The Hidden Cost of GoFundMe Health Care
newyorker.com
newyorker.com
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
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.
https://en.wikipedia.org/wiki/Extreme_Makeover:_Home_Edition
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.
Fine if you win the genetic lottery. Not so much if you’re born with pre-existing conditions.
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I have recently applied for a job in the finance industry in Denmark, the institution did poke into my American financial life. That also happened when I worked for banks the UK and Wall Street.
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".
This is not to detract from your comment about the system being broken
It goes without saying that the healthcare system is completely broken, but that doesn't justify above behavior.
She might get mails and phone calls but the collection agency will not go after her assets, well unless her dad has assets in the USA.
The story lacks some details but if she contact the hospital and negotiate based on that, they would likely reduce the bill. Is this moral or not that’s another question, but I agree that she had few options before asking people for money early on. Specially when making 200k.
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.
Actually, there is- it's when the socialized system decides they're good enough, and stops trying.
There is literally no way a private company could offer something cheaper and better than the government?
Obviously in practice that's not how things work out, so in most cases private companies end up moving faster, leveraging efficiencies, utilising innovation better, and generally being cheaper. The lesson shouldn't be that means the government shouldn't provide services though, but rather that the government should act more like a business and do things businesses do to be competitive.
It's very noticeable that when government does this it works really well. The UK government has brought a lot of it's web and IT services in-house in the past decade, and they're so much better now.
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.
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.
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.
My comment has nothing to do with my opinion on the cost of medical services in the US. If you would like that, I think the Affordable Care Act used up a very rare opportunity for improvement to put us into a worse situation. What we really needed was a public option for the private companies to compete with.
Here in California our subsidized option, Covered California, was horrendous, at least at launch. Also, subsidized was not enough to help, and the subsidization counted as taxable income which was a slap in the face for those who needed it.
Secondly, it sounds like you are making assumptions about her overall financial status, based on what you know about her current salary.
She might have substantial student debt, medical debt, spousal debt, be upside-down on a mortgage, have other family that she is supporting financially, etc.
Just knowing someone's salary doesn't provide a very clear picture of their overall financial status.
> 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.
For me it sounds like she could have done more on her own to solve this problem before “socializing” the solution.
PS: Yes, healthcare is broken but at the end, she as a resident knows that and when someone comes to visit it is her responsibility to advise or buy a travelers insurance. It is not that expensive.
It's prohibitively expensive for a wide range of people not in perfect health.
Travel insurance for older people with prior conditions can be expensive. My parents visited the US for a few weeks and their insurance cost something like $800 with a $500 deductible. Wasn't even that good either, with a stack of pages with terms and conditions. Fortunately they didn't have to use it.
I see your discomfort with her making a GoFundMe the same as you view her not trying to negotiate the price down. When you're comfortable setting boundaries a lot of the discomfort in life goes away and things like trying to negotiate with someone or being uncomfortable with friends looking for (perhaps unnecessary) help on a bill become things you can handle
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at a minimum she should have tried to deal with the insurance and the hospital first. She makes 200k. There are other people who are much more deserving of help.
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.
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.
Should the trash man not stop at your house if you haven't paid your trash bill for the quartter?
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.
Not out of proportion with their income and expenses, no. You might as well ask "are middle class people not allowed to buy a Ferrari?" Of course they're allowed to, but they're going to have trouble raising money when they can't pay their mortgage.
>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?
That's a pretty sweeping assumption, but to some extent what else are you going to do? If someone refuses to participate in society, it's not on me to bail them out. Otherwise I'd spend all my time on the streets of SF trying to fix people.
>Is poor financial sense justification for not helping someone out that needs help?
Yes, absolutely 100%, yes.
No one else is entitled to your money. It doesn't even matter how tenuous the reasons are. There don't need to be any reasons to not give someone money.
We should help this person out. But giving him money clearly is not the best way, in fact it may seem like giving him money is only enabling his bad lifestyle choices.
Money is not the solution here.
Food, shelter, and medical care are absolutely 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
/sad sarcasm as some feel this way
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.
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.
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.
System such as: - Keeping more of their own money via taxes for Employment Insurance when they lose a job. - Arming them with better decision making skills via education - Having a system for healthcare that works fro everyone, funded via taxes, such that having a job or money is not relevant to receiving lifesaving medical care.
>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?
This is an assumption that they didn't show up to work because of a depression bout. It could have been a myriad of reasons, with the possibility that none of them had anything to do with depression.
I'm not a cold hearted person
Well, you kind of are. That's basically of the definition of cold-hearted.
It's 100% your legal and moral right to not contribute to these fundraisers. You could even argue that the best course of action here is to be cold-hearted, but you should at least own it.
If it's an FDA-approved treatment, then it's been vetted by peer-reviewed double-blind trials so it's unlikely to be snake oil.
If it's not an FDA-approved treatment, then I highly advise you to report them to the authorities because you stand to receive whistleblower rewards that are many, many times larger than the tiny sum of $13k.
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.
$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.
[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2837042
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.
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.
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...
> 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.
I imagine it's terribly complex, so I don't mean to simplify. I just have had the nagging feeling lately that we shouldn't have any homeless. It doesn't seem like a useful state of being. If you're mentally healthy but don't want to live a traditional life (job/etc), I'm not sure we should allow you to live under a bridge - go live in the woods, there's plenty left. I just can't see another way to look at the homeless problem.
It just seems that predominately people on the streets are suffering physically and mentally, and we're doing nothing.
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.
https://grapevine.is/news/2018/10/03/thousands-of-foreign-wo...
I perceive that Americans are primarily undecided on how it gets paid for. And if that comes from taxpayers directly, or government coffers directly, then the Americans turn on themselves and prefer a Machiavellian paradise, or the exact opposite where taxpayers and government drop helicopter money on the insurers who laugh all the way to the bank.
A smaller but growing group looks at the insurance companies and other structural issues, hoping to alleviate cost pressure, perhaps to make it more practical to subsidize healthcare after the costs are managed.
https://thehill.com/policy/healthcare/403248-poll-seventy-pe...
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.
1. https://www.healthsystemtracker.org/chart-collection/health-...
Sri Sathya Sai Super Specialty Hospital
>The Sri Sathya Sai Institutes of Higher Medical Sciences also popularly known as Super Specialty Hospitals are tertiary health care hospitals established by Sri Sathya Sai Baba to provide patient care facilities to all irrespective of caste, class, creed, gender, religion or nationality totally free of charge.
https://en.wikipedia.org/wiki/Sri_Sathya_Sai_Super_Specialit...
It's staffed and paid for by devotees of Sri Sathya Sai Baba.
If you disagree please explain how healthcare could be free.