Dear Science,

My conservative relations are pounding me over health-care reform. "Why should the government force me to pay for someone else's medical care?" Moral arguments, like everyone deserves to be cared for when they're ill, aren't exactly getting me all that far. I claim that it's cheaper to just take care of people rather than waiting for them to get really sick and show up in an ER. They deny this. I need proof, Science! Does kindness (in giving everyone health care for free) pay?

With Morals, Wanting Data

Science has the data for you, and it's beautiful—a really lovely study first authored by Mary Larimer at the University of Washington Department of Psychology.

Consider the determined homeless alcoholic. Homeless Americans die at three times the rate of the general population. For someone both alcoholic and homeless (often with the former causing the latter), the expected life span is somewhere around 40 to 50 years; that's what you'd expect for a citizen of the poorest and least developed countries on earth. Resources exist for the homeless—typically ladled out with a good amount of moralistic preaching. Alcoholism is a real disease—devouring some people whole. If you cannot be sober, most programs don't want you. So, you stay outside. You beg for money. You commit petty crimes. Eventually, inevitably, you get sick. Then you present to the emergency room—either by choice, by police (often after "failing jail" for being too sick), or by medics after being "found down." As you reach the end of your life span (entering late age in your 30s and the terminal stretch in your 40s), you find yourself at the ER more and more often. The costs pile up. Then you die. The median cost of this cycling—absorbed by society via cross-billing the insured or taxpayer-supported county hospitals—is about $4,000 per alcoholic per month.

Hearing this, we can imagine your relations spitting. The good authors of this study came up with a solution. It's called Housing First and involves dispensing with moralistic preconditions for compassion.

A list of the region's most expensive alcoholics (in medical costs, jail costs, and shelter costs for alcoholism) was compiled. Each was offered a free room in a dormlike building at 1811 Eastlake in Seattle; with the room came (cheap) preventative basic medical care and counseling. The first 95 selected for this program cost society over $8 million per year before being moved in. After the no-strings-attached housing, total annual costs (including for the rooms) for the 95 dropped to about $4 million—half. On average, those provided housing drank less; some stopped altogether.

Such a plan is ugly. It ignores questions of who deserves what. It worked. Sanctimony is objectively expensive. Ask your relations if they think we can afford it any longer.

Practically Yours,