I want to point out one upstream reason why this is possible which isn't really talked about enough: On the margin, Finland has been better at providing actual numbers of rental units than any of the major cities I lived in in the US (Boston, NYC, Chicago).

I live in one of those hundred-story virtually unadorned 'concrete suburbs' on the edge of town and the fact my rent is closer to 10% than 50% of my income is astonishing to me. I paid more for a single subletted room in the States than I ever have for rent here. Astonishing, and I hope to fight tooth and nail to keep the housing and especially apartment supply healthy in the years to come.

N.B.: Rent in Helsinki is still kind of nuts for now, partly because it's the first stop for most of us foreigners. I don't live there, pretty much for that reason: A 10% increase in take home pay doesn't mean anything is it's eaten twice over by rent. But if you can learn Finnish well enough to live and work elsewhere, the laws of supply and demand suddenly tilt much more in your favor. steeples hands

Welcome to the club. I am another of the historically very few foreigners in Finland (it's going up a bit recently, but still low compared to many other countries.)

So please watch out for the changes announced by the new far-right government: You might be expelled if you happen to lose your job and do not find a new one within 3 months. And finding a new job without being fluent in Finnish can be tough (although slightly easier in the high-tech sector). If you want to pass the citizenship language test consider doing it in Swedish. Unless your mother tongue is Estonian the learning effort will only be a little fraction of that for Finnish. Of course knowing Swedish in daily life has only very limited benefit.

Well, nobody knows. Maybe the government has fallen on its racism scandals before they manage to get anything changed. But the signs are not positive.

https://en.wikipedia.org/wiki/List_of_tallest_buildings_in_F...

(1) People are comfortable on the streets, they enjoy the freedom, or they are at least accustomed to it, and paying rent/bills seems anathema to them.

(2) People are severely disabled by mental illness or addiction, and simply can't manage a household by themselves. Or they never learned how and they fail dramatically. This may be the 20% contingent who are moving back in with friends/family.

(3) People are naturally generous/irresponsible with belongings and income that they will spontaneously share the windfall with everyone they know. So your shelter for one man will end up being a flophouse for a rotating cast of shady types, and poor housekeeping skills definitely become operative here. Homes like this ultimately run into big trouble, like massive drug raids, fires, prostitution or something. Not fun.

Around here, the brass ring of housing is Section 8, and Section 8 has strict rules about guests and inspections and income paperwork every year. If you're not abiding by the rules then you're out on your ear. I don't know how many people wash out, but my case managers have inundated me with certificates and kudos for being one of their best, longest-term clients.

Housing First type approaches is great, and I'm glad to hear that they've "ended homelessness", even though that seems to sort of be contradicted by the 20% figure that was constantly cited in the article.

This is the significant distinction between providing crappy shelter and providing a home. A lot of shelter spaces come with a lot of strings, and the first step to fixing the issues is to accept that you need to cut many or most of the strings - if a significant proportion of homeless prefer homelessness to the help you're offering, perhaps the "help" isn't all that helpful.

If you want to get people off the street, you need to provide a similar level of freedom in the housing you provide as what it replaces.

> (3) People are naturally generous/irresponsible with belongings and income that they will spontaneously share the windfall with everyone they know. So your shelter for one man will end up being a flophouse for a rotating cast of shady types

Is it worse having them in a house than on the streets? And how much of a problem is this going to be when everyone involved have their own shelter? It's only a windfall if you provide it to a few rather than everyone who needs housing.

Can you elaborate on the the specific rules you’re referring to? That might help guide the discussion.

Because at face value, there seems to be an issue where there isn’t an acknowledgment that with freedom comes responsibility. That responsibility looks an awful lot like rules that many people in these situations struggle to manage. It seems hard to argue for one without necessitating the other but maybe some specific examples could clarify your point.

Many/most shelters will not let you bring in a pet. If you've never had any hard times in your life and had a dog companion at the same time you might not understand, but for many people having that pet is the only thing sustaining their will to live day to day.

Many/most shelters will not let you sleep with your companion, even if you're married. The comfort of another human is an easy thing to get used to, and can be devastating to go without. Generally though if you're running a shelter and taking in people with MH issues or other challenges this one makes some sense, you are always at risk bringing of in folks who can't respect boundaries and will want to have inappropriate intimacy in the open (for instance).

All shelters have a strict limit on how many personal belongings you can bring in. If you have no house, but you do have a shopping cart full of possessions, what are you supposed to do with them?

Not being able to take drugs when ever the hell they feel like it is what keeps them out.

The only thing that will fix this is if we change the laws. And those laws are going to feel weird at first. But we need to classify people who are homeless for more than 6 weeks as mentally ill. And at that point we force them into rehab facilities.

The trouble is that people apparently decided that the abuse, neglect, and poor outcomes were due to inpatient status and not anything inherent to the treatments themselves, so in the 40+ years since asylums all closed, we've basically reinvented invisible asylums with a massive apparatus of voluntary, inefficient outpatient programs which are rife with abuse, neglect, and poor outcomes.

The homes they took them to were unlicensed, mismanaged, and committing fraud, and often dumped the natives out on the street with no resources or way home.

Talk about abusing a doubly-vulnerable population; it's appalling. And to think that there is little stopping someone like me from being caught in that.

One of the understandings behind "housing first" policies is that when you treat chronic homelessness as a public health problem, you need to attack the big symptoms first (being unhoused) before you can see the outcomes you want (being a productive member of society).

Housing isn't a reward, it's a basic human need. And it's the baseline for treating people - because you cannot treat people if you cannot find them.

That’s somewhat inaccurate; housing is attacked not because it is a big symptom, but because it (1) grratly complicates addressing the other problems, and (2) admits of a fairly direct solution.

If we could just simply give people thr absence of addiction or mental health problems, that’d be a stronger contender for a first intervention where the problems are cooccurring, but factually we can’t so its not an option.

Why don’t we just give them money? Because, ultimately, housing need is there largely because they can’t afford housing right? So the deeper cause is a financial one.

I suspect most people exist be onboard with this because they know it won’t solve the underlying problems. It’s also the same with simply giving “free” housing.

Most people who deal in processes understand treating the root cause it paramount and should be their priority. Getting sidetracked by proximate causes is a good way to squander resources that can also tend to make things worse.

https://en.wikipedia.org/wiki/GiveDirectly

> Most people who deal in processes understand treating the root cause it paramount

I think that over-simplifies this type of wicked problem where consequences become causes. For example, poverty and under-housing causes abusive childhoods, mental health and substance use issues.

The challenge is not to identify a leaky pipe to stop a flood but to intervene in a complex dynamical system and convert doom cycles into virtuous upward spirals of improvement.

>I think that over-simplifies this type of wicked problem

I disagree. It's acknowledging it's a very complicated problem. As such, we shouldn't get fooled by thinking that if we just focus on this aspect (housing), it will lead to a sustainable solution. You may have to address proximate causes, but you absolutely have to focus on the root cause if you want to make a lasting improvement. Otherwise, it is likely to just turn into a bottomless pit to dump resources. This is like practically any other complex system that needs improvement. There are rarely simple "hacks" to solve the problem, and they take an understanding of the entire system dynamics. But that's not to say the focus shouldn't still be on the root cause.

Also, yeah, addictions are a thing. And I don't mean that as in "Oh, those people are so irresponsible! We can't trust them to spend their money right!". Addiction fucks you up (and/or is a result of the world fucking you up), and if what has been your only way to feel not-completely-terrible for a while is the other option, I don't think I can personally blame anyone who isn't able to take steps along a long and difficult road with uncertain outcomes, with their basic needs still not met.

In short: Money is a tool that can be used to meet basic needs, but by itself it does not meet basic needs. Using it to do that is not easy, especially if you're not used to that, and double-especially if you're addicted to something as a result of your shitty living conditions.

(I should note that I'm _not_ speaking from experience here. If someone who has some, ideally someone who has second-hand experience with many people, please correct me!)

I can get on board with housing being a basic human need that society helps supply. But that’s subtly different than the OP’s claim of housing with virtually the same freedom from rules. I’m not sure “unfettered housing” is a human right.

If you address only the symptoms and not the sociatal issues that exacerbate them, you won't actually solve the problem.

Addiction is a complex result of genetics and circumstance.

A background of poverty makes addiction much more likely. It is unquestionably harder to get clean if you do not have basic social security, let alone no secure shelter. Of course it is. The best indicator of whether you’ll successfully get clean is socio-economic background.

Once you are homeless (people generally prefer “unhoused” these days), being an addict makes it more difficult to get off the street if most state-provided shelter is contingent on getting clean.

So much state-provided shelter is completely inadequate as a secure base for turning your life around- look at the literal human warehouse that Vegas has just built.

A joined-up, personalised, and evidence-based system of care is required that does not exist where I live in the UK or in the US. Frustratingly, all evidence suggests that providing that system is cheaper than not doing so, whilst also relieving astonishing human suffering.

Providing an easy path off the street will help with addiction rates. Providing addiction treatment services will get people off the street. Do both at the same time as part of the same system of care and things really start working.

A google search will readily provide studies that confirm this.

Addiction is termed “persistent” rather than “permanent” by the NIDA. With respect for the net positive effect of abstinence-only programs, I have seen plenty of addicts stay clean long enough to create a stable life for themselves and then go on to safely use alcohol or drugs recreationally. Although, of course, plenty who have attempted that and then spiralled back down. Every individual is different, and tailored care works best.

Can you elaborate on the costs?

You seem to agree with this, but that doesn’t necessarily align with the OP. Giving no strings attached housing isn’t fixing root issues.

I can sympathize with the "baseline for treating people" argument, but that, by itself, doesn't address the fact that there is a fundamental symmetry missing. If people want "freedom" they also need to demonstrate "responsibility" for a society to work. There is no free lunch, unfortunately. Literally every "baseline" right guaranteed by the US Constitution can be framed in this same give/take dynamic.

The OP was conflating the issue IMO. They are saying basic shelter isn't enough; people have a right to free housing with no strings attached. I think those are two very different mental frameworks to view this problem.

If a user relapses, does removing their housing help in recovery?

The pint of the Finnish approach is that the old approach of attaching strings fails at both addressing homelessness and addiction.

If it's the former, then you provide the home to increase efficacy.

Addiction very often isn’t the root problem, there may not even be a unique root problem. Addiction is a difficult to manage persistent condition that complicates, is conplicated by, reinforces, and co-occurs with other problems, which may be caused by it, may cause it, or may be linked by more distant causal connections or not, at root, commonly caused despite interacting and reinforcing each other once present.

You need to deal with the complex situation presented, not try to solve a tricky and generally unsolvable chicken-and-egg problem that is usually irrelevant to the path forward.

It looks more like using permanent supportive housing as a way to get people into treatment programs and stick with them.

I have been on the streets and an an opioid addict in medication assisted treatment. I have yet to meet a single addict who returned to normalcy without taking some stock of the damage they’ve caused and making amends to change their life. People who are given unearned housing with no restrictions continue to live their life in a way that harms not only themselves, but those around them.

There’s a reason that the only countries where safe supply/legalization have worked (Portugal, Estonia, Switzerland, etc) continued to attack drug markets and sellers and set expectations around public assistance and behaviour from those receiving it. You cannot just give an addict a home and drugs and suddenly expect them to become upstanding, contributing members of society.

(I won’t even delve into how the current California/West Coast paradigm is exceptionally dehumanizing as it presumes these people are only able to do one thing - consume money and drugs.)

For one, from what I’ve read, the conditions are squalid. So many reports of bed bugs, old moldy food, etc. I’ve heard family shelters and shelters for women are nicer, but I’m a single male. If I want to sleep with bugs and eat shit, I can do that myself while keeping away from volatile people and situations.

And then there’s theft. Some of the rules regarding property and just the general environment seem to lead to a lot of theft. If I catch someone stealing my shit, I’m going to defend myself and my property, which I imagine a shelter won’t take too kindly to.

Then there’s the fact that they seemed staffed with jaded, underpaid individuals who don’t give a shit about you and want to force their believes down your throat while the owners continuously suck down government money. They also seem to be very much first come first serve, some even charge you money to stay, so it’s not like it’s even a stable position.

In seattle, I’ve seen people in low income housing units complain their neighbors use drugs like marijuana, which they are extremely sensitive to. If you’re trying to get sober, having a neighbor using drugs makes it that much harder.

Imho, most of these rules are normal “be nice to your neighbor”

First, it's a deterrent to cops who fuck around. If they harass or arrest a homeless person with a dog, it's a whole lot more work that involves animal control.... So dogs are cop deterrent.

Secondly, it's defense in some of the homeless camps. Dogs will defend their human.

I’ve also seen enough police killing dog videos to question the first point.

As long as you want to treat homeless as of they're not people, why is it a surprise. many of them don't want to play along?

Hell, I know a behavioral health supervisor who has an angry patient wielding a machete come to their office and the police didn’t think it warranted taking them in. I feel like this is a made up false dichotomy that society either needs to create homeless internment camps or give away free housing, no questions asked. It’s a bad faith narrative.

If you don't let people treat their home as a home, it's not.

Do you expect a hotel, for example, to condone you doing drugs on premises, to bring any manner of pets in, etc.?

This is why tiny homes are touted as solutions (you get private space that isn’t shared), but even in that case they try to form stable communities by again, applying strings (having a neighbor burn down their house in the middle of the night affects other residents of the community).

Recently a few people were murdered at a squatted property near where I live that the police left alone for far too long. Things just get out of hand too quickly at a property taken over by addicts (regardless of their housing status), and yes, that still happens in tents on the street, just to a lesser degree (although we did have a fight for drug turf recently at one encampment that involved IEDs, so maybe that’s changing?).

Part of the goal is to get data on why people don’t accept available shelter and how to address those blockers by creating more shelter spaces that meet more people’s needs. We know we will see the ability to keep companion animals, safe storage for personal items, and the ability to stay with family members as reasons people don’t take shelter. It’s easy to empathize with that. If I were a woman on the street with my mid-sized dog (companionship and protection) with all the possessions I had left (after months at least of hard decisions about what I couldn’t take) and a 13-year-old son (we are likely to get separated in shelter placement) I would be resistant to most of the options available to me. And that doesn’t even begin to address what led me to the streets in the first place (job loss, family support system loss, domestic violence, health expenses).

This is my opinion, but based on some observational experience, the only people for whom living on the streets is “easier” are those who are young, healthy, and have a family support system to return to.

This recent article in the Guardian provides a good overview: https://www.theguardian.com/us-news/2023/aug/17/san-diego-ar...

[1] https://insider.govtech.com/california/news/san-diego-county...

You address what you can, and start by treating them as you would others. We're not talking about letting them get away with more, but about not treating them as second class people with restrictions no non-homeless people would put up with.

That is from top of head, when I last time looked into it.

But also, a bit off topic, many real world rules do not have good reasons. Plenty of rules are arbitrary, just because someone had power to make them.

Housing ongoing drug users costs more per person. Services do not have the budget. You also don’t want active users around other vulnerable clients.

Usually specialist “Wet houses” are set up, following a harm reduction approach. It is a messy business and as a result politically difficult. That is not rational- as far as we know from research, the additional stability and access to harm reduction programs are effective in moderating clients’ patterns of using. Wet houses also cost less than leaving addicts on the streets.

Second, I gave you pretty strong reason - low funds. These institutions are super underfunded and very disliked by middle and upper classes. Being open during day means you have to have worker in place. Workers cost money. Being open means water and heating runs. Both cost money. Lockers for property cost money. They are not cheap. They need to maintained.

The difference you claim here is just really between the poorer and slightly less poor homeless.

Having a home at all significantly restricts freedom. Let alone all the maintenance it requires. If it's an apartment is it too restrictive to their freedom? Should they be exempt from lease terms (no pets/no smoking/no drugs etc.)? Should they have a free housekeeper on top?

At which point is it acceptable to expect some level of responsibility from an adult receiving so much in entitlements? I'd argue that an excess of no-strings-attached programs makes homelessness more attractive than hard work to people who are on the edge.

We need to get away from thinking about these problems as a way to force people to "earn" the relief, and instead think about the resolutions as a way of making everyone else's life better. I don't like that there is homelessness. I don't like seeing drug addicts poop in the street. I want folks in that situation to be taken care of for MY sake – to make my city better, to relieve me of the moral burden of thinking about people suffering, etc.

Because here's the thing: Some people are NEVER going to be able to maintain responsibility. Some people are NEVER going to be upstanding adults. NO MATTER WHAT we put them through, the worst prisons, the worst homelessness, the most outrageous policing, they're just never going to change. There is no remedy that solves this problem with a burden on the unhoused individual. It's society deciding to solve the problem REGARDLESS of whether the individual has "earned" the resolution.

I think most people are willing to chip in to solve the problem. Not just for the transactional benefit of making their own life better, but also just for moralistic purposes of not wanting to see others suffer. I think what you're referring to is more of a political one, where people see their tax dollars consistently being spent without any discernable improvement in the problem. And it's natural for people to balk at the idea that the way out of the mess is to continually throw more money at it.

The second issue seems much more difficult. Again, I think most people want a society that takes care of the infirm, or those just genuinely unable to take care of themselves. But when that population gets relatively high, we need to take stock of why that's occurring. Is it because society has just changed so much that it's incompatible with so many people's constitution and ability? If so, that implies we need to restructure a lot of societal aspects or take a second look at whether all those changes were really for the better, given the blowback. As an example, was the revamping of mental health services in the 1980s under the guise of increasing personal liberty really a net benefit?

Not only will the homes become dilapidated they’ll become a drug den immediately. The interiors will be unkept and stripped of useful components to flip for drugs.

With regard to smoking, this has become rare in Finnish housing both public and private. People know they shouldn't even smoke on their balconies any more but find somewhere outside the building. Tobacco has gradually been taxed higher and higher to the point where much of the population feels it is unaffordable, and the state already has its sights on a complete tobacco ban in the coming years.

This is reduced a lot by early intervention, i.e. always provide housing and always provide free healthcare.

It is so much easier to handle being "slightly mentally ill" when you can trust 100% that you will always have housing, healthcare and enough money for food, clothes and other necessities.

If you can do 90%, then government can provide you with last 10% by paying rent automatically and having a social worker visit once a week. This fixes problems early compared to you becoming homeless.

There is a lot of steps between "fully functional middle class person" and "mental institution".

You might respond that such folks be involuntarily committed to a mental hospital. That step has become taboo in the U.S.

From the research I've seen the rate of severe, not mild, mental illness among the homeless population is estimated to be as high as one third. These are not people who are making choices in any sound state of mind, they actually need to be put in medical care, not because they're dangerous but for their own sake.

It seems like it should in some way. For example, required ethics classes for the practitioners would limit who is allowed to apply such treatments. A bad history should at least prevent further bad history.

At least in Germany the treatment by itself is also not mandatory in a psychiatric clinic, but one can be held there for example in order to prevent suicide. Then it’s up to staff to convince patients of a treatment plan, they have to agree to that for the hospital to start treating. Until then the hospital is pretty limited in administering anything.

But befor the conversation details into ethics questions of forced institutionalizations. I think it’s worthwhile to point out that easy access to mental health is for everyone in society is of utmost importance. I can only assume but I think a lot of people on the street wouldn’t be there if they had seen a psychologist earlier on, if they had not started to self-medicate with alcohol and drugs. It’s beyond me why rich nations in the west don’t promote early intervention much more

Yes it should. It shows how fucked up we humans are. Given a chance we will abuse things again and again.

I don't think GP is saying they're not doing a good job, but that "ending homelessness" sounds like a euphemism.

Housing is only half the equation. For housing-first policies to work (and they can work very successfully), they need to be accompanied by comprehensive psychosocial support to address the issues that cause and perpetuate homelessness. That support is obviously expensive, but it works out much cheaper in the long run.

America has an unusually severe homelessness problem. It is often presupposed that this problem is caused by factors which are unique to America and essentially intractable, which leads to proposed solutions like mass institutionalisation. I believe that this is fundamentally false; the key factor is a lack of political will to invest in the social infrastructure which prevents people from becoming homeless and prevents homelessness from becoming entrenched. This is ultimately a false economy, because the unavoidable costs of having a permanent dysfunctional underclass vastly outweigh the costs of proactively supporting people at the earliest opportunity.

"Ending homelessness" in an absolute sense is a fantasy, but the vast majority of homelessness is avoidable.

However, by providing some housing and supervision to these people, they wind up saving money because on the streets they would be using way more social resources at a far higher cost.

The other issue is that Finland can manage this nationally, while Americans expect the richest cities with the highest property costs to shoulder the burden locally, how many free flats could be provided in SF?

Maybe.

Over 580,000 Americans are experiencing homelessness. That is a rate of ~0.18%, if my calculations are correct (600k / 332m).

Contrast to Sweden (population 10m) which had an estimated 33,000 homeless people in 2020, yielding a rate of 0.33%. [1]

Contrast to Japan, which has an estimated effective homelessness rate of 0%.

So Sweden has a worse homelessness rate than the US but we all suck compared to Japan and Finland!

1. https://www.homelessworldcup.org/sweden#:~:text=Country%20st....

The Japanese do have homelessness problem, they are just not recorded. Knowing Japan, it is something bureaucratic. Unless you register yourself as living in the street, it is assumed you live on your last known adress. And you likely can't register yourself as living on the street as that is illegal.

https://www.theguardian.com/world/2003/dec/19/japan.justinmc...

What is clear is that homelessness in the US is very unequally distributed geographically and has become associated with increasingly severe social problems. The level of homelessness might not be exceptionally high, but there's a prima facie case that the severity of homelessness has. Being inadequately or insecurely housed is undoubtedly bad, but it's a heck of a lot better than living indefinitely in a tent underneath a freeway overpass.

That is entirely false. Full blown paranoid delusion or schizophrenia is not "depression but extra bad".

> Severe mental illness doesn't suddenly emerge out of nowhere

It basically does? I mean it's a cross of genetics and in-vitro development factors with some real life trigger at times, but outside of robust genetic engineering it might as well be from "nowhere".

https://www.nimh.nih.gov/research/research-funded-by-nimh/re...

Your source does not say that.

> Some people who receive early treatment never have another psychotic episode.

That actual number of some (and not "many", "most" or even "meaningful proportion") is not defined in the page or underlying study.

Broader studies seem to suggest some people regardless of treatment only have an isolated episode. It is not clear the RAISE intervention itself changes that proportion.

These problems do not scale linearly.

It is also surprising how much drug addicts and mentally ill can do when the basics has been taken care of.

Bring some food and small bills with you as basically bribes and just talk with some folks. Ask them how they came to be homeless, what they do in their day, what they want to do.

Give them your idea, ask them if they think it's a good idea.

Instead, they are used as an excuse not to do anything for the homeless masses.

When you also have private care available, as you do in almost every country with universal healthcare, the proportion who opts to go private is a good reflection of whether people consider the public care sufficient. I don't know about Finland, but e.g. in the UK only about 10% opts for private insurance - most of it as incidental employment perks in higher paying jobs rather than an explicit choice -, despite private insurance here being far cheaper than the US (in part because the NHS offsets some of their costs by renting out excess capacity, and insurers mostly offer "top up" services - e.g. faster access to specialists etc).

The low level of private healthcare spend in countries with universal healthcare - especially in those, like the UK, where taxpayers pay less in tax per capita for public healthcare than in the US (NHS costs less per capita across the whole population, not just users, than Medicare and Medicaid) - to me is a fairly strong indication that most people don't consider them to provide bad quality of service or too long waits.

The private sector in Finland is, compartively, huge. Like, imagine a normal shopping centre and two of the bigger units are private, nationwide doctors surgeries. This is pretty much any larger shopping centre in a reasonably sized town here. The reason is that employers are mandated to provide some kind of health insurance to employees. It is this health insurance that is then responsible for giving you a sick note or ensuring that workplace injuries are taken care of - not the public service. The legal minimum is pretty low, so you can't go to them like a GP in the UK and be guaranteed that they'll do anything if it's not covered by the contract with your employer. Now, employers are free to top this up, so 'yeah the pay's comparable but the healthcare is much better' is a common point of disussion in social groups. In my personal case, which is not that special, it's great! I can book an appointment for basically _now_ (Sunday afternoon) online and go get whatever I want looked at. If I was dependent on the public system, lol no - just like home pretty much.

Anyway, I guess what I'm saying is that it's very much a two tier system, and I think it was long ago realised that a way for working people to 'skip the queue' was becoming needed, as if these people became ill and stopped working then they wouldn't be paying for the public system (through taxes).

Even many Finns don't understand that this is not correct. Employers are not mandated to provide any kind of general health care. They must take precautions to protect you from work-related health risks. So for IT workers a physiotherapist checking that your are sitting in a good position would probably be enough. In a mine or steel work it would be a bit more. When you get sick and go to your company health care doctor, that is a voluntary part of your employment contract, in no way mandated by law. One explanation given in the public uses to be: Employers don't want to wait for employees to queue in public health care forever, they want then to return to work soon. Even that explanation does not sound very convincing to me. After all the average flu is over in a week if see a doctor and in seven days if you don't. As an employer I would not voluntarily pay significant money for it if I hadn't to for one reason or another.

See also my comment https://news.ycombinator.com/item?id=37199110 , it's a really weird, historically grown cost-sharing model that cannot be explained by legal obligations.

I’m not complaining and I’m certain that I wouldn’t see the full cost in my take home pay should the employer remove it, there must be some kind of tax benefits to them, negotiations, etc.

Maybe because expectations rise with the availability of other options? Why would one pay for a Porsche when they could drive a Prius?

I live in Germany. Our healthcare system struggles a lot (mostly by design, thanks to incompetent/hostile politicians). I'd still bet the average citizen in Germany has better availability for treatments than the average American.

Most of the basic health care is Germany is not publicly organized, but private. The health insurance system is heavily publicly regulated.

I live in Finland and all of my relatives in Germany, so I see the differences very often.

This is a pseudo-distinction imho. Yes, the doctor's offices and clinics are private institutions and not organized under a single umbrella like in the UK the NHS would represent. However, the vast majority take appointments from publicly insured patients and are in compliance with the guidelines setup by the public health insurances. Also, in most cases publicly insured patients make up the majority of appointments.

Moreover, there isn't really a competition between public health insurance providers. The price difference between providers is negligible and so are the services covered (most providers cover the minimum as outlined by the law plus a few extra things you usually don't ever need).

TL;DR: the German healthcare system is public

In Germany the risk of unnecessary treatment is higher, doctors earn money that way.

In Finland being denied treatment is higher, especially for people not good at negotiating. On the appointment line they will just tell you we have no free times. Only insisting and quoting the law might help. And lying about your symptoms. Waiting for surgery typically lasts many months.

Germany spends around 30% more in health expenses than Finland.

Neither of them is perfect. But when I am really ill, the German system feels easier to work with.

The US of course spends even more in health expenses. But only a limited group benefits from most of it.

I wanted to have a particular operation and was told I could have it carried out almost for free if I waited for "about a year". Alternatively I could pay for it myself and have it in "a few weeks".

In that kinda situation, a procedure I wanted for myself, I figured I'd just pay. Certainly there wouldn't have been a problem waiting for it, voluntarily. But given the opportunity it seemed like a good decision to make.

In the past I've had work-related healthcare covering me when I had some forearm injuries, caused by climbing, which directly impacted my keyboard usage. My usage of public healthcare involved having brainscans, and other tests before deciding that I was fine. Both cases were nice and straightforward, even without adequate Finnish language skills on my part.

So I think I've had a decent interaction with all three of the systems - paid stuff, which I managed myself, public system, and private healthcare provided by my employer.

Meanwhile, for millions who would otherwise stretch to afford the latter or skip it altogether, it works extremely well, as it does anytime you just want a bed for the night (the 95% of basic medical treatments), and not jakuzi and 3 restaurant choices.

Edit: As a commenter pointed out it's 50% that use private health care, too. Very few people would exclusively use private health care.

Doesn't mean the free one can't still be "extremely good". I might pay for IntelliJ, even though a free IDE or even editor like Emacs is still extremely good.

And 40% of the population is still a huge number of people, who would otherwise had trouble affording private health care or get the shitty low tier and/or hella expensive private care afforded by the poorer in the US.

It's also not exactly like "50% of the population use private health care". It's more like "50% of the population ALSO use private health care", in addition to the provided free health care.

Well, in the end the employer has reduced your salary by that amount, employers are not known for welfare. Every employee is already entitled for full public health care. Something must be wrong with it if 90% of the employers offer double insurance in away. It's a public secret or gentlemen's agreement that employed people are not supposed to use the public health sector they are entitled to before they need specialist or hospital treatment. The gentlemen's agreement would stop working if basic public healthcare were reasonably good.

I pay for private insurance in one of the countries I mentioned to have choice of doctor and nicer hospital rooms and meant that my (non-urgent) knee reconstruction got done in 6 weeks instead of the 6 months I would have needed to wait for the same surgeon.

Your comparison does not work.

Finland: "The time within which you must get access to non-urgent care and treatment is laid down in law."

source, which has list of waiting times: https://www.hel.fi/en/health-and-social-services/data-and-th...

[1] https://www.laakarilehti.fi/terveydenhuolto/hoitotakuu-pitaa...

[2] https://www.iltalehti.fi/politiikka/a/f3392e98-c524-4c22-a53...

Nowadays more than 50% of Finnish newborns are covered by voluntary private health insurance, although all of them are covered already by public health care. I think that tells very much how much people still trust in the public health system.

Difference to the experience of millions who'd rather skip treatments for even basic stuff like dentals than bear the costs...

The mental illness is a bigger issue but here in Europe most countries have pretty decent healthcare for everyone (even the ones without money) so they don't have to be dumped on the street. Those people usually live their lives in institutions or assisted group living homes depending on their level of capability.

Drug abuse is probably the biggest cause of homelessness here but it's not that common compared to the US. Alcohol abuse is but it's treated similar to mental illness with decent care.

I don't think anyone is comfortable in a tent in finnish winter.

I think mental issue is one of the big thing, article mention conselling is offered, which is good.

Additionnally some people often end up in the streets because they simply don't know their rights and that they can apply for social services. Many euro countries social services will take over payment of a home, basic insurance and needs, "supposedly" enough to have sonething to est everyday. But usually to get that you need a bank account and to habe a bank account you need a physical address. Many end up in the streets because they are at some point in a mental state where they are overwhelmed by the paper work stuff or ashamed to ask for help. Or because it takes too long to get the aforementionned help because of administrative delays.

https://www.cbsnews.com/minnesota/news/we-just-want-to-be-wa...

https://www.kare11.com/article/news/local/homeless-camp-resi...

There's a very tough residence among the "permanent" homeless to any program that offers housing, because it will come with some strings attached. Those with mental health issues fear (wrongly) that they will be involuntarily committed to an asylum or something similar. Others don't want to be forced to try to get a job, or give up drugs.

The "temporary" homeless can, and do, make use of the help the government and non-profit organizations provide. Job training, free bus passes, assistance with rent, food, hygiene etc.

Some in-between will always float back and forth. If they stick to their medicine, they can live pretty independently, but since they don't like the side effects, sooner or later they stop, have a psychotic break, and end up back on the street until a family member finds them and convinced them to get help again.

At least, this is my understanding from someone who works for a program whose funding and sole mission is to the homeless in Minneapolis.

I don't think the article mention this.

Not really any more than the US, the vast majority of people live in cities, or in this triangle zone between Turku, Tampere, and Helsinki.

But yeah calling it rural was not the best description. I agree. I was referring to the huge open areas of course.

Actually, the biggest difference might be public transport: as long as they live in a decent city, you can give people transit passes and they can start to visit doctors, apply for jobs etc. like anyone else.

I think you meant to say “used to be locked up”

There's only so much you can do, no brain debugger+hot patcher invented yet.

Other countries solve it by having protected communities, with more or less supervision and independence depending on the condition.

Some people, yes, but an incredibly small minority. The vast majority of people with severe and enduring mental illness can be managed perfectly well in the community if you have adequate community-based mental healthcare provision. The choice between asylums and people fending for themselves on the streets is a false dichotomy.

>"prayer" or "social support" or whatever isn't a substitute for IV anti-psychotics

We have a wide range of long-acting injectable antipsychotics that can be administered on a fortnightly or monthly basis. You do not need to lock someone up indefinitely in order to administer an injection once every few weeks. Some people will inevitably need to be compelled into treatment, but that number is much smaller if a) you have a mental healthcare workforce who have the time and training to establish rapport and build trust with patients and b) you use early intervention to reach people before they are in crisis.

And you know how the story of "I don't need/don't like the meds/they're out to get me" story goes within the community of people who definitely needs that kind of treatment

Unless I’m way out of the loop, there are still facilities for extreme cases, no? I think the difference is that patients cannot be detained there against their will, vs asylums were full of people who wanted to leave, after being forced there by someone else, and being treated like shit every step of the way

This is part of the problem. People think that homeless people are all drug users, and that’s not accidental. I bet if you ended up on the street, couldn’t get a leg up to get off the street, you might eventually turn to drugs to help forget that you’ve been abandoned by society and a government that will bail out car companies and banks but won’t establish better systems to get people up and running again.

I think the key things we've seen that have hyper-accelerated the trent have been:

* The introduction of fentanyl to the West

* The lockdowns

* "Progressive" policies to be hyper-empathetic on criminals

At this stage no amount of asylums will put Humpty Dumpty together again. We would actually need a criminal system and society that is willing to have people face consequences - and that is currently a "far right" idea as far as the Woke West is concerned.

Moreover, it is a country that keeps punishing criminals long after they left the jail with post conviction restrictions designed to make them fail.

Some provinces do not use all the funds available for healthcare from the federal government.

The immigration rate drastic increase is not helping, but the healthcare issues have started before.

- Most of your concerns are already taken care of by healthcare, notably psychiatry that is free and well funded (people who work there would disagree, but everyone who needs to see a doctor will), social services (same), unemployment and professional training programs.

- It’s below freezing most of the year. There cannot be any rough sleeping: either you are inside, or people pick up your frozen body in the morning. If you end up too drunk to go home (which happens alarmingly often: substance abuse is a huge problem, more than anywhere else) hospitals have drunk tanks and Police officers or ambulances will be more than happy to drive you there before you hurt yourself or others. They are not uncomfortable, just… “easy to clean” and in an odd pink colour. You get coffee in the morning.

What that program actually did was admit that shelters were not working and replaced them with individual flats. Finns’ staunch individualism probably explain that more than anything. (It also explains the substance abuse… anyway.)

- I’m not sure that how rural Finland is super relevant, but it is true: the country was going through rural exodus (what happened in the UK in early 19th century) _this decade_; it doesn’t really mean there’s a village life that disappeared (people don’t talk to their neighbours) but it has contributed to a big real estate boom. Outside of two streets in downtown Helsinki, there isn’t a building that wasn’t built recently—as in, with internet. Therefore, having slats for homeless people is actually a small fraction of the new homes.

The second key thing about Finns (after their lack of social appetite) is their passion for design. Key people in the country: famous people, CEOs, etc. are designers, the way famous people in France, Germany, China, Japan and Korea are engineers and lawyers in the UK and US.

> your shelter for one man will end up being a flophouse for a rotating cast of shady types, and poor housekeeping skills definitely become operative here

That’s the thing: all flats are well designed and minimalistic. There isn’t much you can damage. This might change as the real estate portfolio ages, but it’s not a major concern now–not compared to having to step over a frozen body in the morning.

The 20% is because, even if the program is summarised as “give them a home”, they are not signing title documents on day 1. They likely need help, so while they are de facto occupants with full rights to develop their sense of belonging, on paper they still have a status that roughly translates to ‘homeless’ and formally, they rent for a minimal amount and hardly any eviction clauses.

3) The state will nurse you happily until death no matter how irresponsible you are. Truth it is has turned into a problem long ago which will be very painful to reverse.

Supposedly homeless but I guess some could be and just a temp sharing of a room or couch in a rundown apartment. They continually smash things in it like the sink and walls, doors, etc (I know this because I know someone who knows the company who maintains the building). Laws prevent eviction if it's cold outside.

I'd say many people would be all for homes to assist homeless rather than parks and sidewalks covered in tents. But I'd say they everyone doesn't because they feel we are all being conned. Which prevents the majority of homeless from getting help.

>Section 8 has strict rules about guests and inspections and income paperwork every year.

Sounds good but I've seen how many people who live on the street have become wise to gaming the system. It's a skill they learn to survive so I can't imagine a clueless civil servant here knowing how to spot that. One woman I knew was frighteningly good at it. She had six kids from five or six different men most dead from drugs, she continually stole from stores, but always got sympathy when she turned on the tears. She had a full-time job for most of the time government housing since she had kids. I just checked court records and see she was pregnant yet again by some scumbag two years before she died.

What about all the people living paycheck to paycheck who just lost their job?

What about people fleeing a bad domestic situation?

What about the single mom living with her two kids in a car?

What about the divorcees paying child support who can only afford to live in their car?

What about people struggling with disabilities and no support network?

What about the person in the section 8 apartment nearby doesn't bother anybody?

Realistically there are all kinds of homeless people out there. Some can be easily helped. Some can handle the responsibilities imposed by the modern world. Some can't. Demonizing them all isn't fair.

There are shelters all over the Bay Area that stipulate no drug use. They are complete with transitional housing and job placement programs. The same is true in other west coast cities.

I’ve been very close with formerly homeless people in SF, and they said the exact opposite: people choosing to be homeless move to SF because it’s the nicest place to do it in the U.S.

Almost everyone living on the streets is there because of a series of choices which they made, usually over a long time frame. Perhaps at the time they were not entirely voluntary choices, or conscious choices, but cumulatively they have chosen a certain pathway that led them to losing their income, job, belongings, and housing. Even an abused wife who's been dumped out by her husband, well, she did choose that husband.

Obviously there is nobody who rises from a warm bed one morning, says "screw all this!" sells all they have and goes to rough it on the streets (except, perhaps, for Saint Francis of Assisi, but he found something productive to do.)

I spent a lot of time Downtown hanging out with minors, and one day my good friend who's a dad confided to me something surprising. He said "Most of these kids aren't homeless or runaways, you know. Most of them are from wealthy neighborhoods and have good parents, but they come out here just to mingle." So it was like Future Runaways of America out there. And make no mistake, the area has a huge effort of outreach to runaways and homeless minors.

Once someone winds up on the streets, more choices are offered. Those choices can either drive a person deeply into a hole from which they will never recover and never get off the streets, or they could just keep them going while they can stabilize and find needed services, and begin a process to get off the streets. Many people will pursue the former. Even if they pursue the latter course, they may not make it. And then you have people who realize, hey, this life is ok for me. I guess I don't mind it so much, and it's not worth trying to get housed. So they stay as-is for the rest of their lives.

This is serious stuff which no government wants to touch with a 10 ft pole. When you go down this train of thought it gets pretty dystopian pretty fast. So far we have used the law to judge these people and their actions. But when mental health and poor upbringing is considered, the law is an extremely blunt tool for the job.

In other words, homelessness is very often not a root problem but a symptom of other underlying problems.

What's your policy towards them?

You said that homelessness is a symptom of underlying problems, which is true, but also said, "You need to address the issues that cause people to act like that". Sure, this will work for some, but not others.

I am genuinely asking what you propose to do about the people for whom this is not feasible or possible - whose underlying problems we cannot address.

#2 its hard to imagine someone being more comfortable on the street that in a housing provided by the gov. They don't pay bill/rent there so no anathema here.And when they start having income - pretty sure most will gladly pay rent/bills to not lose their comfort as people get used to comfort very very quickly.

https://en.wikipedia.org/wiki/Cuckooing

As soon as you put some vulnerable people in an isolated setting, they get preyed upon by others looking to take advantage. There are many reasons why somebody would want to use somebody elses home for illegal activity, and scooping up people off the street and putting them in indivudal homes is a massive danger for those who are not able to deal with confrontation. There is already not enough staff or funding to enforce against this. A huge increase in extra housing provided for the homeless would need to come along side a much larger financial package to support the enforcement of it.

This may sound like doom and gloom, but it is the not taking this into account or planning for it which has caused the downfall of most if not all housing initiatives for the homeless.

Someone was stabbed on my doorstep on Holy Saturday one year, apparently about a marijuana sale.

After I moved out (thank GOD), I received a notice from the courthouse that said I may be called as a witness for something I didn't remember, which came to nothing.

There were a couple of shady Muslim dudes who stalked the Catholic Church I attended. One day Mr. Shady encountered me Downtown and summoned me to his home. Who knows why I agreed (well, I was homeless, hungry, and vulnerable.) At his home, I found a Quran on the shelf, a pistol under his sofa cushion when he brandished it for me, and the centerpiece was a computer he wanted me to work on and install software which was obviously pirated. He rewarded me with fried chicken. Ugh, I shiver to imagine getting caught up in that again.

First off, the following is all anecdotal based on some articles I read a few years back now so take it with a grain of salt.

New York had a program to house the homeless in hotels after running the numbers and concluding it would be cheaper to do so in the long run compared to the medical expenses and so on incurred.

As part of that, I believe somewhere between 5 - 10% of people would persistently return to the streets despite having shelter provided.

Most homeless are people in a dark period of their lives and get back on their feet with some aid to break the bootstrapping problem.

A small portion however are considered to always end up there despite any help for whatever reason whether it's mental illness, drug use and so on.

Of course, I'm not citing any links and I'm probably misremembering so I'd encourage you to do some more searching if you're interested.

It seems like the NYC Hotel program was disestablished recently too.

(2) that is why the Finnish model requires free counseling.

(3) if every person has the same access to a council flat, why would you need to share? This seems to be a problem with the american style limited voucher system.

Social services can pay rent and utility bills directly, so the person receiving rent assistance does not have the option to forget to pay the bills.

> People are severely disabled by mental illness or addiction

People with mental illness are typically assigned to an assisted living care home, or mental health institution, involuntarily. This is common in Europe. I understand, in America, involuntary institutionalization is pretty much a taboo.

> (3) People are naturally generous/irresponsible with belongings and income that they will spontaneously share the windfall with everyone they know. So your shelter for one man will end up being a flophouse for a rotating cast of shady types, and poor housekeeping skills definitely become operative here. Homes like this ultimately run into big trouble, like massive drug raids, fires, prostitution or something. Not fun.

Afaik, it is much easier to help these two groups when they do have access to safe and stable housing. Conversely, their issues get much worst when they are homeless.

As in, if you intend to help these people, giving them housing is pretty reasonable start.

> like massive drug raids, fires, prostitution or something

Prostitution is legal in Finland. Second, drug raids is what cops do, not what homeless do. The homeless may do the drug use part, I am just pointing out you picked the phenomenom that is done by somebody else.

I do not understand why managers would be incentivized to keep people in who shouldn't be in. Because there is a huge demand on the front end! People are clamoring for vouchers! I was on a waiting list for at least two years. The waiting lists only open at designated times, and for short periods. The number of people who qualify is enormous, and there are various factors in qualifying for how quickly your number comes up.

When I attended an orientation (which was 10 Black men/women and White me) the word was that vacancies were very low, and a lot of participants were having trouble just finding housing that would accept the voucher. I was an outlier because I was merely transferring programs, and had already secured housing of my choice.

I suppose it could go either way. Are people having trouble finding vacancies because of corrupt managers? Or something else? Anyway, if demand is that far above supply, I don't see any reason why Section 8 couldn't maximize its occupancy year over year no matter, what their turnover rate.

None of these problems are the majority of homless people. There are always some where special care is needed, or for whom nothing works no matter what level of care.

Finnish winter takes care of that item

And even if it's the case that they were formerly sheltered but 'decided' to be homeless again, it's probably the shelter provider that didn't do a great job at accommodating them.

In any case, cultural opposition to housing is a pretty weak argument to make in order to express despair where your valuable taxpayer money goes to.

In my case, I have a disability, I work part-time, and my parents support me too, and Section 8 still pays some rent because I'm not able to cover it all, even after that. And my situation has reached maximum improvement.

There's a Family Self-Sufficiency program which is great. They provide resources for education and employment and stuff, and they escrow some funds which are usually awarded when you "graduate" from the program. Graduation entails raising income so far that your benefits cease and you are officially self-sufficient. They've recounted many success stories over the years. Mostly younger folks who hit a rough patch, but then got through college for a degree and then a great full-time job. I'm in the program, but I don't expect to ever graduate or see my escrowed funds. The FSS program is actually run by HUD as a funnel for first-time homebuyers. They encourage you to use the escrow as a down payment on a house.

I will certainly say that as my income has increased and benefit decreased, that has undoubtedly freed up funds to help many other people, so I do my part by keeping income as high as humanly possible.

I don't know about corruption. They do want people in the program to stay that way, of course. It's mandatory to report income, so every time I report an increase, my benefit goes down, and certainly I could be assured that if I blew the lid off that, my benefit would go away, and I'd be done with the program. I haven't encountered anyone enticing me to lie or conceal anything. YMMV, of course, because these programs are all run at the municipal level, so corruption in some places isn't going to translate to corruption all over.

https://www.ara.fi/en-US/Materials/Homelessness_reports/Home...

It’s the same reason we’ll never “cure cancer.” Cancer isn’t one thing, it’s many things, and it interacts with a complex system. The US is not even one complex system, it’s hundreds of them.

People who live there != people who own property

People who own property want to be seen to be pro more homelessness but if they want higher asset prices and higher rents then they need to fight for non solutions to homelessness.

Homeless people can get shelter for night. Municipalities and the state have an obligation to provide a warm place to sleep, and every individual, regardless of their place of residence, has the right to have it.

But that's not a home. Most homeless stay at relatives or friends (60%). Some stay in institutions, like hospitals or shelters for victims of domestic violence. Then there are homeless dormitories, but they are so full of alcoholics and drug users that many people prefer to sleep outside in tent or something.

Most homelessness is just temporary, but there was still 1,133 long term homeless people in Finland December 2022.

If you are a person without problems managing your life, you get your home typically in few days or weeks.

In any case, sleeping out of doors is only a minor fraction of the homeless. People forced to sleep in shelters, or to couch surf, are also homeless. The federal United States government defines the term to mean those "who lacks a fixed, regular, and adequate nighttime residence" and then goes on in detail.

Utah did it: https://www.cc.com/video/lntv3q/the-daily-show-with-jon-stew...

Worldwide approaches: https://community.solutions/

I bet we aren't doing enough to "graduate" people out of our govt housing facilities, where doing enough is a combo of giving people houses and property that the government owns (via tax auction) and then enforcing stricter compliance with rules and limits in government housing. People live 30+ years in rent free high rises designed for a short term housing stabilization solution!

We also lose "employed persons" because so many are on some form of non-working status.

I don’t mean to invalidate the decisionmaking process of low income people in this context, but it doesn’t make sense to me, it’s not for lack of available housing, and it’s a problem I’ve personally spent a lot of time trying to solve over the last 15 years.