The Most Expensive Apartment in America Is a Hospital Bed

Start with the part that sounds like a lie

Here's a strange fact: take your average chronically homeless man in your city, give him an apartment of his own, ask him for nothing in return, and the public will spend less money than it is spending today to keep him on the sidewalk. Less money this year, on the actual line of the actual budget.

That is the strange thing about making sure everybody has a roof over their head: it does not make you choose between your conscience and your wallet, because for once the two are pointing at the same door. You do not have to be moved by the man. You can be a complete miser about it, run the numbers, and you will arrive at the identical instruction — house him, and keep the change.

What we have already decided

A man with no insurance, no address, and eleven dollars in his pocket can fall down on a sidewalk in any city in this country, and within the hour an ambulance will carry him to an emergency room that is required by law to work on him until he is stable, and no one will ask for a card before they start. That is settled. We decided it long ago. And if, instead of falling down, that same man puts a brick through a storefront window, a second system just as expensive and just as guaranteed is waiting to receive him — the squad car, the holding cell, the public defender, the arraignment, the bed upstate. That is settled too.

All of that is really, really expensive. Many, many highly paid professionals are required to attend to this homeless person in institutions that have enormous overhead. When you realize that, and you compare that kind of economic activity against what's required for a little studio apartment, it begins to make sense.

We decided a long time ago that hospitals and jails are a human right and everyone must have access. We argue without end about food stamps and cash and who deserves what. But these two commitments are not up for debate and never come up for a vote. We renew them every single year, because we long ago agreed that whatever else we are willing to let happen to a person, we are not willing to let him bleed out on the pavement or smash windows without consequence. The responsibility is not hypothetical. It is already ours, and we already fund it.

The doors we chose

The trouble is that those are the two most expensive doors in the building. The chronically homeless man — the one you have stepped around on the same corner for three winters now — costs the public somewhere in the neighborhood of thirty-five thousand dollars a year, almost none of it spent on anything that helps him: ambulance rides, emergency rooms that treat the symptom and discharge him back to the curb, a detox stay, a few nights in jail, repeat. We are already paying to take care of him. We have simply chosen to do it through the institutions that charge the most per night and change the least about his life.

It is the financial equivalent of refusing to buy a forty-dollar umbrella and instead replacing your soaked laptop every time it rains. We are not saving money by leaving him out there. We are spending more of it, in a way arranged so that we never have to see the receipt.

The door we skipped

There is a cheaper door, and it is the obvious one. Give the man an apartment. Not a bed he has to stay sober to keep, not a cot he lines up for at five and is turned out of by seven — a lease, a key, an address that is his. The approach has an unglamorous name, Housing First, and a slightly embarrassing quantity of evidence behind it: in the randomized trials, somewhere between seventy and ninety percent of people are still housed two and three years on, with fewer arrests, fewer nights in the emergency room, fewer of the costly little catastrophes that the street manufactures.

And it is cheaper. In Los Angeles County every dollar put into supportive housing returned about a dollar and twenty cents in public costs that never came due; in Denver, housing these men and women saved better than fifteen thousand dollars a person a year. None of this should surprise anyone who has ever read the itemized bill from a single night in a hospital — the nine-dollar aspirin, the line item with four digits and no explanation beside it. An apartment undercuts a hospital bed by something close to two orders of magnitude. We did not need a study to suspect it. You just need to have both signed a lease on a starter apartment and spent some time in the hospital (or court) to know the difference in cost.

The wife and the stranger

Someone will object that a dollar does more good in a village in the Sahel than on a sidewalk in Sacramento, and on the arithmetic they are right. A few thousand dollars routed to the right place abroad will buy more years of human life than the same sum spent at home, and I am not going to pretend otherwise. But the arithmetic is not the whole of the matter, and a life lived strictly by it would be a cold and finally a monstrous one.

Take the oldest version of the problem. You're in a little rowboat. A hundred feet away, your wife is drowning in the ocean. In the opposite direction, also a hundred feet away, two strangers are also drowning in the ocean. The man who hesitates to consider which rescue yields the greater total of human welfare has, in the pausing itself, become someone no one should want to be married to. He has had, as the philosopher said, one thought too many. The hesitation is not a higher form of goodness. It is the absence of an ordinary one.

Which brings us back to what we do with our money

We actually don't need more taxes, extra compassion or performative empathy to both fix this problem and save money at the same time. We only need to look at the facts and be rational.

If you would like to be a part of this, here are some good places to start. I have kept this list to organizations that put donations into actual units and keys rather than into advocacy or fundraising.

Breaking Ground — New York City. Directly operates more than 4,400 units of permanent supportive housing and houses over thirteen thousand people a year. Four stars and a 99 percent score on Charity Navigator.

Downtown Emergency Service Center — Seattle. Runs over 1,100 units of supportive housing, and the organization whose own residents produced much of the evidence that this approach saves money in the first place.

Charity Navigator — End Homelessness Fund — if you would rather give to a vetted operator closer to your own city, this is a curated, rated place to find one.

Skills

Status

Essay — part of an ongoing argument about consumption, giving, and where attention should go.