Opinion: Now is the Time to Fix Multnomah County
- 1 hour ago
- 3 min read
[March 12, 2026]
by Sharon Meieran
Meieran, M.D., J.D., is a Hillsdale resident and two-term Multnomah County Commissioner (2017-2025). She was a guest speaker at the March 4 meeting of the Hillsdale Neighborhood Association.
Multnomah County is our local government responsible for health and human services, including homeless services, public health, mental health, and addiction services. It is also in charge of animal services, bridges, local elections, and some land use and transportation.
Unfortunately, the county is structurally set up to fail. Here's why:
Money is dispersed across departments and can’t be tracked.
Authority is diffuse and fragmented without a clear chain of command.
Budgets are based on history and inertia rather than strategy and results.
Management turnover is near constant.
The County Chair holds sweeping power with few checks and balances, and no accountability other than an election every four years.
Hundreds of millions of dollars have quietly disappeared into myriad overlapping programs with virtually no end data to prove that anyone receiving county services moves from crisis to stability.
Based on eight years of work and insights on the county commission, my front-line experience as an emergency physician, the feedback of providers and recipients of county services over years, and the successful models of other counties and cities across the country, I have developed a plan to fix Multnomah County.
You can read the details of the plan here, but there are the four basic principles:
Organize for impact
Measure what matters
Budget for results
Account for every dollar
My plan goes into detail about how each principle can be applied across all aspects of the county, but let’s take a look at how it applies to one of the county’s most crucial and visible areas of responsibility: Homeless services.
Organize for Impact:
As Figure 1 shows, the current homeless services structure is essentially chaos. At least five siloed county departments with separate budgets touch on homelessness, and there is no single person in charge. We can re-organize so departments are integrated, and there is clear governance, funding streams and chains of command. (Figure 2)
Measure What Matters:
Measure the outcomes we want to see, not numbers of meetings, referrals, shelter beds, housing vouchers, or money spent (current county practice). Right now we don’t even have a baseline for the most important indicator to tell if homelessness is getting better or worse: the number of people actually living on our streets. Without this baseline, we can’t assess whether our programs are working. Counties that have successfully reduced homelessness measure what matters: number of people living unsheltered in real time; number of eviction filings; reductions in cycling through emergency rooms and jails.
Budget and Contract for Results:
The county contracts with around 400 nonprofit organizations to provide homeless services, yet they are largely uncoordinated, there is little oversight, and contracts are not structured to get results. Programs are funded based on the fact that they were funded the previous year. With my proposed results-driven contracting, payment for services is contingent on performance. With my proposed “zero-based budget,” county department budgets are built from zero, based on anticipated services and costs, rather than based on history.
Account for money spent:
Currently, the county does not compare actual performance to projected results. There is no way to “follow the money” to ensure that public dollars are being spent effectively. The county must regularly review performance vs. promise, and ensure the county is getting what it pays for.
Multnomah County spends more than $4 billion a year - last year nearly $400 million on homelessness alone - yet unsheltered homelessness quintupled in five years, mental illness and addiction remain largely untreated, and public trust has collapsed.
Multnomah County does not need additional funding, nor does it need better administration. It needs a fundamental reset.
My plan is a roadmap to a well-functioning county government leading to thriving communities. It achieves better outcomes while spending less.
It is time for real change. If not now, when?
What you can do to help fix Multnomah County: Learn about the plan, share it with friends, neighbors and on social media, write to current county board members telling them you support the plan, and consider testifying at Multnomah County board meetings asking for the plan to be implemented.
As candidates sign up to run for County Chair in November, ask them whether they support the plan. If they do not, ask them why, and demand a viable alternative.
[Editor's note: The filing period for Multnomah County Chair is June 3 through August 25 for the November 2026 election. Current county commissioners Shannon Singleton and Julia Brim-Edwards have announced their intention to run.]
Questions? Comments? Let us know.
