Having lived in chicago, DC, San Diego, and visited NY, philly, LA, honolulu and baltimore, extensively, and volunteered among the homeless in SF, SD, DC, and Fargo - SF is much worse than the rest of the country.... Except maybe Baltimore. I think the US had a long tradition of taking care of the downtrodden outside of state-run institutions. This tradition was slowly dismantled starting at the beginning of the progressive movement (1920s-1930s through FDR) in favor of having the state run things. The net result now is that the state runs things poorly, and people now think that there is no longer any need for private charitable action, because government will deal with it.