02.13.2020

How Medicare Can Help Address US Homelessness

My first job in health care was at the Harvard Square Homeless Shelter, where I helped launch a clinic to provide medical care to people experiencing homelessness. It was in that setting that I met a patient I’ll called “Fred.” Fred had complex health issues including substance abuse problems and chronic diseases — the kinds of comorbidities that require intense coordination.

But that’s not at all what Fred got from the health care system. Our fee-for-service system of care isn’t designed to provide that level of coordination. I remember, during a particularly frigid Boston winter, Fred got frostbite. He went to a local ER, where doctors performed surgery on his hands...and sent him right back out into the cold.

Needless to say, when I met Fred he didn’t have a lot of trust in doctors or the health system in general. Like so many other services he received, health care was fragmented and didn’t do much to help Fred with the underlying conditions that kept him out on the streets.

Today, the number of people experiencing homelessness in America is staggering. According to the U.S. Census Bureau, more than 550,000 people experienced homelessness on any given day in 2018. We often think of homelessness as a housing issue. But the same conditions prevail today that inspired me to launch that clinic during my undergraduate days: homelessness is both a recognized cause and a result of health problems. 

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