
Watsi uses crowdfunding to provide healthcare, but are patients better off? - thetanuj
https://brightthemag.com/silicon-valley-needs-to-stop-pimping-out-patients-to-alleviate-white-guilt-bc94b4a17885
======
thaumaturgy
No matter what good you do, someone will go out of their way to find the bad
in it.

Are Doctors Without Borders also all collectively suffering "white guilt"?
Project Smile? Are they crippling societies by not forcing the people in those
societies to suffer more in the name of commanding other governments to
bootstrap themselves? And while we're casting aspersions about for ulterior
motives, how grossly western is it to expect other governments to just adopt
ideals like universal health care?

> I clicked on the link, not really sure what to expect given the tone of the
> introduction. I soon found myself on the shiny, Squarespace-y landing page
> of Watsi, a San Francisco-based startup closely linked to the accelerator Y
> Combinator.

"...and I was secretly glad, because I knew I'd found something to fuel my
simmering outrage, and I could write about it and maybe get some attention for
myself."

> A few moments later, charitably-minded voyeurs can flick through photos of
> her and hundreds of other desperate looking men, women, and children from
> around the world and play God — i.e., fund the saddest case they can find
> and feel good about themselves.

"A few moments later, charitable people can be easily connected to someone to
help. No, wait, that doesn't sound very bad. Hmm. Charitable people can just
pick the case that's closest to being fully funded. No, that's not that bad
either. Okay, what words can I cram in here to make this sound really bad?
Where did I leave my thesaurus?"

> If Watsi donors are paying for the healthcare of individuals in developing
> countries, what incentive do those developing country governments have to
> build functioning health systems?

Because clearly the only thing stopping these countries from taking care of
their own citizens is Watsi.

> Getting individual donors to pay for care does not help address the
> structural barriers that exclude many poor people from accessing health
> services.

"I hate everything Watsi stands for, and especially that they aren't doing
more of it."

> In its current state, the model seems to exist more to alleviate “white
> guilt” than to increase access to care.

"I suffer from a cynicism that is so deep and hopelessly dark that I find it
impossible to imagine anyone doing anything unless they're motivated by the
guilt I imagine they should feel for the color of their skin."

> Our goal is to ensure that even if the project fails, patients are better
> off than if it didn’t exist…. We’re working closely with the local
> community, government, and providers that collectively have many, many years
> of experience to design the system and adhere to all local laws in such a
> way that no matter what, patients will benefit.

> Are the bolded words above making anyone else nervous? Or is it just me?

"Damn. That's a pretty good reply. I've ... I've really got nothing to argue
with here. I'll appeal to a vague sense of unease."

> ...allow me to offer a few suggestions:

"Knowing absolutely nothing about their experimental programs, I am going to
make a few vacuous suggestions backed by absolutely no mention of expertise in
this field."

> Healthcare is a human right, and should not be granted based on an
> individual’s state of relative piteousness. No more photos, no more sob
> stories. Pool donor donations and allocate randomly among the patients.

"I would sooner insist that Watsi throw away everything that allows them to
help a few people, and adopt instead my totally untested opinion which will
destroy everything that makes Watsi unique and in all likelihood cause them to
go the way of every other faceless organization begging people for money."

> That means working with governments and Ministries of Health to find the
> most effective and appropriate means (e.g. social insurance, sin taxes,
> etc.) for them to raise sufficient funds to provide universal healthcare for
> their population so you don’t have to.

"I really really hope nobody notices that just a moment ago I was accusing
them of being short-sighted for trying to reduce the overhead costs of health
care. If that worked, the need for funds would be reduced."

\--

I hate this article. I viscerally hate it. "Cee Cee Elle" claims to be a
"public health professional", but this thing she wrote is completely devoid of
any substance at all, any concrete or constructive criticism, anything stated
from experience or expertise, and it's so _transparent_ in the way it tries
one self-righteous insult after another, just to see if any of them might
stick. That's the thing that really grates: not that it's a criticism of
Watsi, but that it's a stupid criticism of Watsi.

~~~
cies
I totally agree this is a really shitty article.

What I like about Watsi is that is finds a model of charity that is
transparent, low-overhead and not-creating-dependencies. By not-creating-
dependencies I mean that supplying food (unless in crises) will make people
dependent on your handouts, thus creating a dependency. Getting an
individual's medical problem fixed, that will otherwise FOR SURE go unfixed
due to lack of money, will truly benefit that person (and their families).

Watsi provides me a clear way to do charity without most of the common
drawbacks (high overhead and creating dependencies).

Thanks Watsi.

------
Johnny555
_It may seem innocuously altruistic, but there are bigger implications of this
work. If Watsi donors are paying for the healthcare of individuals in
developing countries, what incentive do those developing country governments
have to build functioning health systems?_

Is it somehow better for the patients if they are allowed to suffer or die
because they can't afford the treatment?

Perhaps it's true that in the long run, crowdfunding individual treatments
gets in the way of the government building a health care system, I'm not sure
that's true. Look at the dismal state of public health care in the USA, one of
the richest countries in the world.... it seems debatable that much poorer
countries are even capable of coming up with a workable public health care
system.

But in the meantime, why not help some people out that otherwise couldn't
afford the healthcare?

I understand that it can be degrading to have to put your healthcare plight on
the internet and beg for donations to survive... on the other hand, what other
option do these people have _today_?

~~~
hunter23
Anecdotally I've heard from my partner who works in public healthcare that a
lot of poorer countries are coming up with more sustainable health care
systems because they have the luxury of learning fromthe mistakes of US and
other western countries. Most 3rd world countries are building out their
infrastructure now so they have benefit of any greenfield operation.

The US is suffering from the healthcare version of crippling technical debt
(and cultural issues around that).

------
chaseadam17
I'm a Watsi team member, and while this post is already off the front page, I
still wanted to discuss a few of the points raised in the article and address
some inaccuracies:

> "Silicon Valley needs to stop pimping out patients to alleviate white
> guilt."

Watsi donors come from around the world, and we have more donors from China
than any other country. I don't think "white guilt" is something that applies
to most of our donors.

> "She is informed by the doctor that this is a “Watsi facility” and is asked
> if she would like to “share her story with the world.” Faith, who is
> economically vulnerable and facing a non-choice between externally-funded
> treatment and continued disease, agrees. Her photo is then taken and
> uploaded, along with her sob story, to the Watsi site."

This is misleading. As we state on our website, "If a Watsi Crowdfunding
patient doesn’t wish to be featured on the website, we give them the option to
have their healthcare funded via our General Fund without ever appearing on
the website." It's important to us that patients don't have to decide between
sharing their story publicly and receiving healthcare.

> "...to design the system and adhere to all local laws in such a way that no
> matter what, patients will benefit."

I wrote this response to a support email and I'm embarrassed rereading it. It
would have been more accurate to say that we make every effort to identify and
reduce the risks involved with any new project. It's part of my job to
represent Watsi's work accurately and I let us down here.

> "It does not incentivize poor communities to demand their governments
> fulfill their commitment to the World Health Organization..."

I don't believe people in poor communities need to needlessly suffer due to a
lack of healthcare in order for them to be incentivized to advocate for their
basic human rights. This statement is demeaning to people around the world.

> "If the goal really were to increase patient access to life-changing care,
> there would be a commitment to supporting patients and to working with
> governments over the long term to remove those structural barriers to care"

This raises a point that I've struggled with in the past: is it better to help
one person today or try to create a system that helps more people in the
future? I've come to believe it's a false premise. You'd never tell your mom
that she should die of diabetes because you're working to strengthen Medicaid.

Every patient deserves healthcare today, and in the future, and the world has
the resources to provide both. And it's often by starting small and serving
individuals that organizations can learn how to effectively work with
governments to help people over the long term.

> "If YC and Watsi are truly committed to ensuring their model really does
> leave patients better off, allow me to offer a few suggestions...stop
> pimping out patients."

Millions of people in wealthy countries like the US use websites like GoFundMe
in order to post their stories online and crowdfund their medical expenses. Of
course, I wish everyone had access to healthcare and this wasn't necessary.
But it seems crazy to argue that poor people shouldn't have access to the same
fundraising tools that rich people do.

I'd be happy to speak with anyone (including the author) about our work. I'm
at chase at watsi dot org. We're open to any feedback or ideas that can help
us better serve patients.

------
projectileboy
In case anyone from Watsi inadvertently stumbles across this enormous pile of
ridiculousness, please know that the overwhelming majority of us appreciate
the hard work that you're doing to improve the lives of others.

------
techman9
I hate to discuss anything faith-based on HN, but in seeing models of
charities like Watsi's, I'm reminded of how Tzedakah (charity) was discussed
in Hebrew school growing up. Maimonides suggests that not all giving can be
considered equal and outlines a hierarchy for what types of donations are
considered most "pious":

    
    
      1. The lowest: Giving begrudgingly and making the recipient feel disgraced or embarrassed.
      2. Giving cheerfully but giving too little.
      3. Giving cheerfully and adequately but only after being asked.
      4. Giving before being asked.
      5. Giving when you do not know who is the individual benefiting, but the recipient knows your identity.
      6. Giving when you know who is the individual benefiting, but the recipient does not know your identity.
      7. Giving when neither the donor nor the recipient is aware of the other's identity.
      8. The Highest: Giving money, a loan, your time or whatever else it takes to enable an individual to be self-reliant. [0]
    

Maybe it's just the way I was raised, but platforms that allow me to select an
individual person to receive my philanthropy (like watsi) make me deeply
uncomfortable. The intuition here is that it's more pious to give because it
is our duty to take care of those with less than to give out of pity for
someone's plight. I would rather give money through a trusted third party,
such as a reputable NGO that focuses its efforts on healthcare needs in the
developing world. I would rather give to an organization and trust trust their
judgement in distributing my money in the ways they believe it is needed most,
than pick which individuals are deserving of my charity.

[0] [https://www.charitywatch.org/charitywatch-articles/eight-
run...](https://www.charitywatch.org/charitywatch-articles/eight-rungs-of-the-
giving-ladder/73)

~~~
mda
They have universal option where you just say the monthly amount and it is
used pretty randomly.

------
jokull
I'm on the monthly donation to Watsi, which is another product they don't
mention in the article. I don't pick people to cure like the article suggests.

They do send me emails about patients that I've contributed to. But I don't
know who they are ahead of time. It's kind of a gimmick I guess, but a useful
way to retain contributors by reminding them what their money is going
towards.

I believe their model is to raise from investors to cover overheads, but
donations go directly to treatments. You have an assurance (as far as those
go) that what you donate is not paying salaries of management. That hopefully
has a propensity to make the operation more frugal and efficient.

A useful reading if you want to understand what happens if a patient is "not
picked":

[https://watsi.org/faq#what-if-a-profile-isn-t-
funded](https://watsi.org/faq#what-if-a-profile-isn-t-funded)

------
washappy
I used to donate regularly to Watsi, but recently I have churned, as they have
de-emphasized the p2p aspect over universal healthcare. They now seem to be in
an awkward split between two projects, where I'd like to see them stand firmly
in either side of the camp.

I really enjoyed being able to see the patients, hear their story, get updates
on their progress, and receive a "thank you" from their loved ones. Is that
voyeuristic, bad, playing God? Perhaps. Should you be able to give blindly,
with just an abstract generic result in your mind's eye? I'd agree that is
better.

But it worked for me. It worked for Watsi. It worked for multiple patients
receiving around 1000$. It just does not work for the hate and outrage brigade
who want to signal that: doing good is not good enough if doing good makes you
feel good.

I don't care that the SV elite commercializes/optimizes foreign aid to the
point of a one-click-checkout meat market at Amazon. I don't care that it is
probably predominantly white people giving to black people in a weird reverse
kind-of cultural appropriation (black guilt: why can't we solve our own
problems?). I don't care that people suffer after Christmas donations dry up a
few months later. Keep hammering these points though and I may quit charity
all together: I don't want to think about things such as race when donating.
That is just no fun, not easy on the mind, not comfortable.

Exploit it. All commercial companies are doing so (Watsi is competing for my
attention). Why not manipulate people into giving instead of clicking on
advertisements? That only hurts my oversized wallet (and the refined taste of
the outrage brigade).

~~~
RobertoG
"I used to donate regularly to Watsi, but recently I have churned, as they
have de-emphasized the p2p aspect over universal healthcare."

It's my understanding that the their "other projects" are not being funded
from the same bag that the p2p healthcare. I don't see the problem if they
want to expand their activities.

~~~
washappy
The author makes mention of being able to flick through hundreds of patients
to find "the saddest case". (I think this is really only telling of how the
author views the world).

This used to be possible, but now there is just a "meet a patient" button,
showing a single random patient at a time, which works more like StumbleUpon
than Amazon product listings.

Now I need to actually invest way more time to find the "saddest case" (in
more polite terms: A case that resonates with me, usually a child with a life
threatening disease, but a perfectly viable treatment option). Also, skipping
patients was mentally easier for me when they were collections on a page, than
when there is a single patient on the page, and skipping to the next may mean
you never see the patient again.

------
danielbigham
I think a critical eye can be a helpful viewpoint, but the rhetoric in this
article is over the top to say the least (as others have pointed out). The use
of the word "voyeur" is especially off color. Sure, some small percentage of
givers might fit that description, but using it as a blanket description seems
very inappropriate. In general I applaud efforts like Watsi so long as the
hearts of the people involved are good, and they are willing to be humble and
honest. We need good experimentation in all walks of life.

------
brandelune
The question is, would Watsi work if the only thing it offered were pooling of
donations to anonymous care receivers. The article suggests that it would not.

But _that_ is the same idea as taxes. Taxes, that a lot of people like to
hate, offer that service already, and they are pretty efficient (except when
lawmakers prefer to make business owners richer by crippling public services).

So Watsi is only offering voyeurism as a business model. And that's what sucks
about Watsi, and that's why this article is 100% correct.

~~~
fapjacks
What on Earth are you talking about? You don't seem to have any idea what the
world is like outside the West. Taxes there go to whatever nepotistic dictator
or warlord is "in office", and the people _widely_ suffer for it. Violence is
a part of everyday life for _a lot_ of people on this planet. In these places,
medical care of any kind besides the local witchdoctor is a luxury completely
out of the means of most people. There are even places where the Red
Cross/Crescent and Doctors Without Borders _will not go_. Those places exist!
If nothing else, this comment is exactly why Watsi is doing good in the world:
Some people are ignorant of how the rest of humanity lives.

~~~
brandelune
Except that I don't live in the "West". And I've seen my share of the world,
and done my share of NGO work at home and in the places where it's directly
helpful. I also know that taxes are used especially in the West to fund the
military industry that contributes to killing people all over the place. So I
am well aware of the ambivalence of "taxes". But that's not what I am talking
about. I am talking about "taxes" as a way to create a strong public service,
not as taxes to create even stronger dictatorships. Also, places where the Red
Cross/Crescent and BWB won't go are also very unlikely to be places where
Watsi will go.

------
fapjacks
Yeesh. This is some kind of caricature of social signalling or something. What
even is this person trying to say?

------
thisisit
Am I missing something here? Donating money to a cause or individual in
developing/third world country is classic NGO. And Watsi seems to offer
nothing new, except maybe the word "crowdfunding" and based out of SV.

On that end, the indignation of this article is also misguided. This is like
saying - "if X NGO's donors are paying for improving Y in developing
countries, what incentive do those developing country governments have to
improve Y?" This line of logic argues against all donation.

~~~
shkkmo
>This line of logic argues against all donation.

No it doesn't. You do need to be careful about how goods and services are
donated to avoid making the situation worse.

[http://www.djiboutijones.com/2014/02/dont-send-your-used-
sho...](http://www.djiboutijones.com/2014/02/dont-send-your-used-shoes-to-
africa-or-maybe-do-send-them/)

~~~
thisisit
Oh I forgot about the issues on donating used shoes, food cans etc. So let me
rephrase that - This line of logic argues against any _cash_ donation.

------
dnautics
> If Watsi donors are paying for the healthcare of individuals in developing
> countries, what incentive do those developing country governments have to
> build functioning health systems?

Doesn't even stop to consider that maybe donor based healthcare is more
sustainable and a better solution than anything the local government could
offer.

------
frk1206
Do these people not understand that what they are basically saying is "a few
children must be sacrificed so that local governments wake up". Also this
assumes that the local governments have enough resources (or ever will) which
may totally not be the case.

------
quaunaut
This entire article is nothing but making perfect the enemy of good.

------
gremlinsinc
Is everyone in Silicon Valley so out of touch? Those hospitals presumably have
to pay someone to take pictures, upload to watsi the profile, manage the
billing, etc...

Wouldn't it be easier -- if Watsi instead helped these countries institute
some sort of single payer plan, or a plan whereby the Hospital is an insurer.
Everyone in their 'district' is insured by that hospital. They pay monthly
fees based on income 2-4% maybe? Watsi could give grants to hospitals who are
in the red as well as consult them on how to improve productivity and lower
costs...

I think this model would work here as well...

If you're out of network on a business trip or something, you'd go to another
hospital, your home hospital would pay the out of network one. The hospital
benefits because they have MRR from all patients living in their district who
opt-in to their hospital. Hospitals could then standardize all billing and use
a central software/system to manage everything get rid of lots of billers, not
need to deal with insurance companies anymore, and they'd always get paid.

~~~
kaybe
This sounds like something you cannot do with an NGO since it is far to
integrated with government.

And that's a fully different level of activity; you have to go through your
national foreign aid agency (they might laugh at you, hopefully only at
first). You're basically trying to interfere in foreign politics at this
point, and as you can guess the diplomacy involved is crazy (as it should be).

------
shkkmo
How is it not blatently obvious that is not OK to have richer people from
another country picking and choosing which individuals are "deserving" or
"piteous" enough to receive health care?

~~~
chrischen
That’s part of the marketing to help bring awareness to the need for the
service.

I always donate to their general fund, which means they do the allocating.

