The GoFundMe-reliant meltdown of America’s health care system

Photo by Annie Spratt on Unsplash

My younger sister recently had to launch a GoFundMe account to pay for an out-of-network surgery that, along with days of unpaid time off from her job, without help would drive her and her family deep under financial water, if not bankrupt them.

This isn’t a new story in American health care. GoFundMe is packed with fundraisers meant to cover surgeries, cutting edge treatments, and other medical costs.

The platform is well aware of its role in health care as well as other areas of basic survival. CEO Tim Cadogan wrote an op-ed in early 2021 essentially begging the U.S. Congress to do its job and support the American people with the tax dollars we all pay:

“We’ve known for years that most Americans don’t have $500 to spare to cover unexpected emergencies, like a car breakdown. Now, it’s as if their entire lives are breaking down again and again and again.”

He wrote about a “level of desperation” and the specific areas of food, monthly bills, and small business support that had seen a surge in fundraising requests over the course of the COVID-19 pandemic. The fundraising platform also drew attention to the reliance on GoFundMe for health care costs in a Facebook post:

“We believe families shouldn’t have to fundraise to pay for their medical bills. We believe that 1 in 3 fundraisers on GoFundMe shouldn’t be for medical costs. We believe health care is a human right, not a privilege.”

And yet, like my sister, this is a situation that far too many families and individuals find themselves in. My sister and her husband work long hours at decent jobs but don’t have the kind of income that can cover an extensive, specialized surgery, much less cover the unpaid time off for recovery. Nobody in our family has ever had — or likely will ever have — a comfortable financial cushion or trust fund or the kind of income that can simply pay these costs.

Not many Americans do, but the point really is that we shouldn’t have to. Nobody should walk through life terrified of the costs of an emergency medical situation or a chronic medical condition.

GoFundMe’s previous CEO, Rob Solomon, said in 2019 that he was shocked when he realized how hard it was for people to pay their medical bills:

“I guess what I realized [when I came] to this job is that I had no notion of how severe the problem is. You read about the debate about single-payer health care and all the issues, the partisan politics. What I really learned is the health care system in the United States is really broken. Way too many people fall through the cracks.

The government is supposed to be there and sometimes they are. The health care companies are supposed to be there and sometimes they are. But for literally millions of people they’re not. The only thing you can really do is rely on the kindness of friends and family and community.”

The kindness of friends and family and community is something we all need, something we should also be able to rely on. But nobody should have to rely on the good fortune of social connections simply to cover the price of being alive.

For my sister, as for many people, the cost of her upcoming surgery is partly due to the surgery herself — only one place in the country deals with the kind of extensive endometriosis she’s been suffering from for over 20 years — but a significant portion is the rest of it: the travel, the accomodation to stay near the clinic and hospital, and the time off of work for recovery. As Solomon pointed out in that 2019 interview, it’s not just the health system that’s failed, but all of the support structures around it:

“In the places like the United Kingdom, Canada and other European countries that have some form of universal or government-sponsored health coverage, medical [costs] are still the largest category. So it’s not just medical bills for treatment. There’s travel and accommodations for families who have to support people when they fall ill.”

I wish my sister’s story, my family’s story, were unique. But it’s not. When my sister balked at the idea of asking financially-strapped friends and relatives for help, a mutual friend texted me, “That’s what GoFundMe is for!”

But it’s not. It shouldn’t be. “We shouldn’t be the solution to a complex set of systemic problems,” Solomon stated, accurately. “They should be solved by the government working properly, and by health care companies working with their constituents.” By the systems — all the systems — functioning. What is an economy for if not to promote human well-being?

In a sane, supposedly civilized society, people would not have to desperately rely on the good will and loose change of friends, relatives, and colleagues to get life-saving medical treatment. That isn’t what “community” means, though it’s community that steps in as our institutions crumble.

This is far more like a Black Mirror episode, where the ideals of mutual aid are warped into a health care version of “Nosedive,” your access to survival determined not just by your wealth, but by even more amorphous assets: your social capital, and the guilt and goodwill of others.