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Netherlands, which has a restrictive immigration policy compared to the United States. Most European nations, including the Netherlands, after all, have universal health insurance coverage, which makes drug treatment and psychiatric treatment more available, and the Dutch government subsidizes more housing. Finally, the Netherlands’ big success was with heroin, which has effective pharmacological substitutes, methadone and Suboxone, not with meth, which lacks anything similar. But there may be fewer obstacles than appear. The Netherlands has a private health-care insurance system similar to that of the United States and covered the people who needed health care in ways similar to Medicaid and the Affordable Care Act, which significantly expanded access to drug treatment, including medically assisted treatment, in the United States.4 San Francisco subsidizes a significant quantity of housing, as we have seen. While California is larger than the Netherlands, the population of Amsterdam (872,000) is nearly identical to San Francisco’s (882,000).5 And while California’s population and geographic area are larger and more difficult to manage than those of the Netherlands, California also has significantly greater wealth and resources, constituting in 2019 the fifth-largest economy in the world.6 And the approach to breaking up open drug scenes, treating addiction, and providing psychiatric care is fundamentally the same whether in five European cities, Philadelphia, New York, or Phoenix.

... there is a difference between reading about the end of the world and actually seeing it with your own eyes. Watching a kingdom, drunk on sugar and youth culture and hippie nostalgia and reality TV and porno dreams and Hollywood lies, shrivel up and fall apart; it's like watching Alexandria and Constantinople and Rome and Athens all crumble to ash. Rising poverty. The annual migration inland, as the unemployment and homelessness and hopelessness on the West Coast spread like poison through a society that hadn't yet recovered from the pandemic. And on top of that, the forest fires that began earlier and ended later each year, meaning that a period that had once stretched from June to September now spanned April to November. Some parts of California were now more or less uninhabitable, there were places the insurance companies refused to cover, with homeowners unable to renew their existing policies, and I knew enough to understand that once the money starts leaving a place, the people follow.

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