have no idea. I kind of doubt it. But
the comment above gave specific examples of things that impact us to this day
that are clearly based on racism, and that won't be solved simply by a
generational shift in attitudes (which has largely already occurred in the
US).

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elil17
This whole situation is just really messed up. What’s happening with this
company is great, but we should not be in a position as a society where a
homeless person can’t get housing until living on the street has made them so
sick that it’s profitable for an insurance company to buy them an apartment.
This particular solution is definitely a positive thing, it’s just a small
bandage over a massive wound.

~~~
claudeganon
The end stage of neoliberal technocracy is this kind of Rube Goldberg
management of suffering.

------
mc32
Homelessness is not going to be fixed till it is addressed at the federal
level.

There are difficulties: there are different homeless population types
characterized by Mental health, substance abuse, cost of living, unemployment,
etc.

Also because of a reaction to heavy handed policies of the past, it’s
difficult to institutionalize those who need mental health intervention.

That said we could at least tackle the easier population whose issue is an
economic one.

~~~
wffurr
Can we declare a "war" on homelessness and redirect some military spending?
Maybe instead of another fighter jets, nuclear aircraft carrier, or nuclear
missiles, we can help our citizens instead.

I would be a lot happier paying taxes if the spending ratios were reversed.

~~~
SpicyLemonZest
Why do you think it's a money thing? Major cities already spend a lot of money
on homelessness, and the richest cities are often struggling the most. It's
not obvious to me that they'll succeed if they just get a bit more funding.

~~~
ratsmack
That's because a large portion of homeless people have drug addiction and/or
have mental disease. Just giving them a place to stay doesn't cure the root
problem.

~~~
criddell
Homeless people, like everybody else, usually have many problems. You can fix
their problem of not having a home by giving them a home. Once somebody has an
address and a little more stability, your chances of dealing with other issues
goes up.

~~~
tathougies
Yeah the issue is that housing them together puts the woman down on her luck
next to the guy with a violent drug addiction and then you have to kick him
out when he starts attacking people.

~~~
criddell
So don't house them together.

~~~
tathougies
Oh? Which demographic is deserving of living with violence?

~~~
criddell
None, of course.

You aren't suggesting that providing housing to the homeless will lead to more
violence than when the homeless live on the streets, are you?

~~~
tathougies
No, I'm suggesting that we bear less responsibility for violence experienced
by homeless on the streets than the responsibility we would had if we provided
housing and forced the homeless to live in them. In the same way the
government is not responsible for discord in my relationship with my friends,
but would be responsible for discord between me and the police.

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jawns
Nitpick: Title should read "America's Largest Private Health Insurer."
America's largest health insurer is the government, via Medicare, Medicaid,
and similar programs.

I'm interested in seeing how this corporate-funded/corporate-managed program
compares to the many housing assistance programs that are funded by public
funds or private donations.

I'm sure there are plenty of businesses out there that already help fund such
programs indirectly by donating to charities that run affordable-housing
programs.

But it will be interesting to see what happens when the businesses are running
the programs directly, cutting out the nonprofits as a middleman.

My somewhat pessimistic take is that any efficiencies that might be gained by
applying more rigorous business methods will be offset by lack of domain
knowledge and for-profit perspective -- seeing a homeless person as a problem
to be solved rather than a person to be served.

That said, I'm all for large corporations trying their best to address
homelessness and housing insecurity, even if they do so imperfectly.

~~~
azernik
To nitpick your nitpick - this "private" insurer is actually a government
contractor, administering Medicaid for individual states.

> The research and development lab for this experiment is a pair of apartment
> complexes in a down-at-the-heels corner of Phoenix called Maryvale. Here,
> Brenner is using UnitedHealth’s money to pay for housing and support
> services for roughly 60 formerly homeless recipients of Medicaid, the
> safety-net insurance program for low-income people. Most states outsource
> their Medicaid programs to private companies such as UnitedHealth, paying
> the insurer a per-head monthly fee—typically $500 to $1,000—to manage
> members’ care. The company’s 6 million Medicaid members produced $43 billion
> in 2018, almost 20% of total revenue.

...

> To keep down costs and avoid the difficulty of running a health-care system,
> most states contract with UnitedHealth and its competitors to establish what
> are called Medicaid managed-care programs. In 2017, $264 billion, almost 50¢
> of every Medicaid dollar, went toward care for the 54 million people on
> private Medicaid plans.

------
Gunax
> This is just sad. This is just stupid,” Brenner says. “Why do we let this go
> on?”

Because this is practically textbook definition of a perverse incentive.

What about healthy homeless people? Do they get homes? We are encouraging
people to be sick and to a abuse the ER. And what about all of the working
poor who are doing the right thing, but still have to pay half of their income
in rent?

The reason we don't provide homes is you can never just provide homes to the
ones who'would have abused the ER' but instead have to provide them to all
homeless.

Also, as sad as it is to admit, there is a portion of homeless who you could
literally buy a house for, and they will still end up homeless.

I hope I am wrong and this program works out.

~~~
jakelazaroff
On the contrary, a lot of homeless people’s primary impediment is the fact
that they don’t have their own living space. There‘s a lot of evidence that
“housing first” is an effective way of combatting homelessness [1].

More broadly, unless a system is truly overwhelmed by bad actors, I’m inclined
to not worry about them at all. Is it really that important that we _only_
help anyone who “truly” need it — and burn the whole system down to that end?

[1]
[https://en.wikipedia.org/wiki/Housing_First](https://en.wikipedia.org/wiki/Housing_First)

~~~
gerbilly
> More broadly, unless a system is truly overwhelmed by bad actors, I’m
> inclined to not worry about them at all.

It's more expensive to means test many of these programmes than to just hand
the money/benefits out.

But it's a common human bias that cheating must be prevented, even when it
doesn't make sense in the aggregate.

It's a cognitive limitation we have to get beyond.

This is why americans don't have universal healthcare, because they are
obsessed with making sure that no one gets care who doesn't 'deserve' it as
much as they do, even though it would actually benefit them in the aggregate
if everyone in society was cared for.

------
tehjoker
This is the sort of thing Tim Faust talks about in the concept of health
justice. If we move people into a single payer system that takes care of them
long term, it will suddenly be obvious that we need to do more stuff like this
as it's more expensive and stupid not to.

------
Animats
_" In 1986, Congress enacted a law to bar hospitals from turning away patients
who are unable to pay. Any hospital with an emergency room that participates
in federal health programs must evaluate and stabilize every patient who comes
through the door, including those who are uninsured, indigent, addicted to
drugs, or mentally ill."_

That's part of what pushed the price of health care up - huge numbers of
people going to fully equipped emergency rooms for problems that could be
handled by a GP or a nurse-practitioner. It's free health care for all, done
all wrong.

------
skizm
I want all the insurance companies to get together and go a calculation and
see if banding together and opening a nationwide series of no questions asked
homeless shelters with meals would bring down their costs at all. They could
each contribute an amount that was proportional to their market share or
something similar. Off the top of my head I want to say it wouldn't be worth
it, but if this article is accurate, and the costs for insurance companies are
actually going down, then who knows.

~~~
ianai
Conversely, if this helps one portion of the economy that greatly then it will
surely benefit the entire economy even more - or at least equally.

Precisely why I would say this should be a governmental system of bare
essentials living and housing. Every dollar spent on people with nothing will
be spent by those people and increase aggregate demand, economically, and
health, at a societal level.

------
carapace
Dr.: "Hello, Mr. Smith, here's your Rx: one home."

If that's the reframe it takes, more power to ya.

It's uneconomical to let the homeless remain homeless. Such a blindingly
simple fact.

------
munherty
Im going to go against the grain here but I think it might be good to be able
to get good data on homeless populations. Much data now is not accurate. At
the very least this will provide key data points that could help resolve and
better serve these populations

~~~
DanTheManPR
One major issue with counting the number of people who are homeless is that
most of them are not on the street, but are instead relying on friends and
family for shelter. The people who live on the street are the spear tip of a
much larger and broader group of people who are facing various degrees of
crisis in finding housing. It is difficult to come up with a method that
captures data about all the people who, for example, were evicted and spent
several months living on couches and in their car.

~~~
tathougies
Right, this is because the homelessness industry needs to justify its
existence with ever inflated numbers. Someone down on their luck and staying
with parents or siblings is not homeless and does not need intervention for
shelter. In general, we should encourage extended family living as its
economically easy and socially good. These 'homeless' need economic help, not
shelter, and its likely that, due to their proximity to family or friends,
this help can be provided in large part by the private sector as long as
government policy encouraged the creation of jobs. Really, when civilians say
homeless they mean what researchers call unsheltered, the subset of homeless
living on the street. This group has much higher needs, typically around
mental health and drugs

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gok
I could have guessed it was UnitedHealthcare before I clicked the link. Maybe
instead of buying apartments they could spend a little money on their billing
system, which has literally fucked up every single medical expense I've ever
had.

------
ceejayoz
How long before getting one of these requires accepting smart home monitoring
of things like your medication compliance?

"Our cameras caught you smoking, we're revoking your housing and your health
insurance for lying about being a non-smoker."

~~~
pjc50
Quite likely. People are very keen on this kind of thing for punitive reasons
- being on the street will of course kill someone far quicker than smoking.
"You have to give up smoking for the good of your health or we'll hasten your
death" is the sort of thing Kafkaesque systems are built from.

~~~
ianai
Here’s hoping that’s not how it goes. But maybe blow back from that sort of
homeless fleecing and privacy invasion would result in proper governmental
homeless assistance. (But people currently have a high tolerance for privacy
invasion so...)

~~~
pjc50
There's definitely a faction demanding more cruelty to the homeless; they
routinely have their property taken and destroyed as a sort of extra-legal
punishment for being homeless in the "wrong" place.

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solidsnack9000
This actually makes a lot of sense. A large insurer is in a position to
actually see the end-to-end costs and since they are regulated in such a way
as to have to pay them, this turns out to be the best way to run their
company.

------
EricE
What a brilliant idea - focus on prevention and not just putting the fire out.

It makes far too much sense to ever gain popularity - and whoops, I just
looked at the majority of comments in this thread and am not disappointed :(

------
shmerl
Smart idea, that actually saves them money.

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matheusmoreira
> Brenner shows me data on a patient named Steve, a 54-year-old with multiple
> sclerosis, cerebral palsy, heart disease, and diabetes.

No patient confidentiality?

~~~
pjc50
Names are usually changed in these circumstances.

~~~
matheusmoreira
When they change names, they usually write something like:

> Some names and identifying details have been changed to protect the privacy
> of individuals.

The author did not write that. I don't see any evidence the patient consented
to have his case published either.

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arnonejoe
UHC still made 12.68 billion net income in 2018.

[https://www.google.com/search?q=unitedhealth+net+income](https://www.google.com/search?q=unitedhealth+net+income)

