By Lambert Strether of Corrente.

And now abideth faith, hope, charity, these three; but the greatest of these is charity. –Corinthians 13:13

I posted this letter in Links, but I found I could expand on it. Spectrum Health Care’s letter to Hedda Martin speaks for itself, and for what our health care system has become under neoliberalism:

(The provenance: I started with AOC, who hat-tipped @DanRiffle, who linked to the original poster, @DanRadzikowski, quoted above. From Radzikowski’s thread, Hedda Martin: “This is me”; Martin’s GoFundMe, which was successful.) In this post, I’ll focus on two things: the intriguing backstory of Spectrum Health, the institution that denied Martin care until she could raise $10,000; and the weaknesses of GoFundMe as a solution. Before I get to the main part of the post, however, I’ll point out that Hedda Martin’s example is not exception, and it shows what a debacle the laughingly-named “Affordable Care Act” has been. Mother Jones:

The total amount in donations generated by crowdfunding sites has increased eleven­fold since the appearance of Obamacare. In 2011, sites like GoFundMe and YouCaring were generating a total of $837 million. Three years later, that number had climbed to $9.5 billion.

Wowsers. It’s almost like there are people who don’t have “access” to care, isn’t it?

Spectrum Health Care and Squillionaire Richard DeVos

Spectrum Health System, located in Grand Rapids, MI, is a “a not-for-profit, integrated, managed care health care organization.” It’s a $6.5 billion firm with a $100 million venture capital fund. You will have noted the following line at the bottom of the Spectrum Health stationery, which explains why Martin sought them out:

SPECTRUM HEALTH RICHARD DEVOS HEART AND LUNG TRANSPLANT CLINIC

DeVos, eh? It’s not crystal clear which “RICHARD” is meant: Richard “Dick” DeVos, Jr., Spectrum chair, or his father, Richard DeVos of Amway (“American Way”) fame. (Junior is married to Betsy, charter weasel and purveyor of dubious medical remedies, sister of mercenary and war criminal Erik Prince, currently Secretary of Education.) But since DeVos Senior (d. 2017) was a major Spectrum donor, we’ll assume that’s his name on the stationery. From MLive:

Rich DeVos has left a large imprint on health care in Grand Rapids, particularly with the life-saving programs at Spectrum Health. Spectrum has a rising transplant program: significant private donations and the availability of donor organs. DeVos and his wife, Helen, provided the money to launch Spectrum’s Richard DeVos Heart & Lung Transplant Program, including an endowment to pay the salary of Dr. Asghar Khaghaniover, the renowned surgeon on the U.K. transplant team that gave Rich DeVos a new heart in 1997.

(The transplant program seems well-regarded.) Oddly, or not, MLive doesn’t mention anything about the health care system in which Dr. Khaghaniover practiced in the U.K. Digging a little deeper, we find this from the Daily Mail in 1999[1]:

Billionaire thanks God for his NHS heart. An American billionaire thanked God last night for giving him a new heart – in a British hospital ahead of Health Service patients. ‘I believe in miracles and I praise the Lord for giving me this,’ said Richard DeVos, 73. ‘It had nothing to do with money.’…. How he was able to jump the queue in Britain for a £60,000 operation performed by Sir Magdi Yacoub at Harefield Hospital, West London, in June 1997, remained unclear yesterday.

I’ll bet. From the Scottish Daily Record & Sunday Mail, also in 1999:

I can’t buy a way out of my death sentence; Mum’s anger as billionaire pays pounds 60,000 for new heart But John Evans, chairman of the British Organ Donor Society, said: “I look at this with a degree of unrest. “It appears as though an American billionaire has been able to receive a transplant via the back door. “What troubles me is that we just do not know what is going on behind the scenes. He added: “ We are deeply opposed to people buying organs for transplant. It would mean the impoverished would have no chance of receiving treatment against someone with money . “In America, they are very, very worried about people buying their way into the system. And that is in a country where cash is usually the bottom line.” [DeVos] is a devout Christian who bankrolls a TV evangelism group and has immense influence in US business and political circles.

The irony is so thick you can cut it with scalpel, isn’t it? DeVos BUD FROM LEGAL gives every appearance of having used his billions to jump the queue at the UK’s National Health Service — socialized medicine, ZOMG!!!!! — to get a new heart stitched into his chest. Then, to be fair, DeVos “gives back” by endowing Spectrum and hijacking the NHS’ doctor. But when it comes time for Spectrum to treat somebody who doesn’t have the money to join the queue at all, what does Spectrum do? They turn her down. Still being fair, I suppose we should thank the Spectrum Health for their relative restraint and positive attitude. After all, they helpfully gave Martin a link to GoFundMe, instead of simply telling her to pray harder, as no doubt DeVos would have done.

GoFundMe for Health Care as a Dystopian Hellscape

I’ll look at GoFundMe — generically, crowdsourcing[2] — from two angles: market dysfunction, and class warfare. But first, I’m sure you’ve all seen health care GoFundMes — maybe some of you have run them yourselves — but for the record I’ll post two:

Heading to ER. Shingles is in my eye. Could lose Vision.. please share this, our go fund me. You know we need help, home in foreclosure, Christmas coming, now my health.. #Gofundme#help#scaredhttps://t.co/uqZsTj69q9 pic.twitter.com/oikKt2vnMA — #FightingForMeagan (@for_meagan) November 23, 2018

(This and the next should not be interpreted as solicitations to donate; I’ll get to information asymmetry issues below. But one example from the New York Post: “Homeless vet, couple allegedly made up story for GoFundMe scam.”) And the second:

(Just looking at the images, I’m not seeing NPR tote bags, let alone Rolex watches; Martin was 60 — not yet old enough for Medicare — and a dog-walker/pet-sitter.)

And now let’s turn to market dysfunction. Matthew J.Renwick and EliasMossialos, in “Crowdfunding our health: Economic risks and benefits” (Social Science & Medicine, October 2017) have a useful wrap-up. They write:

However, the market for crowdfunding is susceptible to market inefficiencies that may impede economically valuable transactions or even cause market failure. The primary dilemma appears to be asymmetrical information. This discrepancy in information availability is amplified in the crowdfunding setting. Project initiators are often geographically isolated from their funders whom are often inexperienced in the project field.

As we saw above in the example from the New York Post. More:

Thus, the relationship between funders and the project initiator is described as that of a principal and agent….The project initiator (i.e. the agent) is essentially paid to carry out the project’s stated goals on behalf of the funders (i.e. the principal). Two chief negative outcomes can arise from a principal-agent relationship: moral hazard and adverse selection. Moral hazard would describe a situation where a project initiator acts in self-interest and fails to deliver on project goals.

It’s hard to see how “moral hazard” would kick in for Martin’s new heart — why would she not deliver on “project goals”? — but for fundraisers that are not matters of life and death, you can easily see that the money raised, being fungible, could be used for any purpose.

Given the nature of crowdfunding, funders cannot easily hold the initiator accountable or may not be privy to information regarding the project’s progress and success. Adverse selection might occur when high-quality project initiators consistently choose to access funding through more traditional avenues like banks, leaving only low-quality ventures in the crowdfunding market pool.

That would be the case here, since the “traditional avenues” of health insurance, or Medcaid/Medicare, are not available or inadequate.

Herding behaviour is another consequence of information asymmetry that has been observed in the crowdfunding market (Agrawal et al., 2014, Belleflamme et al., 2015; E. Lee and Lee, 2012). Herding occurs when funders collectively make inferences about project quality based on decisions of other funders. There is a tendency for funders to swarm projects that are receiving strong support because the crowd perceives these projects to be higher quality.

Martin’s “project” was surely swarmed, by virture of having gone viral, and then being boosted by AOC.

Next, class warfare. First, understand that most crowdsourcing projects fail. The Outline:

But crowdfunding’s fatal flaw is that not every campaign ends up getting the money it needs. A recent study published in the journal Social Science & Medicine found that more than 90 percent of GoFundMe campaigns never meet their goal. For every crowdfunding success story, there are hundreds of failures.

Why? Because the skills to run a successful fundraiser aren’t evenly distributed! More:

Crowdfunding is as much about marketing as it is about charity, and those who can’t package their struggles in a compelling way — because they lack the social capital, the social network, or whatever magic ingredient causes some campaigns to go viral — often fade into obscurity.

Buzzfeed writes:

And while crowdfunding platforms themselves may not be discriminatory (although they do prohibit “controversial” campaigns like abortions and euthanasia) the crowdfunding paradigm is not itself fair. It discriminates without intending; much like society at large, it benefits those who are skilled and young and attractive and connected.

The Financial Times confirms:

Crowdfunding may also perpetuate existing inequalities. Well-off people can tap into networks of well-off friends who have money to donate in a crisis. Poorer people tend to have ties to poorer people with less to give. [Nora Kenworthy of the University of Washington] and co-researcher Lauren Berliner warn that results can also be distorted by prejudicial notions of ‘deservingness’ based on race, class and immigration status. ‘Crowdfunding seems to be best for people who are of a dominant social group who have fallen on hard times,’ Kenworthy says.

And nobody seems to mention that crowdsourcing requires the Internet, which is in itself a form of class warfare. I mean, it’s hard to imagine running a GoFundMe campaign from a public library connection.

* * *

It is odd that the United States regards charity as an invidual act, or at best the province of churches or non-profits. Why can’t the state been seen as performing charity? Isn’t passing Medicare for All about as good an example of “faith, hope, and charity” as you could find?

NOTES

[1] Because the Internet is making us stupider with link rot and destroyed data, the original stories for both the Daily Mail and the Scottish Daily Record are not available. I found references to them, however.

[2] The academic expert on crowdsourcing appears to be Daren C. Brabham. From his 2008 article:

Coined by Jeff Howe and Mark Robinson in the June 2006 issue of Wired magazine (Howe, 2006f), the term crowdsourcing describes a new web-based business model that harnesses the creative solutions of a distributed network of individuals through what amounts to an open call for proposals.

As we can see, although the platforms may have remained the same, desperate people seeking health care doesn’t really fall under the heading of “an open call for proposals.”