Is this what health care’s come to: ‘Beg or else’?

Bill Knight column for 1-21, 22 or 23, 2019

The sadly familiar collection cans at convenience-store or gas-station counters asking for help for medical bills has changed into “crowdfunding” campaigns that hope to use online appeals to get assistance.

Using sites like Fundly, GiveForward, YouCaring and others, crowdfunding for medical costs is touching, sometimes tragic, and certainly senseless in a modern industrialized society.

The implicit desperation in the phenomenon – shocking as an observer and shameful as an American – stem from unexpected emergencies requiring expensive tests and/or procedures; long treatments and recoveries from strokes, cancers, cardiac issues, etc.; or ongoing attention to those coping with chronic conditions such as Parkinson’s, muscular dystrophy or ALS (Lou Gehrig’s disease). A longtime friend was recently diagnosed with ALS (personally heart-wrenching since I’d witnessed two others – both colleagues at a daily paper’s newsroom – deal with that for years). She’s had to turn to GoFundMe, and one in three fundraisers there are to help with medical bills, according to consumer advocate Ralph Nader.

Helping others is great but crowdsourcing in a consumer-oriented health-care system is far less reliable than mutual aid organized by government, as in Medicare, Medicaid and proposed reforms.

“We are a community and should support each other,” comments Dr. Pamella Gronemeyer, an Illinois physician and small-business owner. “Disease does not discriminate and only go after those who ‘deserve to be sick’ or have not followed a virtuous life path. Diseases can affect young and old.

“The country is only as well as the state of health of the sickest and weakest.”

We’re not well.

A result of the rise of medical crowdfunding is the way it shapes us to see health care as a personal good to be earned, rather than a universal human right, according to a 2017 study published in in the journal Social Science & Medicine.

“Relying on these sites changes how we perceive the problem,” said study co-author Nora Kenworthy, assistant professor of nursing and health studies at the University of Washington/ Bothell. “It masks a more open conversation we could be having about the inequities of our health system. There’s no space for a structural critique in your personal appeal.”

The increase in crowdfunding indicates that both insured and uninsured people are struggling with health-care expenses, and these needs aren’t just for hospitalization or medical care, but also insurance premiums, deductibles, co-payments and other expenditures like lost work, caregiving, and travel or lodging necessary to get care.

“Crowdfunding normalizes a means of health care financing that runs counter to a more rights-based system of values,” says study co-author Lauren S. Berliner, assistant professor at UW’s School of Interdisciplinary Arts & Sciences. “People say ‘I wish I didn’t have to do this. I’m so embarrassed. They use disclaimers: ‘I wouldn’t do this unless I had nowhere else to turn’.”

The study found that success can depend on factors like socioeconomic networks, media literacy and the knack of expressing a clear and compelling narrative. Success also can hinge on the nature of the appeal, they write. For instance, people tend to respond less to requests for assistance with ongoing caregiving costs than for costs of a specific medical procedure.

So crowdfunding cannot be counted on. (My friend’s GoFundMe plea seeks $30,000 to help with treatment options, buy a scooter, and build a ramp for her home, where she remains despite the degenerative disease. She’s raised $17,000.)

            Meanwhile, the Journal of the American Medical Association this month reported that the health-care industry spends about $30 billion annually just on advertising, and there’s a rise in television commercials from hospitals trying to lure lucrative patients needing expensive procedures.

            “Last year, hospitals nationwide spent more than $450 million on advertising overall, according to figures from Kantar Media, a firm that monitors ad spending,” reported Shefali Luthra in Kaiser Health News.

Elsewhere, these patients/victims of the commercial health-care system are just some of the millions of Americans coping with medical debts, the leading cause of bankruptcy. Michael Karpman and Kyle J. Caswell of the Urban Institute last year showed that almost one-fourth of Americans age 18-64 have past-due medical bills: 23.8 percent (19.9 percent in Illinois – one in five of us).

“Many adults with insurance coverage remain unable to pay their medical bills on time,” they reported.

            So, increasingly Americans are forced to publicly seek handouts, and their understandable discomfort leads to resentment, and more and more, many Americans long for a future when greedy insurance corporations must hold walk-a-thon fund-raisers or bake sales to prop up their huge profit margins instead of exploiting the ill or injured.