Watsi uses crowdfunding to provide healthcare, but are patients better off?
brightthemag.comNo matter what good you do, someone will go out of their way to find the bad in it.
Are Doctors Without Borders also all collectively suffering "white guilt"? Project Smile? Are they crippling societies by not forcing the people in those societies to suffer more in the name of commanding other governments to bootstrap themselves? And while we're casting aspersions about for ulterior motives, how grossly western is it to expect other governments to just adopt ideals like universal health care?
> I clicked on the link, not really sure what to expect given the tone of the introduction. I soon found myself on the shiny, Squarespace-y landing page of Watsi, a San Francisco-based startup closely linked to the accelerator Y Combinator.
"...and I was secretly glad, because I knew I'd found something to fuel my simmering outrage, and I could write about it and maybe get some attention for myself."
> A few moments later, charitably-minded voyeurs can flick through photos of her and hundreds of other desperate looking men, women, and children from around the world and play God — i.e., fund the saddest case they can find and feel good about themselves.
"A few moments later, charitable people can be easily connected to someone to help. No, wait, that doesn't sound very bad. Hmm. Charitable people can just pick the case that's closest to being fully funded. No, that's not that bad either. Okay, what words can I cram in here to make this sound really bad? Where did I leave my thesaurus?"
> If Watsi donors are paying for the healthcare of individuals in developing countries, what incentive do those developing country governments have to build functioning health systems?
Because clearly the only thing stopping these countries from taking care of their own citizens is Watsi.
> Getting individual donors to pay for care does not help address the structural barriers that exclude many poor people from accessing health services.
"I hate everything Watsi stands for, and especially that they aren't doing more of it."
> In its current state, the model seems to exist more to alleviate “white guilt” than to increase access to care.
"I suffer from a cynicism that is so deep and hopelessly dark that I find it impossible to imagine anyone doing anything unless they're motivated by the guilt I imagine they should feel for the color of their skin."
> Our goal is to ensure that even if the project fails, patients are better off than if it didn’t exist…. We’re working closely with the local community, government, and providers that collectively have many, many years of experience to design the system and adhere to all local laws in such a way that no matter what, patients will benefit.
> Are the bolded words above making anyone else nervous? Or is it just me?
"Damn. That's a pretty good reply. I've ... I've really got nothing to argue with here. I'll appeal to a vague sense of unease."
> ...allow me to offer a few suggestions:
"Knowing absolutely nothing about their experimental programs, I am going to make a few vacuous suggestions backed by absolutely no mention of expertise in this field."
> Healthcare is a human right, and should not be granted based on an individual’s state of relative piteousness. No more photos, no more sob stories. Pool donor donations and allocate randomly among the patients.
"I would sooner insist that Watsi throw away everything that allows them to help a few people, and adopt instead my totally untested opinion which will destroy everything that makes Watsi unique and in all likelihood cause them to go the way of every other faceless organization begging people for money."
> That means working with governments and Ministries of Health to find the most effective and appropriate means (e.g. social insurance, sin taxes, etc.) for them to raise sufficient funds to provide universal healthcare for their population so you don’t have to.
"I really really hope nobody notices that just a moment ago I was accusing them of being short-sighted for trying to reduce the overhead costs of health care. If that worked, the need for funds would be reduced."
--
I hate this article. I viscerally hate it. "Cee Cee Elle" claims to be a "public health professional", but this thing she wrote is completely devoid of any substance at all, any concrete or constructive criticism, anything stated from experience or expertise, and it's so transparent in the way it tries one self-righteous insult after another, just to see if any of them might stick. That's the thing that really grates: not that it's a criticism of Watsi, but that it's a stupid criticism of Watsi.
I totally agree this is a really shitty article.
What I like about Watsi is that is finds a model of charity that is transparent, low-overhead and not-creating-dependencies. By not-creating-dependencies I mean that supplying food (unless in crises) will make people dependent on your handouts, thus creating a dependency. Getting an individual's medical problem fixed, that will otherwise FOR SURE go unfixed due to lack of money, will truly benefit that person (and their families).
Watsi provides me a clear way to do charity without most of the common drawbacks (high overhead and creating dependencies).
Thanks Watsi.
You can't engage these people in conversation.
You're trying to make logical arguments to someone who is simply trying to express their illogical racism.
100% spot on.
It may seem innocuously altruistic, but there are bigger implications of this work. If Watsi donors are paying for the healthcare of individuals in developing countries, what incentive do those developing country governments have to build functioning health systems?
Is it somehow better for the patients if they are allowed to suffer or die because they can't afford the treatment?
Perhaps it's true that in the long run, crowdfunding individual treatments gets in the way of the government building a health care system, I'm not sure that's true. Look at the dismal state of public health care in the USA, one of the richest countries in the world.... it seems debatable that much poorer countries are even capable of coming up with a workable public health care system.
But in the meantime, why not help some people out that otherwise couldn't afford the healthcare?
I understand that it can be degrading to have to put your healthcare plight on the internet and beg for donations to survive... on the other hand, what other option do these people have today?
Anecdotally I've heard from my partner who works in public healthcare that a lot of poorer countries are coming up with more sustainable health care systems because they have the luxury of learning fromthe mistakes of US and other western countries. Most 3rd world countries are building out their infrastructure now so they have benefit of any greenfield operation.
The US is suffering from the healthcare version of crippling technical debt (and cultural issues around that).
This seems like the "Copenhagen Interpretation of Ethics". If there is a problem unrelated to you, under this concept you are free to ignore it, and no one will blame you, because it is someone else's problem. But when you do anything to help, you become entangled with the problem, and then of course people can blame you for any imperfection.
https://blog.jaibot.com/the-copenhagen-interpretation-of-eth...
I'm a Watsi team member, and while this post is already off the front page, I still wanted to discuss a few of the points raised in the article and address some inaccuracies:
> "Silicon Valley needs to stop pimping out patients to alleviate white guilt."
Watsi donors come from around the world, and we have more donors from China than any other country. I don't think "white guilt" is something that applies to most of our donors.
> "She is informed by the doctor that this is a “Watsi facility” and is asked if she would like to “share her story with the world.” Faith, who is economically vulnerable and facing a non-choice between externally-funded treatment and continued disease, agrees. Her photo is then taken and uploaded, along with her sob story, to the Watsi site."
This is misleading. As we state on our website, "If a Watsi Crowdfunding patient doesn’t wish to be featured on the website, we give them the option to have their healthcare funded via our General Fund without ever appearing on the website." It's important to us that patients don't have to decide between sharing their story publicly and receiving healthcare.
> "...to design the system and adhere to all local laws in such a way that no matter what, patients will benefit."
I wrote this response to a support email and I'm embarrassed rereading it. It would have been more accurate to say that we make every effort to identify and reduce the risks involved with any new project. It's part of my job to represent Watsi's work accurately and I let us down here.
> "It does not incentivize poor communities to demand their governments fulfill their commitment to the World Health Organization..."
I don't believe people in poor communities need to needlessly suffer due to a lack of healthcare in order for them to be incentivized to advocate for their basic human rights. This statement is demeaning to people around the world.
> "If the goal really were to increase patient access to life-changing care, there would be a commitment to supporting patients and to working with governments over the long term to remove those structural barriers to care"
This raises a point that I've struggled with in the past: is it better to help one person today or try to create a system that helps more people in the future? I've come to believe it's a false premise. You'd never tell your mom that she should die of diabetes because you're working to strengthen Medicaid.
Every patient deserves healthcare today, and in the future, and the world has the resources to provide both. And it's often by starting small and serving individuals that organizations can learn how to effectively work with governments to help people over the long term.
> "If YC and Watsi are truly committed to ensuring their model really does leave patients better off, allow me to offer a few suggestions...stop pimping out patients."
Millions of people in wealthy countries like the US use websites like GoFundMe in order to post their stories online and crowdfund their medical expenses. Of course, I wish everyone had access to healthcare and this wasn't necessary. But it seems crazy to argue that poor people shouldn't have access to the same fundraising tools that rich people do.
I'd be happy to speak with anyone (including the author) about our work. I'm at chase at watsi dot org. We're open to any feedback or ideas that can help us better serve patients.
In case anyone from Watsi inadvertently stumbles across this enormous pile of ridiculousness, please know that the overwhelming majority of us appreciate the hard work that you're doing to improve the lives of others.
I hate to discuss anything faith-based on HN, but in seeing models of charities like Watsi's, I'm reminded of how Tzedakah (charity) was discussed in Hebrew school growing up. Maimonides suggests that not all giving can be considered equal and outlines a hierarchy for what types of donations are considered most "pious":
1. The lowest: Giving begrudgingly and making the recipient feel disgraced or embarrassed.
2. Giving cheerfully but giving too little.
3. Giving cheerfully and adequately but only after being asked.
4. Giving before being asked.
5. Giving when you do not know who is the individual benefiting, but the recipient knows your identity.
6. Giving when you know who is the individual benefiting, but the recipient does not know your identity.
7. Giving when neither the donor nor the recipient is aware of the other's identity.
8. The Highest: Giving money, a loan, your time or whatever else it takes to enable an individual to be self-reliant. [0]
[0] https://www.charitywatch.org/charitywatch-articles/eight-run...
They have universal option where you just say the monthly amount and it is used pretty randomly.
I think it's fine to choose somebody.
Why? Because others will chose the others and everyone who on the list will receive the care. It doesn't matter which one I choose since my choice doesn't make a difference to the person in need.
It's nice to hear how it turned out though. I stopped giving money to charities that don't tell me what happened after. Like.. just write me an email. 'With the money donated this month we bought clean water for hurricane victims in whereever. Find the full list of activities this month here <link>.'
I would guess one response is to suggest that Watsi is moving people from steps 1/2/3 to step 4. The list, when reverse engineered pretty much suggests that it's easier to get people to give if they know who is getting the money, so Watsi is applying that principle to raise more money.
For a lot of the charities where you select an individual there is no guarantee the money actually goes to that person.
I'm on the monthly donation to Watsi, which is another product they don't mention in the article. I don't pick people to cure like the article suggests.
They do send me emails about patients that I've contributed to. But I don't know who they are ahead of time. It's kind of a gimmick I guess, but a useful way to retain contributors by reminding them what their money is going towards.
I believe their model is to raise from investors to cover overheads, but donations go directly to treatments. You have an assurance (as far as those go) that what you donate is not paying salaries of management. That hopefully has a propensity to make the operation more frugal and efficient.
A useful reading if you want to understand what happens if a patient is "not picked":
I used to donate regularly to Watsi, but recently I have churned, as they have de-emphasized the p2p aspect over universal healthcare. They now seem to be in an awkward split between two projects, where I'd like to see them stand firmly in either side of the camp.
I really enjoyed being able to see the patients, hear their story, get updates on their progress, and receive a "thank you" from their loved ones. Is that voyeuristic, bad, playing God? Perhaps. Should you be able to give blindly, with just an abstract generic result in your mind's eye? I'd agree that is better.
But it worked for me. It worked for Watsi. It worked for multiple patients receiving around 1000$. It just does not work for the hate and outrage brigade who want to signal that: doing good is not good enough if doing good makes you feel good.
I don't care that the SV elite commercializes/optimizes foreign aid to the point of a one-click-checkout meat market at Amazon. I don't care that it is probably predominantly white people giving to black people in a weird reverse kind-of cultural appropriation (black guilt: why can't we solve our own problems?). I don't care that people suffer after Christmas donations dry up a few months later. Keep hammering these points though and I may quit charity all together: I don't want to think about things such as race when donating. That is just no fun, not easy on the mind, not comfortable.
Exploit it. All commercial companies are doing so (Watsi is competing for my attention). Why not manipulate people into giving instead of clicking on advertisements? That only hurts my oversized wallet (and the refined taste of the outrage brigade).
"I used to donate regularly to Watsi, but recently I have churned, as they have de-emphasized the p2p aspect over universal healthcare."
It's my understanding that the their "other projects" are not being funded from the same bag that the p2p healthcare. I don't see the problem if they want to expand their activities.
The author makes mention of being able to flick through hundreds of patients to find "the saddest case". (I think this is really only telling of how the author views the world).
This used to be possible, but now there is just a "meet a patient" button, showing a single random patient at a time, which works more like StumbleUpon than Amazon product listings.
Now I need to actually invest way more time to find the "saddest case" (in more polite terms: A case that resonates with me, usually a child with a life threatening disease, but a perfectly viable treatment option). Also, skipping patients was mentally easier for me when they were collections on a page, than when there is a single patient on the page, and skipping to the next may mean you never see the patient again.
I think a critical eye can be a helpful viewpoint, but the rhetoric in this article is over the top to say the least (as others have pointed out). The use of the word "voyeur" is especially off color. Sure, some small percentage of givers might fit that description, but using it as a blanket description seems very inappropriate. In general I applaud efforts like Watsi so long as the hearts of the people involved are good, and they are willing to be humble and honest. We need good experimentation in all walks of life.
The question is, would Watsi work if the only thing it offered were pooling of donations to anonymous care receivers. The article suggests that it would not.
But that is the same idea as taxes. Taxes, that a lot of people like to hate, offer that service already, and they are pretty efficient (except when lawmakers prefer to make business owners richer by crippling public services).
So Watsi is only offering voyeurism as a business model. And that's what sucks about Watsi, and that's why this article is 100% correct.
What on Earth are you talking about? You don't seem to have any idea what the world is like outside the West. Taxes there go to whatever nepotistic dictator or warlord is "in office", and the people widely suffer for it. Violence is a part of everyday life for a lot of people on this planet. In these places, medical care of any kind besides the local witchdoctor is a luxury completely out of the means of most people. There are even places where the Red Cross/Crescent and Doctors Without Borders will not go. Those places exist! If nothing else, this comment is exactly why Watsi is doing good in the world: Some people are ignorant of how the rest of humanity lives.
Except that I don't live in the "West". And I've seen my share of the world, and done my share of NGO work at home and in the places where it's directly helpful. I also know that taxes are used especially in the West to fund the military industry that contributes to killing people all over the place. So I am well aware of the ambivalence of "taxes". But that's not what I am talking about. I am talking about "taxes" as a way to create a strong public service, not as taxes to create even stronger dictatorships. Also, places where the Red Cross/Crescent and BWB won't go are also very unlikely to be places where Watsi will go.
OC is moreso talking about taxes as a concept.
I use watsi to send money to fund healthcare abroad in countries with less equitable systems than the one I live in (where taxes pay for universal healthcare, as they should).
For me they’re a trusted partner who vets healthcare professionals in another country and allows them to allocate funds to fund everyday treatments for people who can’t afford them. I also give to msf but like that watsi is not disaster relief but healthcare. I use the universal fund so rarely choose a specific patient.
The stories and photos I’m ambivalent about and do see why one might object, but also how they drive engagement and build trust. I’d still give money without this - what you call voyeurism.
Cheap cynicism is really easy; making a difference is hard. I think Watsi makes a difference.
Just like NGOs are making a change. And that's what's criticized in the article. You can't just click away misery.
The idea of online donations is nothing new. The idea of online donations to support people with health issues is nothing new. Give to your local Red Cross. Give to the Army of Salvation. Give to your local groups. Help the people in need in your neighborhood.
There are plenty of things you can do locally to alleviate people's pain and suffering, and it does not involve sending money through a site that feeds on voyeurism.
Not like other ngos, as I already pointed out. Also see the universal scheme - people don’t choose recipients.
People didn’t ask for or need your direction on who to give money to, nor is watsi mutually exclusive with local charity or healthcare. Perhaps find a better target for your self-righteous preening about virtuous giving.
Yeesh. This is some kind of caricature of social signalling or something. What even is this person trying to say?
Am I missing something here? Donating money to a cause or individual in developing/third world country is classic NGO. And Watsi seems to offer nothing new, except maybe the word "crowdfunding" and based out of SV.
On that end, the indignation of this article is also misguided. This is like saying - "if X NGO's donors are paying for improving Y in developing countries, what incentive do those developing country governments have to improve Y?" This line of logic argues against all donation.
>This line of logic argues against all donation.
No it doesn't. You do need to be careful about how goods and services are donated to avoid making the situation worse.
http://www.djiboutijones.com/2014/02/dont-send-your-used-sho...
Oh I forgot about the issues on donating used shoes, food cans etc. So let me rephrase that - This line of logic argues against any cash donation.
> If Watsi donors are paying for the healthcare of individuals in developing countries, what incentive do those developing country governments have to build functioning health systems?
Doesn't even stop to consider that maybe donor based healthcare is more sustainable and a better solution than anything the local government could offer.
Do these people not understand that what they are basically saying is "a few children must be sacrificed so that local governments wake up". Also this assumes that the local governments have enough resources (or ever will) which may totally not be the case.
This entire article is nothing but making perfect the enemy of good.
Is everyone in Silicon Valley so out of touch? Those hospitals presumably have to pay someone to take pictures, upload to watsi the profile, manage the billing, etc...
Wouldn't it be easier -- if Watsi instead helped these countries institute some sort of single payer plan, or a plan whereby the Hospital is an insurer. Everyone in their 'district' is insured by that hospital. They pay monthly fees based on income 2-4% maybe? Watsi could give grants to hospitals who are in the red as well as consult them on how to improve productivity and lower costs...
I think this model would work here as well...
If you're out of network on a business trip or something, you'd go to another hospital, your home hospital would pay the out of network one. The hospital benefits because they have MRR from all patients living in their district who opt-in to their hospital. Hospitals could then standardize all billing and use a central software/system to manage everything get rid of lots of billers, not need to deal with insurance companies anymore, and they'd always get paid.
This sounds like something you cannot do with an NGO since it is far to integrated with government.
And that's a fully different level of activity; you have to go through your national foreign aid agency (they might laugh at you, hopefully only at first). You're basically trying to interfere in foreign politics at this point, and as you can guess the diplomacy involved is crazy (as it should be).
How is it not blatently obvious that is not OK to have richer people from another country picking and choosing which individuals are "deserving" or "piteous" enough to receive health care?
That’s part of the marketing to help bring awareness to the need for the service.
I always donate to their general fund, which means they do the allocating.
Because they aren't picking and choosing who lives and dies, who is sick and healthy, they're deciding how to spend their money to help people, not on something that would give them more selfish enjoyment. Not sure how you spin this to an evil thing.