“Many are ashamed to ask for help”: Poverty in the US

It is a successful year that the crowdfunding service GoFundMe.com is celebrating on its website. In 2023, more than 39 million individual donations were received. “Look what help can do!” is at the top of the homepage. If you scroll down, you’ll see photos of happy recipients of money and read stories about successful campaigns from the past twelve months.

For example, there’s a bookstore in New York City that burned down and about $370,000 was raised to rebuild it. The Jamaica women’s soccer team was able to travel to the World Cup in Australia last July thanks to donations of $75,000. But there are also campaigns like this one: “When Delayne donated a kidney to her father, donors helped her pay the bills,” according to GoFundMe’s annual review. The call was initiated by a young woman from the US state of Montana named Delayne Ivanowski. In a long text on GoFundMe.com she describes her father’s medical history. He did not want to go to the doctor for a long time, until he suddenly had to undergo dialysis and urgently needed a new organ. She wants to give back to her parents and therefore asks for financial help to cover the costs of organ donation that insurance does not cover. She has now surpassed her original fundraising goal of $20,000.

The crowdfunding industry is growing. What’s good for the founders and users of platforms like GoFundMe and Spotfund is evidence of problems elsewhere. The services in the US have long since taken over parts of the functions of a porous social system. Every year, hundreds of thousands of Americans raise money to cover the costs of hospital stays, medications and doctor visits. Such bills are one of the most common reasons people get into debt in the United States. Surveys show that 70 percent of people in the United States cannot afford an unexpected $500 medical bill. The corona pandemic has exacerbated this need.

It doesn’t just affect those who don’t have health insurance; in 2022, there were still about 26 million people in the US. However, for many people, insurance does not reimburse or only reimburse part of the costs. That was also the case with Delayne Ivanowski, who donated a kidney to her father and raised money through GoFundMe. About half of Americans report in surveys that it is difficult to pay for their health care. “On sites like GoFundMe, we also see people who have insurance, but are still faced with astronomically high medical bills that are not covered,” says health sociologist Nora Kenworthy of the University of Washington in Seattle. “Another group is people who may even be doing well with hospital costs, but whose friends and family are organizing a fundraiser for them as a kind of emotional support strategy.”

This mirrors what Kenworthy discovered in her research. Over the past few years, she has investigated thousands of GoFundMe campaigns. Their conclusion: mercy is not the same as justice. The money often does not go to those who urgently need it. Very few crowdfunding appeals are truly successful: according to Kenworthy’s research, nine in ten don’t reach their donation goal, and many come away empty-handed. In 2020, about a third of those seeking assistance were unable to raise any money at all.

In the first year of Corona, the number of people in the US who tried to finance their livelihood through donations rose sharply. But while the pandemic itself has subsided and the economy is recovering, the need remains high. The Corona relief programs, which had become an indispensable support for many Americans, also came to an end. “We continue to see many campaigns aimed at meeting very basic needs that Americans often cannot afford,” Kenworthy said. “This includes healthcare, as well as rent, food and childcare.”

If you want to rely on GoFundMe or Spotfund, the categories ‘Medical’, ‘Souvenir’ and ‘Emergency’ will appear first in the selection. The “Souvenirs” section covers the costs of funerals or caring for a family after a sudden death. Just as with the treatment of a serious illness, there should actually be a social safety net in such a situation. But in the US this is extremely porous.

Crowdfunding seems like an obvious way to get help. But who benefits the most? When gymnast Mary Lou Retton, a five-time Olympic medalist in 1984 and a star not only in the US, recently had to go to intensive care with pneumonia, her daughter started an appeal for donations on Spotfund.com. Her mother had no health insurance, she wrote. The goal was 50,000 dollars, but almost ten times that amount has now been raised: just under 460,000 dollars, about 418,000 euros.

Social media accounts with a wide reach can also help. When prominent bloggers like Humans of New York launch calls for donations, hundreds of thousands of dollars can quickly be raised. Very few people are lucky enough to encounter them. It’s not just the lack of publicity that’s a problem for people in need who are already on the margins of society, says Kenworthy. “There are also very practical obstacles such as a bank account, which you need to have the donations paid out.” Presenting yourself, writing an appealing text: these are also matters that are not easy for everyone.

Social factors also played a role: “Many people are ashamed to ask for help. And this shame is greatest among those who are most in need.” Their fear of being judged is also not unfounded, says Kenworthy: “Our assessment of the needs of others is largely influenced by prejudice. There is a history in the United States of people who seek and accept help feeling guilty.” The reason for the call for donations also plays a role. An addiction has worse odds than an unexpected accident; the same goes for abortions.

Structural injustices are even more apparent in online crowdfunding, Kenworthy and her colleagues Aaron Renee Davis and Shauna K. Elbers examined in a separate study. They focused on particularly successful fundraising campaigns. Their conclusion: young, white men who are confronted with sudden fates such as cancer or accidents have the greatest chances. “Only a very, very small percentage were black and an even smaller percentage were black women,” says Nora Kenworthy. The wealth gap in the United States is already pronounced. “In crowdfunding we also see racial distortions when it comes to who is considered to need help and who is not.”

What role do the platforms themselves play in terms of visibility and therefore the chance of success? For example, GoFundMe, the largest and best known, is a for-profit company. It makes money from donation transaction fees. Starting a fundraising campaign costs nothing. But the company keeps just under three percent plus thirty cents per donation. It is also in the interest of campaigns that are already running well to become even more successful: the higher the donation amount, the more money GoFundMe ultimately receives.

The platform shows ‘trending campaigns’ on its website, and Spotfund has the ‘top fundraisers’ right on the homepage – including the appeal for Mary Lou Retton, which has long surpassed its target. How do you determine who can be seen there and who cannot? And are they really the ones who need it most, because otherwise they wouldn’t get much attention? “A first step would be for the platforms to publish more of their data and algorithms,” says Kenworthy. “Then we can better understand who ends up on the GoFundMe homepage, for example, or who appears on social media accounts.”

It’s not just scientists like Kenworthy who find it difficult to get information from GoFundMe. To a written question from ZEIT ONLINE about the exact share of requests for donations for medical bills, a company spokeswoman would only respond by telephone. ‘Medical’ is one of the largest categories, she doesn’t want to say anything more about it. She emphasizes several times that GoFundMe has always seen itself as a place where people in need can go; However, it can only complement social safety nets and cannot replace them.

GoFundMe’s then-director, Rob Salomon, became clearer a few years ago. “I would love nothing more than for Medical not to be a category on GoFundMe,” he said in a 2019 interview with the KFF Health News portal. “But the reality is that access to health care depends on the ability to pay for it,” he continued. This leads to suffering and death for people who cannot afford appropriate care.

This will probably remain the case. This year, more people than ever before have signed up for the government health care subsidy programs known as “Obamacare.” But the system has holes. And the question is how long it will last: Republicans have been dreaming of phasing it out for years. Donald Trump tried this during his first term but was blocked by the Supreme Court. Now he’s campaigning on a promise to try again. If he is elected in 2024, many more Americans than before will be able to rely on crowdfunding.

And non-medical needs are also increasing, in line with corresponding political developments. America’s free school lunch program expired in the fall. At the same time, the number of requests for support for starving children has quadrupled compared to last year, according to the GoFundMe 2023 annual report. And the Biden administration’s partial inability to cancel student debt is also reflected there: 40 percent more people than last year seeking financial help on the platform to pay off their student loans. This debt remains a burden for many Americans for the rest of their lives.

This article first appeared on Zeit Online. Watson may have changed the headings and subheadings. Click here for the original.