Mayor Daniel Lurie has tapped Michael Levine, a Massachusetts Medicaid executive, to lead San Francisco's Department of Homelessness and Supportive Housing — making him the latest in a growing roster of outsiders recruited to tackle the city's seemingly intractable drug and homelessness crises.

Levine's appointment isn't random. He previously worked alongside SF Health Department head Daniel Tsai during a four-year stint on Massachusetts Medicaid, which at least suggests some institutional chemistry. Whether that translates to results on the streets of the Tenderloin and SoMa remains very much an open question.

Let's be honest about the track record here. San Francisco spends north of $600 million a year on homelessness services. The city has cycled through leadership, strategies, and acronyms — and yet the tent encampments persist, the shelters remain underfunded relative to demand, and taxpayers keep writing bigger checks with diminishing confidence that the money is doing what it's supposed to do.

Bringing in outside talent isn't inherently a bad move. Fresh eyes can identify the bureaucratic bloat and institutional inertia that insiders have learned to ignore. But "outsider" status cuts both ways. San Francisco's homelessness crisis is uniquely tangled — driven by sky-high housing costs, permissive drug policies, a labyrinth of nonprofit contracts, and decades of political dysfunction. Understanding those dynamics takes more than a good PowerPoint deck.

The real test for Levine won't be his credentials. It'll be whether he's willing to do the uncomfortable work: audit where the money actually goes, demand measurable outcomes from service providers, and push back against the entrenched nonprofit-industrial complex that has turned homelessness into a permanent industry rather than a solvable problem.

Lurie clearly wants to build his own team. That's his prerogative. But San Franciscans — the ones stepping over needles on their morning commute and watching their tax dollars evaporate — deserve more than another appointment announcement. They deserve accountability. And results.

Welcome to San Francisco, Mr. Levine. The clock is ticking.