London Breed breezed through her re-election at the beginning of the month, taking almost 70% of the vote in San Francisco’s mayoral race. But in winning, she might have also lost. No big-city mayor in the country has a tougher job ahead of them. 

San Francisco’s troubles start with a hardened homelessness problem, and what might be the most stubborn housing crisis in the nation. And they don’t end there.

San Francisco is being devoured by homelessness. Human feces, human urine, and hypodermic needles blight the streets and sidewalks. Tents block public passage, pedestrians have to step over and around sleeping bodies, and disease threatens public health. Fed-up residents have resorted to placing boulders on sidewalks to block encampments. Activists, who claim to represent the interests of the homeless but are a large part of the problem, pushed them out onto the street, which just added to the problems. Business Insider reported the big rocks created a traffic hazard, forcing the city to move “the boulders back onto the sidewalk via crane.”

These conditions aren’t limited to the city’s skid row. They’ve bled into the tonier districts. 

Many of the homeless are mentally ill, which has created what seems to be an intractable problem. Unlike those who are homeless because they’ve lost jobs, been evicted or foreclosed on, can’t afford housing, are victims of domestic violence, or kicked out by a friend or family member, the mentally ill truly have special needs.

Exacerbating the homelessness tensions is a miserable housing crisis. Homes are so expensive in San Francisco that many have been priced out of the market. A low-wage worker, for example, has no chance in the city. Middle class prospects are on the bubble. No major city in the U.S. has a higher median home price. In June, it reached $1.7 million.

The high cost of housing is reflected in the city’s high cost of living, which, according to move.org, is the highest in the country at $4,210 a month. 

None of this is secret. Yet the entire mess seems to be an inexplicable mystery to policymakers and most voters. They keep doing the same things over and over, and nothing changes — unless things get worse.

For example, the city budgeted about $305 million for fiscal 2017-18 trying to get a handle on homelessness, after spending $275 million the year before, and which followed annual expenditures of about $250 million. Last fall, residents passed Proposition C, adding another $300 million a year in spending through a business tax, which will surely increase the more than $40,000 San Francisco has been spending on each homeless person every year.

Throughout all of this, the homeless population increased 17% from 2017 to 2019. There are now nearly 10,000 in the city without housing. 

Meanwhile, government-directed efforts to make housing more affordable, such Proposition A, a $600 bond issue to fund affordable housing approved by more by nearly 70% of voters on Nov. 5, can’t break the jam. 

A city serious about solving its problems would repeal its rent-control laws; work non-stop to ease restrictive zoning; slash construction fees; rein in the city’s Planning Department and Planning Commission, which are “complicit in obstructing all kinds of new housing … crisis be damned,” says San Francisco writer Hunter Oatman-Stanford; and demand an overhaul the California Environmental Quality Act, the most stubborn obstacle to homebuilding in the state.

It would also root out the criminal gang whose drug trade, say some residents, feeds homelessness; stop listening to the politically powerful activists who regard the homeless as victims and demand they be treated as an endangered species is treated, meaning that they cannot be removed from their habitat; and never tolerate a prosecutor who has declared urinating and camping in public, as well as blocking sidewalks, are acceptable behaviors.

City Hall also ought to move toward a community-based system that integrates those on the streets in need of mental health care “back into their neighborhoods.” Some Californians have visited Trieste, Italy, and found its “radical” program for the mentally ill to be an effective and humane response. At the very least San Francisco should monitor the progress of a pilot program in Hollywood based on the Italian model.

While focusing on homelessness and housing, Breed can’t ignore the garbage problem in a city known for having too few trash cans, nor the festering traffic issues that include more than two dozen deaths this year, miserable congestion, and an ugly tension between drivers and cyclists.

San Francisco isn’t New York, Los Angeles, or Chicago. But its problems, and Breed’s, are just as big. 

Kerry Jackson is a fellow with the Center for California Reform at the Pacific Research Institute.