If Senate Republicans follow through and pass their health care bill, which would leave an estimated 22 million more Americans uninsured by 2026, according to the Congressional Budget Office, people with high medical bills and no health insurance could turn to crowdfunding to pay for medical treatment.
“Whether it’s Obamacare or Trumpcare, the weight of health-care costs on consumers will only increase,” Dan Saper, chief executive officer of YouCaring, a crowdfunding site, told Bloomberg.
For a few lucky people, raising money on crowdfunding sites like GoFundMe and YouCaring has meant not having to choose between medical care and bankruptcy.
But for the vast majority, crowdfunding is a frustrating popularity contest and a poor substitute for affordable health services.
“Organized begging is not a way to solve access problems in health care,” Arthur Caplan, the founding director of New York University’s division of medical ethics, told HuffPost. “It’s a Band-Aid that doesn’t really cover what I’ll call ‘hemorrhaging wounds.’”
But at a time when a significant proportion of Americans struggle to pay their medical bills, crowdfunding can seem like the only viable option. More than a quarter of U.S. adults reported that they or someone in their household had trouble paying their medical bills over the previous year, according to a 2016 Kaiser Family Foundation/New York Times survey.
That number rose even higher among the uninsured, 53 percent of whom reported medical bill difficulties.
It’s no coincidence that crowdfunding sites for medical expenses have exploded in popularity. GoFundMe has raised $3 billion since 2010, according to its annual giving report, with medical and health campaigns consistently making up the most popular funding category.
In practice, however, the vast majority of medical campaigns fail to meet their funding goals.
According to a study published in the journal Social Science and Medicine in February, 90 percent of medical campaigns did not meet their funding goals. Researchers analyzed 200 medical campaigns on GoFundMe in 2016 and found that campaigns raised an average of 41 percent of their target, with 3.5 percent of campaigns raising zero funds whatsoever.
Most troubling of all, poor and poorly resourced users are both more reliant on crowdfunding and less likely to succeed with it.
Crowdfunding reflects inequality and class dynamics.
Who got funded wasn’t random ― some of the same dynamics that make some people more likely to succeed elsewhere also tended to come up here. Put another way, because crowdfunding requires the person asking for money to market their illness for donations, people with less education, lower socioeconomic status and fewer technology skills are at a distinct disadvantage.
There’s also the potential for funder bias. The study found that medical problems with a single solvable problem, such as operating on a child with a congenital disease, tended to be more successful. Campaigns that requested money for more intractable and less direct costs, such as lost wages for missed work, house payments and child care, didn’t gain as much traction.
And since 72 percent of people who donated to GoFundMe campaigns to help a person in need gave to someone they knew, rather than a stranger, richer people with wealthier social networks have a fundraising advantage.
Wealth doesn’t necessarily spell success, though. Potential funders are faced with an onslaught of requests from loved ones and strangers, creating an environment in which they need to choose who deserves their help the most.
“Crowdfunding takes our already unfair health system and makes it more unfair by asking people to market themselves –- in essence, to produce a worthy illness ― in order to survive,” Nora Kenworthy, study author and assistant professor of nursing and health studies at University of Washington Bothell, told HuffPost.
For maximum funding, be a ‘perfect patient.’
To run a successful campaign, GoFundMe recommends using high-quality photos and video and clearly explaining what the user is raising money for.
“It’s also about telling an upbeat, and promising story ― which requires social media skills and various literacies — knowing how to create compelling photographs and video content, translating complex medical information for a general audience, and knowing how and where to share campaigns within one’s social networks,” Lauren Berliner, study author and assistant professor in the School of Interdisciplinary Arts and Sciences at University of Washington Bothell, told HuffPost.
“We also have reason to suspect that success is linked to identity factors, like race, ethnicity, class, as well as what particular kind of health problem you have.”
There’s also the thorny question of whether an individual contributed to his or her poor health.
“If you’re a little kid with a puppy and a bad disease, you’ve got some shot,” Caplan said. “If you’re a 52-year-old trying to get a drug for Alzheimer’s or your failing liver because you were a drinker, forget it.”
“If we flip the question and start thinking of people as ‘undeserving’ of much-needed health care, we then must directly confront a system based on inequity and personal responsibility,” Berliner said. “That is a really scary and depressing realization for millions of Americans.”
People without health care access are more likely to lean on crowdfunding.
Another striking finding from the study was that a disproportionate number of medical campaigns came from states that didn’t expand Medicaid under the Affordable Care Act, otherwise known as Obamacare.
“This indicates to us that where barriers to health care coverage are more extensive, crowdfunding may be more important as a last resort option for those who cannot afford care or [to] pay their bills,” Kenworthy said.
“We can only imagine how much more reliant on crowdfunding people will be if the Senate healthcare bill is passed,” she added.
Many conservatives believe that higher out-of-pocket medical costs triggered by the Senate health bill would encourage Americans to be more judicious about using health services, since they’ll have “skin in the game.”
In reality, the bill may drive those patients to the internet for help.
“There are some who argue that we should only give insurance to those who earn it, who deserve it, the responsibility idea,” Caplan said.
“But the other side is, [if] you’re sick or someone in your family is sick, telling me to go out with a tin cup on the internet is cruel, is disrespectful, is lacking in any type of true compassion.”
GoFundMe did not immediately respond to a request for comment.