A meme I saw on Facebook recently really struck me as odd. Something to the tune of "You shouldn't have to go to Go Fund Me to pay your medical bills." It was some kind of cheap rhetorical argument for universal healthcare or something like that.
My reaction was: Doesn't that kind of work? When someone gets sick, isn't there an outpouring of community support? Whenever someone at my workplace got seriously ill, there was some kind of benefit event for them, presumably to offset the costs of medical care and loss of income for the family. I've seen several fliers on bulletin boards over the years for people who had some kind of sudden medical problem (cancer and ALS to name two examples regarding people I know personally).
Maybe someone can argue that the money from these benefits isn't enough. The sick person gets some random amount, which may or may not be enough to cover their expenses, which may in fact be totally uncorrelated with their actual expenses. Same deal with a Go Fund Me campaign, the argument goes. I don't think that's right. I think someone with a more severe illness elicits a stronger outpouring of community support. Charitable supply rises to meet the demand.
Maybe, or maybe not. But what struck me about the meme was the dismissal of a private solution to an unmet need. The assumption behind the meme is that government provided healthcare is a moral necessity. If the government solution isn't adequate and people are meeting their needs via other means, it implies that the government solution just didn't go far enough.
Suppose Go Fund Me solves the problem, and everyone who needs expensive medicine can basically raise the funds they need. Maybe some people need to scrimp a little and opt for their second or third best option rather than their first. They might not get treatment from the very best doctor at the very best hospital. (That's a problem under any system, though. Even the most thoroughly socialized medical system can't send every patient in the nation to the single best doctor.) But that's probably better than making an open-ended promise to give everyone 100% of the medicine they ask for and paying for it out of general tax revenues.
I wrote about this topic a while ago, but to reiterate there are many private means of getting healthcare to people who "can't afford" it. (Charity, price discrimination in favor of the poor, tax write-offs by hospitals and clinics for the free care given.) You're free to think those solutions are inadequate for some reason, but it's silly to observe a solution to a problem, actually working in the real world, and declare that "nobody should have to" do the thing that's actually fixing the problem.
I think many people view the marketing efforts required to raise money through a go-fund me as an indignity that is potentially shame-inducing. Adding insult to injury. Their true objection could be framed as something like, "We should be attempting to support and nurture the sickest and most physically vulnerable people in our society, not forcing them to work on their personal brand, panhandle on the internet, and reveal private and personal information. I'm glad that they are able to get their medical bills paid, but this is still a terrible state of affairs."
ReplyDeleteIts a bit different in the case of workplace charity, which often is developed organically among concerned friends and co-workers and doesn't require proselytizing.
I'm also not fully buying the story about charitable supply meeting demand. I am only able to speak from anecdotes, but I think things like, attractiveness, warm outgoing personality, willingness to reveal sensitive information, and strength of connection to a local community are all significant. I'm happy to be proven wrong on this point though, and have no idea if there is actually any interesting research out there.
Points well taken, thank you. I understand the visceral revulsion some people have to using Go Fund Me for medical bills, I just think it’s a little bit misguided. I don’t necessarily see charity as less indignity-inducing when it’s compulsory. Some things about socializing the costs seem very undignifying. (For example, you’re not a paying customer, so healthcare providers place almost zero value on the time you spend waiting in line. They don’t really care how much they inconvenience you. I suspect this is a bigger deal for the working poor than it is for middle-class salaried patients.)
ReplyDeleteThis reminds me of a post by Bryan Caplan called “Tough Luck.” Maybe the “free-market, beg for charity” model leaves some people without medicine, but then again so does the “government makes an open-ended promise to give everyone free medicine” option. Someone has to say “No” at some point. It would be great if there were an infinite supply of medicine and nobody would ever have to say “No”, but there has to be some mechanism for saying no to people who want more of something. That’s true under any system.
I also think of Hansonian medicine: the marginal value of extra medicine is zero. We’re already pretty saturated. When people need (really, truly *need*) medicine, by hook or by crook they get it. The book Ensuring America’s Health (my review is linked to above) suggests how this might be happening. The RAND healthcare experiment and the Oregon Medicaid experiment both showed that you don’t get population-level health improvements by giving out more medicine for free, even among the poor. If we take those results seriously, apparently the current mix (charity plus government) is getting the job done. And Robin Hanson argues (persuasively, I think) that we could cut medicine in half and get similar health outcomes.