Comment by ben_jones | Hacker News Reader

Comment by ben_jones | Hacker News Reader

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Vote for what? Here in San Francisco we just voted to raise hundreds of millions of dollars in additional funds for homeless and related services. Most of this will be funneled to over 40 NGOs/non-profits by our city officials, the same 40+ organizations that have ineffectively applied nearly $500m a year for the past decade. My hope is that some of this money TRICKLES DOWN, but my hope for change is pretty much gone. Simply raising/spending the money gives incumbent politicians plausible deniability that they are "fixing the problem" even though they aren't. It's an homeless-industrial-complex at this point where major players are motivated to sustain it because it gets them paid well.

We could vote to build more housing. Oh wait, SB50 just got rejected by the appropriations committee - which is full of non-elected government officials.

I know, we could completely re-elect all of our local government officials to shake everything up, oh wait that's the promise of our last N mayors who haven't done anything.

I'm disgruntled, if any of these points are incorrect please let me know - it's very frustrating and I feel helpless as a voter (in SF).

Vote for Medicare for All to build a more solid foundation for healthcare and health services instead of each of our single cities having to patchwork with yet more bandaids.

My Senator, Stabenow, a dem, replied to my letter about a year ago that she’s “studying” that proposal.

A year later, she said she’s still studying the proposal.

She’s happy about voting for those expanded pentagon budgets though!

In my grand ole state of Utah, even our voting doesn't matter [0]! The Utah legislature gutted a medicaid expansion program which the population had passed in a ballot initiative in 2018.

Technically legal? Sure, they're the legislature, they can do whatever they want. Incredibly disappointing as a voter.

[0]: https://www.politico.com/story/2019/02/11/utah-medicaid-expa...

> Sure, they're the legislature, they can do whatever they want.

Except for staying in office if the voters vote them out.

That only works when there is an effective provider network exists and the main problems are expanding it and removing cost as a barrier to access.

The problem with mental health care is that such providers either don't exist or are very rare, meaning there is little to no effective care to be had for any amount of money. Simply throwing more money at this problem will not do anything to solve it.

Providers presumably respond to economic incentives; if there are not enough therapists in your area, enticing more people to become therapists really will help. It's a better problem to have.

I don't think my point was clear. I'm arguing that most of the extant providers are at best worthless. Too much of mental health "care" is focused on treating the symptoms, rather than the underlying cause. More money isn't going to fix ineffective treatment; it's just going to multiply the number of practitioners of it.

It's not throwing more money at it per se, it's supplying a reliable funding source. Because insurance companies deny funding so often, and public funding is unreliable patchwork which can ebb and flow with the attention and power of individual politicians, provider services for mental health are much smaller than they could our should be to serve our population.

On the other hand, if an individual provider can rely on getting a fee for service without crazy overheads of private insurance approvals/unapprovals, then they can make a business commitment to supplying that service. This costs far less overall when you don't have to price risk and extra work into the service rendered.

> provider services for mental health are much smaller than they could our should be to serve our population

As I responded to your sibling commenter, I don't think my original point was clear. I'm asserting that those existing provider services suck and are ineffective, and that what is needed is a paradigm shift in how mental health care is formulated and delivered, not a spread of those existing services.

I think poor service and unstable sources of funding are fundamentally linked, and that stable funding is a precursor needed (or at least strongly helping) when considering a paradigm shift in how to deliver mental health care.

The funding societally is so poor now that the common end path is people ending up in prison. And, as the article indicates, it's not like the private insurance companies are picking up the expenditure.

This is exactly why I'd much rather give money to my church which runs an actual program to help the homeless, which I can verify and have input on, than give to the government, which funnels it through cronies and faux-NGO's who have zero accountability, except for votes delivered at election time.

I agree with you that for any given $20, it's probably more effective to give it directly to an outreach program. But this doesn't scale. Consider a charity that wants to build housing for the homeless. Well now they need to buy property. But now they need a holding company or some business structure to legally own that property. That holding's company has fees for bank accounts, po boxes, people to check the po boxes, etc. Now the business decisions matter: how to structure that investment to minimize tax or properly insure it. Then you need to build on that property. That requires permits to be filed, and construction plans to be drafted. now you need educated business people to manage this. Those people don't work for free. So now you're paying salaries. So now you need to manage that situation. Who do those people report to, how much do they get paid, etc. Now you have a corporate structure (and significant overhead).

My solution is to introduce salary caps. So that NGO's cannot compensate any employee more than some modest amount. Bonus if the state or local gov could give people tax breaks (fed would never go for this) for working on an NGO. So, say a lawyer or accountant could take a few months off their high-stress, white-collar job and work for an NGO for part of the year, make enough for rent, reduce their tax bill, reduce their stress levels for a while, and help the community, then go back to "real" work.

"Those people don't work for free." except at my church they do. We've got nearly a thousand people in the congregation, including lawyers, construction business owners, accountants, professionals of all sorts. We have agreements with other churches to share resources. You're right it doesn't scale up to city wide levels, but it's got a whole lot more top talent than you could get paying below market wages at an NGO.

AFAIK it can't accept the $0.5bn/year government funding SFO provides the homeless because of separation between church and state.

>oh wait that's the promise of our last N mayors who haven't done anything.

Sounds like what ever metric is used to determine these are good people to elect is broken and needs to be adjusted.

Vote out the city officials then.

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