
The Hidden Cost of GoFundMe Health Care - longdefeat
https://www.newyorker.com/magazine/2019/07/01/the-perverse-logic-of-gofundme-health-care
======
sharkweek
I wrote about this on here once before, but for a while I was working on a
short story about a fictional dystopia in which crowdfunded healthcare
devolves into a televised game show where people pitch their sob story to
viewers. Whomever ends up with the most votes (a la The Voice), moves onto the
next round, until finally one person is crowned the winner and has all of
their needs taken care of. What was supposed to be a silly story turned super
cynical and depressing, so I stopped working on it.

When I last talked about it, someone pointed out that this was already a
thing, back in the 1950s, called "Queen for a Day" \-
[https://en.wikipedia.org/wiki/Queen_for_a_Day](https://en.wikipedia.org/wiki/Queen_for_a_Day)

 _Each contestant was asked to talk about the recent financial and emotional
hard times she had been through. The interview would climax with Bailey asking
the contestant what she needed most and why she wanted to win the title of
Queen for a Day. Often the request was for medical care or therapeutic
equipment to help a chronically ill child, or might be for a hearing aid, a
new washing machine, or a refrigerator. Many women broke down sobbing as they
described their plights._

~~~
ehsankia
Sounds like a perfect pitch for a Black Mirror episode. Although "Fifteen
Million Merits" gets kinda close.

~~~
bschne
I think "Nosedive" goes into similar territory and might even be the better
fit, since success in this kind of show and GoFundMe campaigns could be
considered a proxy for popularity and/or "good" presentation.

------
noncoml
I have an acquaintance who is working in a top Bay Area tech company with a
total compensation of close to $200k.

Her parents visited her and sadly her Dad had a cardiac episode and had to be
taken to ER.

They stabilized him and thankfully he managed to go back to his home country
and get proper treatment.

The ER bill was about $50k and she decided that the best way to pay it was by
creating a GoFundMe campaign before she even tried to negotiate with the
hospital or fight it with the insurance.

She managed to raise $15k.

After seeing that I am reluctant to donate any money to GoFundMe campaigns.

~~~
superfrank
Maybe I'm just being dumb, but I don't really understand why that makes you
reluctant to donate.

It's not like your friend is trying to scam you or anything. That money is
actually going to a bill that they are required to pay. Most people I talk to
don't even know they can negotiate hospital bills.

Seems weird to act like your friend or GoFundMe is the villain here, when the
issue is really a healthcare system that has a "secret menu".

~~~
noncoml
I am not so sure. When she has the money to pay for it, but instead chooses to
portrait like she doesn't and asks others to pay for it, I think it's at least
immoral.

It goes without saying that the healthcare system is completely broken, but
that doesn't justify above behavior.

~~~
bbarn
200K in the bay area is not exactly wealthy. It's a solid middle to upper-
middle class wage. Taking a 50K hit for something you did nothing to deserve,
just because you love your parent is stupid. I would hate it if my daughter
tried to do that for me.

~~~
maxxxxx
" I would hate it if my daughter tried to do that for me."

But you are OK if other well-meaning people pay? If you make 200k you can take
the hit and you should have known better.

~~~
onion2k
You do realise that if you buy insurance and don't claim anything that's
literally you paying for other people's healthcare, right? That's how
insurance works. The only difference between that and the socialised national
health systems around the world is that you also pay for the insurance
company's profit.

~~~
dpkonofa
I feel like I have to say this to everyone all the time when they try to
defend the US as having the greatest healthcare system ever. It's literally
impossible to offer the same service as a socialized, government program for
cheaper when the non-socialized option has to make a profit. If a non-
socialized system can drive costs down, so can a socialized provider. There's
literally no situation where the socialized system loses on this.

~~~
jjeaff
Huh? So really, all services should be socialized is what you are saying?

There is literally no way a private company could offer something cheaper and
better than the government?

~~~
dpkonofa
I never said all services should be socialized. For example, I don't think
auto repair services should be socialized. Do you see how silly your statement
is?

And no... there is no way that a private company could offer something cheaper
because both entities function the same way except that a private company also
has to make a profit. Governments are not profit-making entities. Take
whatever method a private company has to make something cheaper and remove
profit and you have something the government can handle.

~~~
jjeaff
I didn't realize we were talking fantasy hypotheticals. Reality is, private
companies can and will always do better than the government in almost
everything. For the exact reason that you claim to be the problem. They want
profit.

Industries like healthcare are plagued with government interference. Some
regulations are important. Many just serve as a moat around the oligopoly that
is the current private health Care system.

~~~
dpkonofa
No one's talking fantasy hypotheticals except for you. The "reality" that
you're claiming is not at all actually reality considering that every other
industrialized nation on the planet pays less for healthcare and prescription
drugs than we do in the United States. If private industry can drive prices
down, then so can government. The USPS was the poster child for efficient and
effective government service until Republicans decided to absolutely decimate
it because of lobbying from private industry. Government services don't need
to make a profit, they don't need to lobby, and they don't have any of the
greed-driven motivation that private companies do.

You're either being intentionally obtuse or you're intentionally being
misleading for some reason. This isn't rocket science. If two things are equal
and one has the requirement to also generate profit, there's no way the other
can possibly cost more.

------
avgDev
I am upset that any individual needs a GoFundMe page to get money for a
treatment. However, I also know many people who simply make terrible life
decisions such as lack of insurance, buy luxury cars/homes and generally live
beyond their means. Then, when shit hits the fan they own nothing and have to
rely on assistance. I would much rather have the government take the money
from everyone then use it to fund healthcare. Most average people are not
smart about money.

Also, I recently donated to a family member, even though the treatment she is
receiving is in my opinion snake oil. There is 0 peer reviewed studies. I
still have mixed feelings about it. I researched what other people experienced
with the treatment and results were mostly negative. They sell hope.

I too have a chronic condition, and there are doctors who offer magic
solutions for large sums of money. There is a doctor who claims he had the
condition and treated himself. Then weeks later his website went up and he now
offers the treatment for a tiny sum of like $13k. Desperate people will pay
that money for having hope. It is sad imo.

In general regular doctors will be blunt and honest. Doctor needs to tell you
that if there is no hope there is no hope and how much time you have or what
you can expect. In the practices that operate in grey areas and provide
treatments which are not backed up by science people are getting scammed. I
have been to one of those places with a family member...everywhere you look
they have quotes about hope and not giving up but then when it comes time to
leave you are responsible for $3000 for a visit, of course no insurance will
cover it. Makes me disgusted, as that money would be better spent trying to
adapt to your new condition if possible.

I too had a hard time coping with my condition and honestly the US social
safety net is pure garbage. Disability takes two fucking years to get a
decision, and you will most likely need a lawyer. You could not even get
healthcare before obamacare or pre-existing condition would not be covered. I
lost a job and had to pay $600 for cobra insurance. Honestly, just thinking
what I had to go through makes me want to go back to Europe.

Edit: Apologies that this turned into a rant.

~~~
bluedino
One of the bars I go to, every other month or so seems to have a fundraiser
for a regular at the bar.

I almost never donate unless I'm there the day of the fundraiser, or there's
food involved. $10 spagetti dinner for instance.

I understand this person needs help. But in almost every case, I know this
person. I know how much $$$ they spend on acohol a week. I know how they got
fired from their job for not showing up. I know they blew their tax return in
a week. I'm not a cold hearted person but I don't understand why others have
to bail them out.

~~~
supergauntlet
>I know how much $$$ they spend on acohol a week.

Are poor people not allowed to have fun?

>I know how they got fired from their job for not showing up.

Are depressed people not worthy of keeping alive? Do they not bring enough
value to the table, so it's okay to just let them die?

>I know they blew their tax return in a week.

Is poor financial sense justification for not helping someone out that needs
help?

I dunno, these all seem like kinda tenuous justifications for not giving. By
all means, it's your money. I'm not telling you how to spend it. Just that I
don't agree with the core idea that poor people should live like hermits, that
you know everything about people's lives, that not being taught finance by
anyone is a solid justification for not giving.

It seems rather post-hoc. Personally I don't think any of thse things should
justify someone losing basic human rights like food, shelter, or health. This
isn't to say the problem should be solved by private charity, it shouldn't.
Can't, I would even say.

~~~
homonculus1
Personal responsibility is a pretty simple concept: if you cannot afford
_necessities_ like food, shelter, and medical care (which are not "human
rights" in the sense that you do not have the right to compel other people to
perform the labor required to supply you with these things) then you should
not be buying alcohol, especially not at marked-up prices for having someone
serve it to you, and neither should you be blowing your tax returns on other
discretionary items. Everything else is just excuses. Nobody should be
prioritizing "having fun" over food and shelter, and those that do are not
entitled to have their impulsive behavior subsidized by others.

~~~
minikites
>(which are not "human rights" in the sense that you do not have the right to
compel other people to perform the labor required to supply you with these
things)

Food, shelter, and medical care are absolutely human rights:
[https://www.un.org/en/universal-declaration-human-
rights/](https://www.un.org/en/universal-declaration-human-rights/)

>(1) Everyone has the right to a standard of living adequate for the health
and well-being of himself and of his family, including food, clothing, housing
and medical care

~~~
homonculus1
The UN can say whatever they feel like but the notion of positive rights for
able adults is arbitrary and unfounded. You aren't entitled to the care of
society unless you uphold your part of the social contract and contribute in
return.

Or in other words if you have a right to others' labor, then by not working
you are violating their human right to yours, and therefore their obligations
cease.

~~~
minikites
The end result of your line of thinking is that the disabled (who are unable
to contribute) should be left to die or be executed.

~~~
homonculus1
>able adults

I already covered this. Children and the infirm lack the capacity to produce
so they owe nothing.

Also do note that nowhere have I argued that the genuinely destitute should
starve, even capable adults. But if you have the spare cash to throw away on
being a regular at a bar, as in the scenerio at hand, then I have no sympathy.

~~~
minikites
>I already covered this. Children and the infirm lack the capacity to produce
so they owe nothing.

How do you define "able enough to work"? What if someone has severe mental
deficiencies but can still lift and move things? Can you determine with near
certainty who is able enough to work and who is malingering?

These are not new problems, but your proposal is worse than the status quo.

------
maxxxxx
Whenever I see these I tend to think that the people who have the best story
will get the most money and not the ones who need it. It's pretty much a
market for self-promoters and scammers, not necessarily people who need help.
I also believe that in a civilized, developed, wealthy country this should not
be necessary.

~~~
luckylion
> I also believe that in a civilized, developed, wealthy country this should
> not be necessary.

This I generally agree with, though we will probably disagree on the extent
and how much it should cover, what limitations it should put on your behavior
etc.

> It's pretty much a market for self-promoters and scammers, not necessarily
> people who need help.

This, I feel, just describes reality. The squeaky wheel gets the oil, those
that ask for help the most, cry the loudest, demand support the most
aggressive etc get most of it, not necessarily (and imho rarely) those that
need it the most.

------
JudgeWapner
I wonder what would happen if you could preemptively donate onto a pool that
would guarantee you first place in line should you ever need to pay for an
emergency medical expense? Yes this is almost the same as insurance, just
without the middle man:

$100 upfront buys you 2 years of protection up to $50k for _emergency issues_.
I would go for it. The major issue I see are the grey area in what constitutes
an emergency, as well as the "hidden menu" as someone here calls it. That if
you don't try to negotiate, you are throwing away massive amounts by paying
sticker price.

Perhaps another approach is to buy "attorney insurance" that buys you an
expert negotiator (and legal representation) should you ever need to fight the
hospital over one of these ordeals.

~~~
JamesBarney
The biggest issue is death spirals. Healthier people will drop out of the
market increasing costs, causing the almost healthy people to drop out,
increasing costs, until no one is left.

------
Rotten194
One thing this article didn't mention is how crowdfunding also exacerbates
existing inequalities: for example, racial biases [1].

[1]
[https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2837042](https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2837042)

------
willwagner
Having worked for a competitor that was later acquired by GoFundMe, the
reality we faced was that we could determine pretty quickly whether a
fundraiser was going to be successful within 48hrs or so. While we spent a lot
of time developing tools to help people setup a good fundraiser which would
increase their chances, for the most part, it just came down to their extended
social network.

Most people came to our service directly to give to a specific fundraiser (as
opposed to coming to our site to find a fundraiser to give) and while we did
things like "now that you gave here, check out this" type features, the
results were somewhat lackluster. If I were to start a compassionate
crowdfunding site today, I'd try to build it in such a way that it could be
embedded into niche communities that are both to gather content, support, and
fundraising.

The whole experience is that it was fantastic to work with people really
dedicated to the mission and feeling like you are making a difference. On the
other hand, it's hard also not to change your mind on how healthcare is viewed
in the US, that the majority of Americans are one car transmission away from a
downward spiral into poverty, and while I appreciate GoFundMe and other
compassionate crowdfunding sites, a high tech only, private enterprise
solution is not always the best way to solve humanities problems. Coming from
a die hard capitalist, that's saying something.

------
sysbin
I’m a visible transgender woman and meaning I don’t pass as a woman
aesthetically. I’ve spent several years fighting the healthcare system &
insurance provider but no prevail. I can see a transgender woman in Toronto
managed to get funding in a few days using GoFundMe. She looks gorgeous in her
picture and I’m surprised she doesn’t pass. I’m not sure how I feel about it,
somewhat happy for her and frustrated personally. Seems like everything is
painfully pointless when it comes to decency in society. Everything is a
battle to keep the poor close to suicide it feels like.

~~~
qwsxyh
I suspect you won't get a good response posting this on HN.

~~~
sysbin
IDK, a lot of people on HN seem to understand from comments I've read, that
the healthcare & insurance system are needed to be overhauled.

The GoFundMe did help a woman in great pain of life being too challenging to
finance her surgeries and when every other system designed to help is denying
the treatments that should be medically necessary.

I could even say the healthcare & insurance system are currently designed for
having a person live a hellish life. They don't care even if a person has a
letter from a doctor saying the surgeries are medically necessary from my
experience.

It would be nice if people that downvote actually express why. HN used to be
that way several years ago. I enjoyed learning who I'm dealing with when it
comes to people against my insight in life; as I think anybody does.

------
billions
Always felt homeless photo diaries could be funded

~~~
TylerE
Why?

There is overwhelming evidence that homeless is primarily a mental health
problem, not a financial one.

~~~
ceejayoz
> There is overwhelming evidence that homeless is primarily a mental health
> problem, not a financial one.

[https://www.npr.org/2015/12/10/459100751/utah-reduced-
chroni...](https://www.npr.org/2015/12/10/459100751/utah-reduced-chronic-
homelessness-by-91-percent-heres-how)

> As of 2015, the state can just about declare victory: The population of
> chronically homeless people has dropped by 91 percent.

This by approaching housing access/payment _before_ anything like mental
health services.

Unfortunately, after over a decade, funding was withdrawn... and the homeless
population spiked again.

~~~
TylerE
But that's giving housing, often with counseling attached, not money.

~~~
ceejayoz
They're subsidizing their housing. With _money_.

------
hugi
As an Icelander, I'm glad I'm not American. Your values and health care are
extremely fucked up.

~~~
elwesties
This comment might be generalised to "I live in a functional country, I'm
gland im not American"... I agree f-that

~~~
benatkin
No country with a population more than half the size of the US has its shit
together.

~~~
onion2k
So... large countries should be broken up?

~~~
magduf
He's right, I have to admit: every country with a population more than ~175M
is pretty f-ed up somehow if you think about it.

It really makes me wonder if there's an actual scaling problem here. Just look
at how much trouble large corporations have with inefficiency. Maybe humans
just aren't capable yet of making extremely large organizations work well.

------
40acres
This is peak #LateStakeCapitalism, no fault to GoFundMe but these campaigns
are such like something out of a YA dystopian novel. Slowly but surely I do
believe American's are becoming more comfortable with the idea of free
healthcare, in whatever form that comes in.

~~~
err4nt
There isn't really such thing as free healthcare as long as staff need
education and training, doctors have to be paid, hospitals need to be
administrated, and treatments have material costs, etc. If it's being paid for
by the taxpayer, it's not coming at no cost to them, they're paying for it in
a pretty direct way.

~~~
silversconfused
I wonder if it would cost as much as the F35 program. I'd rather pay for a
junkie's health care than a token national alliance tech project jet that no
one needs.

~~~
harryh
Estimates for the cost of the F35 program vary widely, but a decent guess is
1-1.5 trillion over 50 years or 20 to 30 billion a year.

The US currently spends ~3.5 trillion per year on health care.

So yes, taxpayer funded health care would cost as much as the F35 program. In
fact, quite a bit more. Perhaps 150x more per year.

~~~
supergauntlet
Yes, but we're already paying that _and_ we're spending more than everyone
else. [1] Universal healthcare isn't just morally justified, it's also
financially justified. The only justifications for our insane system are
regulatory capture or sadism.

1\. [https://www.healthsystemtracker.org/chart-
collection/health-...](https://www.healthsystemtracker.org/chart-
collection/health-spending-u-s-compare-countries/#item-relative-size-wealth-u-
s-spends-disproportionate-amount-health)

~~~
0xffff2
You seem to be assuming that introducing universal healthcare in the US would
bring down costs. I've never seen any evidence whatsoever to support that
claim.

~~~
ikiris
You could look at every other country that did it for the evidence you seek,
provided you aren't limiting to the pool of evidence "in the US".

~~~
0xffff2
Changing the country changes too many variables at once. The US also spends a
whole lot more on infrastructure than virtually everyone else in the world,
and there's no obvious reason why. Just assuming that universal healthcare
would solve all of our cost problems is comically optimistic.

