Crowdfunding for Medical Bills Shows the Limits of Empathy

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Kickstarter has been around for a while now. You’ve probably seen someone try to use it to raise money to make a film or video game or whatever else. In recent years, though, it feels like a different, less sunny form of crowdfunding is on the rise: Crowdfunding appeals, usually on sites like GoFundMe or YouCaring, for people who are in dire financial straits and are seeking out strangers’ assistance.

Writing for BuzzFeed, Anne Helen Petersen has a very interesting article about crowdfunding efforts to help people cover their medical bills. Oftentimes the bills in question are overwhelming, and the person making the appeal is doing so because the only other option is bankruptcy, eviction, and so forth. Early on in her piece, for example, Petersen focuses on the story of McFarland, a 26-year-old with a rare and debilitating genetic condition called Ehlers-Danlos who lost her health coverage after her father died last year, and who set up a YouCaring page.

Petersen’s basic thesis is that while it’s good for individuals to be able to survive financial hardship (of course), the question of which medical-cost crowdfunding appeals succeed and which don’t is fraught with uncomfortable truths that reveal how unjust the country’s health-care system is, overall. For one thing, as Petersen points out, it’s generally easy to crowdfund for so-called “faultless” conditions like cancer and genetic disorders as compared toconditions like “addiction and mental health in particular” which society generally views as the result of bad decision making or some sort of moral shortcoming.

Overall, she writes, “many of those with the greatest need are those whose story or situation simply is not compatible with the crowdfunding model.” If you are among the most needy and desperate, that is, you probably lack the resources to put together a crowdfunding appeal, let alone a slick and well-produced one.

Summing up the problems with this sort of crowdfunding, Petersen writes:

Crowdfunding is fantastic at addressing need — but only certain types, and for certain people. It can activate our most charitable selves, but it also, through its very format, often exploits our worst societally ingrained biases — toward melodrama and causes we can “root for” without complication, but also toward an understanding of the world that prizes individual choice and “return on investment,” even when old-school foundations and philanthropies provide a much more efficient and effective means of investing in care, research, and societal assistance in general. Some charities have been criticized for organizational bloat and waste, but as [Jeremy Snyder, the author of a research paper on the ethics of crowdfunding for medical care] points out, such “professional aid organizations,” whether Habitat for Humanity or the Susan G. Komen Foundation, are also incredibly adept at figuring out the most effective ways to identify need, how to bundle donations to effectively address that need, and how to advocate for the sort of policy changes that could eliminate that need. “All areas,” according to Snyder, “in which individual crowdfunding campaigns fall short.”

Reading Petersen’s article made me think, over and over, about Paul Bloom’s book Against Empathy: The Case for Rational Compassion. The book, which I wrote about in December, made the counterintuitive but surprisingly convincing argument that empathy is not the one-way path to a juster and fairer society most people believe it is. Rather, because of its “spotlight effect” — it’s hard to really feel empathy for more than one or two people at the same time — empathy causes us to hone in on certain people, sometimes not the neediest ones, showering them with resources that could do more good if allocated in a more rational way. (The example from his book I’ll never forget is when the Make-A-Wish Foundation gave thousands of dollars to allow a terminally ill child to be Batman for a day in San Francisco.) It’s also easier to feel empathy for those who are most similar to us, whether with regard to race, nationality, religion, or any of the other categories humans use to carve themselves up into.

As Bloom’s title suggests, his favored alternative for empathy is “rational compassion.” While empathy usually focuses on one individual, compassion is a bigger, broader feeling of warmth and goodwill toward the whole human family. It’s a different type of emotion than empathy, and one, he argues, more likely to lead to smarter, less emotionally driven decisions about how society should allocate its resources. For example, rational compassion allows one to understand the need for programs to help the poor, but to approach their administration from a best-bang-for-the-buck approach, rather than giving money to whichever subset of poor people can stoke the strongest sense of empathy — which might not line up with who is in the most need.

There’s a lot of empathy-versus-compassion in Peterson’s crowdfunding article. If you donate to someone’s cancer care because of their GoFundMe appeal, there’s nothing wrong with that, of course — you are really helping them. But you’re donating because they stoked a certain feeling in you, and that feeling can lead us astray. “Health care is an illustrative — and urgent — example of how our gut feelings are terrible moral guides,” Bloom said in an email after I sent him Petersen’s article. “We do much better, here and elsewhere, when we’re motivated by compassion for others, and use this motivation to construct policies and systems that make the world a better place.”

That’s easier said than done, of course. But in his book, Bloom makes a strong case that the way out of our current, deeply immoral morass — one in which people have to beg for help just to survive conditions that wouldn’t put their lives at risk in Canada or France or Germany — is more compassion, not more empathy. And Petersen’s article is a prime example.

Crowdfunding for Medical Bills Shows the Limits of Empathy