This is an independent opinion. IVN San Diego invited all campaigns, including the No on Measure A campaign, to submit commentary. Have an opinion of your own? Send it to hoa@ivn.us

As the EMS medical director of the city of San Diego for 20 years and a career UCSD faculty emergency physician I saw plenty of health and economic damage inflicted by homelessness. Not a day went by in the Emergency Department that I didn’t factor a patient’s housing status in a discharge plan. I knew homeless patients had worse outcomes for reasons having nothing to do with the effectiveness of a medication. Something as simple as treating a foot infection became a gamble… could I manage the problem with oral antibiotics, dressing changes and leg elevation knowing the patient lived in an alley, or canyon? Healthcare that doesn’t address a person’s lack of access to housing, food, and transportation produces poor clinical outcomes and higher costs for everyone. This is why I strongly endorse Measure A, which will generate the funds needed to make a big dent in the critical shortage of affordable housing in our city.

We now know that social factors are inescapably linked to clinical outcomes and that “housing is healthcare.” Unfortunately, San Diegans are currently at high risk due to the striking shortage of housing stock. Years of gentrification have eliminated the single-room occupancies and other inexpensive places that the vulnerable once called home. Now, our streets are filled with people coping not just with the elements but also with a lack of access to basic public health and sanitary needs known to be essential for over a century. Housing navigators all over the city will tell you that people in need of stable housing today are unlikely to be successfully placed for a long time. The situation isn’t just kind of bad: it’s very bad. A couple years ago, a neurosurgical colleague told me about a young man with a brain tumor who was doing poorly — not because of the type of cancer (it was treatable) but because no one could arrange follow-up for him since he lived in Balboa Park.

In 2011, I collaborated with the United Way of San Diego County and others to prove that housing the homeless wasn’t just a feel-good concept. Project 25 (P25) identified 28 of the most impactful individuals in our community based upon their contacts with police, fire, EMS, jail and mental health. They were offered permanent supportive housing with intensive individualized support. To those who knew the issue, the results came as no surprise: P25 reduced taxpayer costs by $3.7 million (67%) over just two years. It also restored the health and dignity of 28 real people. Despite its success, this innovative program was never taken to scale, and today we continue to have individuals disproportionately consuming critical public safety resources (aka tax dollars) with zero long-term gain. 

Rather than rejecting Measure A based upon the premise that we already pay too many taxes, its approval would demonstrate that San Diegans understand the way to advance both the health and wealth of our great city is to actually invest in smart solutions like this when they come along. 

Importantly, while this small number of recidivist, high-impact people are often portrayed as the face of homelessness, there are many other homeless individuals who had been teetering on the brink until an unfortunate event (such as a medical bill) pushed them off the cliff. Their lives could be quickly restored by the availability of affordable housing. The 2020 Point-in-Time Count identified 7,613 homeless, of whom 52 were youth and 323 were families. Can San Diego really call itself America’s Finest City without having a financial solution to the nation’s 4th biggest homeless problem? If money could be grown on trees, a stem-cell lab in San Diego would have already figured out how to do it. Instead of invoking magical thinking, San Diego needs the reasoned voices of voters who know we all need to pitch in to solve the big problems even if we wish it was otherwise.

It’s hard for me to believe that people don’t care about homelessness. I assume everyone gets a little uncomfortable when a truly needy person approaches them asking for spare change. What I like about Measure A is that it provides a tangible way to begin to address the immediate problem while also refreshing a social contract we share with one another. Rather than rejecting Measure A based upon the premise that we already pay too many taxes (translated by me to mean “Let’s kick the can down the road again”), its approval would demonstrate that San Diegans understand the way to advance both the health and wealth of our great city is to actually invest in smart solutions like this when they come along. 

Find More Election 2020 Coverage Here

As to the question of whether some people don’t care much about others... Did you know that the new UCSD Sanford Institute for Empathy and Compassion was created in part to study just such questions? Someday, we will know a lot more about the neurologic underpinnings of caring and compassion, including how and where empathic skills reside in the brain and whether they can be taught. Presumably, these discoveries will result in everyone understanding and respecting each other, so we won’t need ballot measures like this anymore, right? I predict we’ll see this breakthrough right about the time we also get those pigs to fly.