
GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding - aaronbrethorst
https://khn.org/news/gofundme-ceo-gigantic-gaps-in-health-system-showing-up-in-crowdfunding/
======
sharkweek
I like to write short stories in my free time.

One that I’ve been working on over the last year is one where the concept of
“crowdfunded healthcare” evolves into a dystopian game show where people go on
TV and share their sob story on why they need money. Then the viewers at home
get to choose who gets the show’s prize money each season through a bracket
style voting system that crowns a champion at the end.

I had to stop working on it as it got really, really dark the more I wrote.

On that note, I find it supremely fucked up that people have to turn to
crowdfunding to get their unexpected healthcare costs covered by benevolent
internet citizens.

~~~
ekianjo
> On that note, I find it supremely fucked up that people have to turn to
> crowdfunding to get their unexpected healthcare costs covered by benevolent
> internet citizens.

So who should pay for it? All taxpayers instead? All countries that have tried
that are now in the red. The only good solution, I think, it to work to make
healthcare a lot cheaper in the long run.

~~~
A2017U1
The US is the only major developed country that doesn't have universal
healthcare and they are still deep "in the red".

~~~
ekianjo
At least the US is developing new drugs. About 99% of other countries produce
none.

~~~
dmitriid
\- 30% of drugs in the US are funded by taxpayer money [1]

\- true, the US is producing about ~50% new drugs (sometimes more, sometimes
less). Europe and Japan account for the most of the rest of the drugs [2]. The
reason is simple: these are wealthy countries.

[1]
[https://news.ycombinator.com/item?id=19264699](https://news.ycombinator.com/item?id=19264699)

[2] [http://www.hbmpartners.com/media/docs/industry-
reports/Analy...](http://www.hbmpartners.com/media/docs/industry-
reports/Analysis-of-FDA-Approvals-2018-and-Previous-Years.pdf)

------
Brendinooo
>Or the Tennessee couple who want to get pregnant, but whose insurance doesn’t
cover the $20,000 worth of “medications, surgeries, scans, lab monitoring, and
appointments [that] will need to be paid for upfront and out-of-pocket” for in
vitro fertilization.

Would an ideal healthcare system cover in vitro for anyone, full stop? Took a
buzz through the NHS requirements[0] and there are definitely restrictions.
And in vitro is certainly not an uncontroversial procedure.

I just thought that was a strange example to use. There are always going to be
gaps in what a health system will cover, right?

There's always gonna be a market for crowdfunding health stuff, and that's not
inherently a bad thing. (Which is my only point, not trying to comment on the
broader issue.)

[0]:
[https://www.nhs.uk/conditions/ivf/availability/](https://www.nhs.uk/conditions/ivf/availability/)

~~~
Aloha
From my perspective, it shouldn't. Yes, its cold and heartless to say so, but
wanting children isn't a health issue.

~~~
fastball
Could you not argue that it is a mental health issue?

~~~
thanatos_dem
I feel like people go more crazy as a result of having kids than as a result
of not having them.

~~~
silencio
Speaking as someone with infertility working on kid #2 via IVF right now,
nothing positive comes out of wanting kids but not being able to have them.
(Also with the big disclaimer that adopting children costs just as much if not
more, in some way or another...)

There's parent nights out and dates with my partner to rant about toddlers
being shits that are nice to have, but my fertility clinic has an MFT on staff
and my old fertility clinic had referrals out for therapy and support groups
facilitated by therapists. After almost 18 months the first time, too, I
worked out a lot of depression and anger through 1:1 therapy weekly for
months. I'm heavily relying on those old coping mechanisms, this time around.

Just. does. not. compare.

------
jimrhods23
We need to get rid of health insurance companies. They are the reason all of
our costs are massively inflated.

The same thing is happening in education: universities know that a large
percentage of students are getting financial aid, so the true costs are buried
in a layer of bureaucracy.

Fees and administrative fees continue to go up and the universities will
always get their money.

The students are then on the hook to pay the loan back. If the Universities
actually had to worry about students defaulting, they would be forced to
reduce costs or they would go under.

~~~
obrisintor
Care to explain your logic? Cat repair isn't so expensive even though everyone
with a car has car insurance.

~~~
AnIdiotOnTheNet
Competitive pressure. If your can't be fixed or you don't want to fix it you
have alternative forms of transportation or you can purchase another one
(either at full price or used). Also, many of us only carry liability.

------
narrator
Most people involved in health care, like insurance companies, health care
providers, drug companies, doctors and gofundme want more money to be spent on
healthcare. That's because it goes eventually into their pockets. The U.S
spends double, as a percentage of GDP, on healthcare (16%) as any other
country which is good evidence that the solution to healthcare problems being
to spend more money is very popular.

The solution has hit negative marginal returns though and the only way out is
a more fundamental change to health care, possibly in the form of price
controls on drugs or the 150% of Medicare reimbursment maximum price on all
procedures. This sort of predictability of costs will obsolete a whole layer
of insurance price game players at the hospital and insurance companies that
add to health care costs.

------
temp1928384
I'm on insurance, and to be very real I have gotten bills in the past from
providers that I never ended up paying. The reality is that this is more
common than not...providers only collect some small % of the part of the bill
the patient (and not insurance company) is responsible for. They usually end
up selling this debt for pennies on the dollar to collections agencies.

Do I feel guilty? Not really. But the lesson is that the number you see on
some bill from a hospital or provider is _not_ non-negotiable, and in general
unlike the IRS they don't exactly have any power to garner your wages to
collect.

If you find yourself in a position where you're getting some ridiculous bill,
you should definitely hire a trusted lawyer to negotiate down a bill on your
behalf.

~~~
antisthenes
That's become my strategy as well.

1\. Ignore all bills except the most persistent ones. Look at which ones are
still being sent 3 months later.

2\. Triage and sort the bills. Prioritize the ones that are related to the
primary care facility where you were treated. Call them and negotiate to pay
less.

3\. Wait until 6 months and see if any bills are still coming. If they are,
look at them again in order of priority, seeing if any of them are still
reasonable and you have actually received the service/care.

After 12 months, if you haven't been receiving any care, toss any bills.

------
taxicabjesus
In America health care is supposed to be as expensive as possible. People
demand the system spare no expense on their care.

I have some notes to write about "the predicaments of old people". Both my
grandfathers lived an extra few years thanks to the pacemakers Medicare paid
for. But they just suffered for those final years.

A lot of old people's problems are related to excess alcohol consumption.
IMHO, there would be much more funds available to spend on the gaps
experienced by younger people, if doctors assumed their elderly patients are
drinking heavily and treated them for that instead of blowing the programs'
budgets on treating the down-stream effects of heavy alcohol consumption
[edit2].

I have some friends who lived in Canada for a while. They said the Canadian
system doesn't go all-out to keep people alive who are going to die anyways...

A few years ago I stopped by to see one of the passengers whom I'd given a
free ride to a few years before. She told me she was pregnant. "But I thought
you were becoming a man?" She wasn't a he yet, and she'd gotten with a cis-
male... They'd called it off before too long, but that's how she'd gotten
knocked up. She also said it had a heart defect (she was maybe 4 months
along?). This was caused by the hormones she'd been taking to transition.

I was pretty sure the baby wouldn't survive long, but didn't say anything... I
followed them on teh Facebook. ... Scheduled c-section, a half dozen heart
surgeries, after maybe four or six months the infant died anyways.

I think other countries' health systems are more careful about how they
allocate their health resources [0].

[0] How Cubans Live as Long as Americans at a Tenth of the Cost -
[https://www.theatlantic.com/health/archive/2016/11/cuba-
heal...](https://www.theatlantic.com/health/archive/2016/11/cuba-
health/508859/)

[edit1: minor edits] [edit2: changed this from quip about keeping people alive
for an extra month or two]

~~~
raesene9
When you say "People demand the system spare no expense on their care." is
that really __all __americans?

So there's no market for cheaper but somewhat less effective health care?

Given that medical bills are the number one cause of personal bankruptcy in
the USA[1], it seems really odd that all those people who's lives are getting
seriously messed up by this wouldn't want some form of cheaper health care,
even if it wasn't the no.1 most effective option.

[https://www.thebalance.com/medical-bankruptcy-
statistics-415...](https://www.thebalance.com/medical-bankruptcy-
statistics-4154729)

~~~
taxicabjesus
> When you say "People demand the system spare no expense on their care." is
> that really all americans?

There are nuances. The insurance model trains people to not care about the
cost of the services they receive.

> So there's no market for cheaper but somewhat less effective health care?

I think healthcare that focuses on actual problems instead of downstream
problems is more effective in addition to being cheaper.

------
ourmandave
Every gas station and convenience store I go into has a glass jar with
somebody's family picture and a handwritten note pleading for money to help
them afford a life saving operation. Most times it's that f*cker, cancer.

~~~
pault
I spent a few years in Belize and sadly this is the de facto public health
insurance program there. Everyone who gets cancer or has a major accident has
local fundraisers to get help from the community.

~~~
linuxftw
This is essentially what single-payer is, except people are free to determine
who the actually want to cover. A bunch of normal folks setting aside money.

Unless people just expect 'the rich' to pay for everything.

~~~
enraged_camel
You have an astonishing lack of understanding of what single-payer is.

------
ferros
I think this is a reflection of what people _want_ to donate/contribute to as
much as anything.

I’d be keen to know what percent of listings are health related vs what
percent of total money raised is health related.

~~~
ddebernardy
> I think this is a reflection of what people want to donate/contribute to as
> much as anything.

Just spitballing, but I'd think it's more of a reflection of how broken the US
health care system is.

A more interesting datapoint would be the health vs non-health money raised
broken down by country.

~~~
ferros
> A more interesting datapoint would be the health vs non-health money raised
> broken down by country.

This!!

------
adsadadsad
GoFundMe is comical, every day there is a new idiot asking for money for not
buying (or invalidating) their travel insurance . Little Fred is sitting in
hospital now with bills over $xx,xxx due to a motorbike accident whilst
backpacking in XYZ, please give generously so Little Fred can keep his iPhoneX
and his large family don't have to put their hands in their pocket.

e.g. [https://www.gofundme.com/injured-by-scooter-
accident](https://www.gofundme.com/injured-by-scooter-accident)

~~~
hippich
This is what bothers me... I once donated to a GoFundMe run by someone I know
(not really friends) - their house got heavy water damage in Houston a couple
of years ago.

Only a couple weeks later to see pictures of them buying a new car from a
dealership to their son.

I do not know... Perhaps it is because me, who unlikely to ever buy a new car
(despite having several Xs of income than that family) or perhaps the fact
they were not committed 100% to solve their immediate problem themselves first
and instead looked for someone to donate some extras - it pissed me off.
Unlikely to ever donate to anyone ever again, unless I know for sure people
are in genuine trouble.

~~~
adsadadsad
Happens all over the world. I walked into a expat bar a while ago and there
was a cash collection for Joe (not his real name incase I get accused of
doxxing again lol), he just been diagnosis with some form of cancer (high
chance curable) and needed to do chemo. I was like WTF? This guy has top of
the range health insurance, a full time job and supportive employer, and sat
on a healthy stack of savings and investments. I couldn't believe what I was
seeing, it wasn't going to charity or for some gift, just pure cash. Joe is
fine now, doesn't drink as much, the money went into his bank - Joe isn't a
charitable person - he is actually a consistent cunt (but when someone gets
the Big C that all changes and no one has anything but the best to say about
them)

------
refurb
Obviously not to the same extent, but you see go fund me campaigns for places
with single payer systems.

[https://www.gofundme.com/canadahealthfail](https://www.gofundme.com/canadahealthfail)

------
kevmo
How much longer until GoFundMe becomes America's leading healthcare provider?

~~~
toomuchtodo
If Watsi open sourced their platform (Rails on Heroku if memory serves me),
I’d bolt it together with medical tourism (travel arrangement through bulk
purchasing and scheduling with foreign providers) to get these Americans
treated in Canada, Mexico, Cuba, and India for a fraction of the price. It’d
be a shim to save lives and reduce suffering until the US implements universal
healthcare.

Healthcare is my hill to die on due to life experience.

------
RickJWagner
It's obvious the CEO cares greatly about this issue. But not quite enough to
reduce the percentage that GoFundMe rakes in with every donation.

~~~
tanin
Gofundme doesn't take any fee on certain countries (including US)
[https://support.gofundme.com/hc/en-
us/articles/203604424-Fee...](https://support.gofundme.com/hc/en-
us/articles/203604424-Fees-on-GoFundMe)

------
exabrial
This is wonderful, it really warms my heart to see people contribute
voluntarily.

That being said, it appears a large portion are people that were uninsured and
then came upon a major medical emergency. Why do people take their health for
granted? Even those that are insured, look at the obesity and smoking rates,
two significant factors in unexpected early death.

~~~
ourmandave
A couple years ago my friend and his wife had a head-on collision at highway
speed when some drunk asshole crossed the center line.

The helicopter ride to the hospital was $80,000 _per person_.

They have awesome insurance (plus supplemental) that doesn't cover a dime of
that.

Countless surgeries later and that $160K is a tiny fraction of the total.

