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Gov. Newsom on homelessness and health

February 20, 2020

Topics: Quote of the Day

Office of California Governor Gavin Newsom, February 19, 2020

The California Dream is for all.

To that end, there are 1.6 million fewer Californians living in poverty today than in 2011—a full quarter of the nation’s decrease.

But no amount of progress can camouflage the most pernicious crisis in our midst, the ultimate manifestation of poverty: homelessness.

That’s why I’m devoting today’s remarks to this crisis.

Let’s call it what it is, a disgrace, that the richest state in the richest nation—succeeding across so many sectors—is failing to properly house, heal, and humanely treat so many of its own people.

Every day, the California Dream is dimmed by the wrenching reality of families, children and seniors living unfed on a concrete bed.

Military veterans who wore the uniform of our country in a foreign land, abandoned here at home.

LGBTQ youth fleeing abuse and rejection from their families and communities.

Faces of despair. Failed by our country’s leaders and our nation’s institutions.

As Californians, we pride ourselves on our unwavering sense of compassion and justice for humankind—but there’s nothing compassionate about allowing fellow Californians to live on the streets, huddled in cars or makeshift encampments.

And there’s nothing just about sidewalks and street corners that aren’t safe and clean for everybody.

The problem has persisted for decades—caused by massive failures in our mental health system and disinvestment in our social safety net—exacerbated by widening income inequality and California’s housing shortage.

The hard truth is we ignored the problem.

We turned away when it wasn’t our sister, our brother, our neighbor, our friend.

And when it was a loved one, help wasn’t there.

Most of us experienced homelessness as a pang of guilt, not a call to action.

Back in 2005, when we started our point-in-time counts, there were over 188,000 homeless people in California—35,000 more than we have today. Even at that peak, the state didn’t treat it with the urgency required.

It became normalized.

Concentrated in skid rows and tent cities in big urban centers.

Now it’s no longer isolated.

In fact, some of the most troubling increases have occurred in rural areas, in small towns, and remote parts of our state.

No place is immune.

No person untouched.

And too often no one wants to take responsibility.

I’ve even heard local officials proclaim in public: it’s not my problem.

Servants of the public too busy pointing fingers to step up and help? That’s shameful.

After all, every homeless Californian, living on a boulevard of broken dreams, is a casualty of institutional failures—a person who’s fallen through every possible hole in the safety net.

Homelessness impacts everyone, but not equally. Some communities have been hit much harder.

Urban renewal and gentrification broke up communities of color and throttled their abilities to move into the middle class.

These are systemic issues rooted in poverty and racial discrimination.

Black Californians comprise 8 percent of Los Angeles County’s population—but 42 percent of its homeless.

And a recent poll found that nearly half of Latinos in the state are afraid that they or a family member could become homeless.

The State of California can no longer treat homelessness and housing insecurity as someone else’s problem, buried below other priorities which are easier to win or better suited for soundbites.

It is our responsibility.


In the 1940’s and 50’s, our nation began the trend toward “deinstitutionalization.”

Not a single policy, but a series of policies.

Outrage over conditions in institutions—as well as the creation of new medications to treat mental illness—sparked a movement to treat people in their communities, rather than locking them away.

California passed the Short-Doyle Act in 1957 to fund community mental health services.

The federal government, too, pursued this worthy goal.

President Kennedy envisioned a system in which, in his words, “the reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern.”

State mental hospitals were closed. But the promise of community mental health was never fully realized.

The states were burdened with the responsibility but provided little in the way of support.

Laws were changed that made it harder to compel mental health treatment. Governor Ronald Reagan signed the Lanterman-Petris-Short Act in 1967, designed to end the inappropriate lifetime commitment of people with mental illness.

And critically, in 1975, a U.S. Supreme Court decision, O’Connor v. Donaldson, ruled that “mental illness alone cannot justify a state locking a person up against his will.”

All of these changes, coincided with safety net cuts, block grants, and tightened eligibility standards of the 80’s and 90’s, along with wholesale razing of skid rows and SROs—which for so many was the only housing option.

The cumulative impact made county jails the de facto mental health institutions.

Patients and their families were left with inadequate options to get the mental health care they needed.

In a politically polarized world, liberals and conservatives blame one another for these failures.

Historically speaking, both are right.

It’s time to stop pointing fingers and join hands in a transformational solution.

This year, we have proposed CalAIM, a once-in-a-generation reform of our Medi-Cal system, based on the obvious, but long-ignored principle, that physical health and brain health are inextricably linked.

After all, 10 million Californians—1 in 4—suffer from some type of behavioral health condition. It’s not a narrow issue, nor a new one.

The deeper truth is that our healthcare system has been designed to treat some of our parts, not the sum of our parts. That must change.

This landmark proposal calls for leveraging Medi-Cal as a tool to help California’s most vulnerable residents: the homeless, our children, and people cycling in and out of the criminal justice system.

This is about integrating care. Targeting social determinants of health and expanding our Whole Person Care pilots statewide.

Health care and housing can no longer be divorced. After all, what’s more fundamental to a person’s well-being than a roof over their head?

Doctors should be able to write prescriptions for housing the same way they do for insulin or antibiotics.

That’s the aim of CalAIM, transforming Medi-Cal as we know it, backed by a $695 million budget request to make this real.


We need a new approach.

In the budget I just submitted, I proposed a new California Access to Housing Fund, and, with it, a whole new way of investing in homeless solutions.

We have a clear purpose for this Fund: paying for what works.

Gap financing for innovative housing models like hotel/motel conversions and securing vacant units wherever we can find them.

Stabilizing and expanding board and care homes.

And preventing homelessness in the first place through rent subsidies and rapid rehousing to help people one job loss, one illness, away from homelessness.

With this first-in-the-nation statewide housing fund, we can braid together state and philanthropic dollars, as well as health care, mental health, and social services—paying for housing, not overhead, by capping all administrative costs at 10 percent.

Nimble and flexible to evolve from best practices to next practices.


Look: not one city, not one county, not even one state can shoulder this responsibility alone. This is a national crisis.

Federal decision-making contributed to this moment and our federal government has an obligation to match its rhetoric with specific, constructive, and deliverable results.

California has and will continue to extend its hand of partnership to Washington, seeking to jointly address this issue.

Honestly, this partnership should be a given.

But empty words and symbolic gestures won’t mask a 15 percent across-the-board cut to HUD’s budget.

I’m old enough to remember when HUD was in the housing business. And I’m hopeful it will be again.

After all, homelessness isn’t a blue or a red issue. It’s an everyone issue—a blight on the soul of America.

It’s time for California to say yes to housing. We cannot wait.

So this is the challenge before us and those are the tough choices we must make.

Overcoming adversity and tackling intractable problems are as ingrained in California’s character as our sun-kissed coast and our bread-basket valley.

With homelessness, I know it can be done because I’ve seen successes along the way.

15 years ago, when I was Mayor of San Francisco, in the face of long odds and stiff opposition, we established Project Homeless Connect to bring local government services directly to people. It has been wildly successful and adopted in 250 other cities.

Last year, I went back to Homeless Connect and spoke with a man named Richard Oliva.

Four years ago, Richard was homeless, drug addicted and seeking medical help at one of Connect’s neighborhood fairs.

Thanks to this program, Richard got clean, obtained disability support and ultimately moved into subsidized permanent housing.

This time, he was back—but as a volunteer.

For three years now, he has been passing out free reading glasses to people in need.

While I was there, Richard hugged me with tears in his eyes and said, “thanks to this program, I have a home of my own.”

Richard’s story reminds us that there are no lost causes in our California community.

It’s an enduring California value that every Californian has value.

So when critics tell you homelessness can’t be solved, introduce them to Richard, and the thousands of others like him who are a living testament.

I don’t think homelessness can be solved.

I know homelessness can be solved.

This is our cause. This is our calling.

Let us rise to the challenge and make California stand as an exemplar of what true courage and compassion can achieve.

Let’s get to work.

https://www.gov.ca.gov…


 

Comment:

By Don McCanne, M.D.

Housing is a crucial factor in personal health and public health. Homelessness cannot possibly be eliminated through charitable, voluntary effort. It requires public policies administered through the community on all levels. We can’t do it alone, but we can do it together.

The same goes for our health care system. Voluntary, charitable efforts cannot and do not fill the voids in our health care delivery. We are already spending more than enough to meet the health care needs of all of our residents, but we cannot expect to achieve equitable allocations of our health care without guiding public policies. It’s not that we don’t understand how to do it – single payer Medicare for All would fix this problem for us – it’s just that we have to decide to go ahead and do it.

Homelessness provides the visual and olfactory stimuli that should spur our public stewards into action. Too bad that there is a lack of transparency of financial hardship and human suffering that is so prevalent as a result of the dysfunction of our health care financing system. But then, since before now we seem to have been unable to overcome the inertia preventing us from assisting the homeless in moving from their miserable subhuman accommodations into facilities that at least provide the bare basics, will we actually be inspired to move forward with the plea of Governor Newsom for us to get to work – not only for the homeless but also with his perpetual plea to provide health care for all? What will it take?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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