Crowdfunding As Socialized Healthcare

Charity, ostensibly a central moral and social American institution, is alive and flourishing–online, on crowdfunding sites, as thousands and thousands of perfect strangers and sometimes acquaintances and friends and family, line up to donate to the latest plea for help. (Perhaps someone needs a vital organ transplant, extended chemotherapy and radiation, or a new, life-saving alternative therapy; or perhaps, like most Americans, they went into a hospital hoping to emerge healthier, and instead, found themselves facing a foreclosure-inducing medical bill.) As Bloomberg reports in an article unironically titled ‘America’s Healthcare Crisis Is a Gold Mine For Crowdfunding–later changed to ‘American Health Care Tragedies Are Taking Over Crowdfunding’:

Crowdfunding platforms such as GoFundMe and YouCaring have turned sympathy for Americans drowning in medical expenses into a cottage industry….Business is already booming, and its leaders expect the rapid growth to continue no matter what happens on the Hill. “Whether it’s Obamacare or Trumpcare, the weight of health-care costs on consumers will only increase,” said Dan Saper, chief executive officer of YouCaring. “It will drive more people to try and figure out how to pay health-care needs, and crowdfunding is in its early days as a way to help those people.”

Indeed:

Growth has been rapid….one million campaigns set up over the previous year had raised $1 billion from nearly 12 million donors. By February 2016, the total was $2 billion. In October 2016, it was $3 billion, from 25 million donors….GoFundMe had indicated that $930 million of the $2 billion raised in the period the study analyzed was from medical campaigns….medical fundraisers made up 70 percent of GiveForward’s campaigns. The combined companies have 8 million donors who have contributed $800 million to a wide range of campaigns. A big part…was donated to medical campaigns…It was approaching 50 percent of all fundraisers at YouCaring before the acquisition, and the growth rate is set to triple this year.

Indeed, no matter what the flavor of the current healthcare system, it will not take care of most Americans, and neither will it do anything to drive down the rising costs of healthcare. Short of progressive taxation, a national single-payer system, and extensive structural reform to bring the American healthcare system into line with the ‘best practices’–both financial and clinical–of the best national healthcare systems in the world, Americans look destined to continue pay the highest rates for healthcare in the world, while receiving outcomes that can be described, at best, as ‘mediocre.’ In these conditions, the success of crowdfunding campaigns is entirely unexpected and unsurprising; ‘look to private resources’ is the fairly explicit message of the current healthcare system, and it is there that Americans have turned. ‘Private resources’ are normally taken to mean financial support from family; Americans seem to have found a much larger family of sorts; a blessing of a kind, one supposes.

But mostly, reactions to this state of affairs can hardly afford to be sanguine. Such methods of paying for healthcare costs suffer from too much contingency; some campaigns succeed, yet others fail. Perhaps your pitch was not ‘moving’ enough; perhaps you did not include the right pictures of cute families; perhaps potential donors were financially exhausted. The health of the citizens of any country, let alone one with pretensions to greatness, should not be riven by so much uncertainty, so much dependence on the unpredictable largesse of others.

A Teachable Moment For The Republican Party

That famous Republican Party discipline (or, ideological commitment), the one that made sure that many of Barack Obama’s legislative priorities were derailed through relentless parliamentary grandstanding, that ensured the federal government’s operations were shut down, producing misery and inconvenience for many, that produced budgetary brinksmanship of the highest order and negatively affected the national debt rating, it also ensured a stinging defeat for the Donald Trump-Paul Ryan effort to repeal and replace the Affordable Care Act. The Freedom Caucus–that benign moniker which identifies a group of apparently sworn nihilists determined to gut government from the inside out–did not find the modified Republican replacement for ‘Obamacare’ sufficiently heartless; it healed too many, served too many; not even the prospect of doing damage to Paul Ryan’s risible and entirely concocted image as a policy wonk was enough to deter them from their opposition to the bill. (The Trump Administration’s attempts to placate this crew led in turn to so-called Republican ‘moderates’ to threaten to abandon ship; causal responsibility rests solely with the Freedom Caucus.)

Captain Trump and the USS Republican Party were headed for the shoals, and that’s where they ended up. Capitol Hill is not a campaign rally venue. There are old lessons here to be learned, apparently.  In writing of the various Athenian power struggles that preceded the Battle of Marathon against Persian forces (The First Clash: The Miraculous Greek Victory at Marathon, And Its Impact on Western Civilization, Bantam, New York, 2013, p. 80), Jim Lacey makes note of the struggles between the aristocrats Isagoras and Cleisthenes:

With Isagoras deposed, Cleisthenes and his supporters returned. Whatever his own predisposition, he now had to deliver on the promises he had made during his political struggles with Isagoras and the other noble families. He probably was also beginning to understand that it is easier for an adroit politician to manipulate the masses than it is to manage powerful competing factions.

It is small comfort for the American polity to realize that this bill failed because a Republican faction did not find it dastardly enough, because its primary architects were simply too incompetent to shepherd it through the legislative gauntlet. This same factionalization and incompetence could very well help produce a more radical version of another bill, which would gut comfort and safety elsewhere.

But there is another side to this story of Republican failure, which is that Republican representatives and senators chickened out of a ‘No’ vote because their constituents threatened them with electoral reprisals. They did so by calling in, by attending town halls, by sending postcards; in so doing, they proved, yet again, that old-fashioned citizen pressure on elected representatives works. Give the bastards hell, indeed. Elected Republicans are finding out–the hard way–that the President’s unpopularity is both deep and wide; it brings all the formerly somnolent members of the electorate to the yard; that loud presence has made the threat of disaster in 2018 more likely; and if there is anything that will help induce flight from His Orangeness’ apparently contagious success, it is the fear of contracting a fatal electoral disease.

Much damage could still be done to the Republic and its denizens; there are more bullets to be dodged; but also some lessons to be learned by those infected with hubris.