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.

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?

> "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.

  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 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":

https://watsi.org/faq#what-if-a-profile-isn-t-funded

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).

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.

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.

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.

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.

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>.'

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.