The link came with a half-hearted one-liner from a former colleague: “Either way patients will benefit, eh?”
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. According to its site, Watsi aims to “provide healthcare for every person in the world.” Specifically, they seek crowdfunding for individual patients around the world. A person in the Bay Area can choose between alleviating the plight of a two-month-old baby in Guatemala, a 32-year-old woman in Burma, or hundreds of other suffering human beings.
How does this actually work?
Let’s look at a hypothetical example. A sick patient — let’s call her Faith — arrives at the hospital and can’t afford the treatment the doctor prescribes. 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. 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.
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?
Getting individual donors to pay for care does not help address the structural barriers that exclude many poor people from accessing health services. It does not incentivize poor communities to demand their governments fulfill their commitment to the World Health Organization to allocate 15% of their annual budgets to healthcare. And it certainly doesn’t ensure that patients will benefit when donor interest (and dollars) fade away.
Instead, it creates a long-term cycle of dependency and exploitation.
This model, not that different from of Kiva.org, exploits vulnerable people made even more vulnerable by their medical condition. In its current state, the model seems to exist more to alleviate “white guilt” than to increase access to care.
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, not just to giving foreign donors one-click guilt relief.
Y-Combinator and Watsi are now partnering to explore a new form of primary care built on an open software platform. In an unnamed “community in the developing world,” they’ll experiment with ways to reduce the administrative costs and increase overall health system efficiency — with the ultimate goal of making universal healthcare a reality. Very lofty and admirable goals — but again, I’m skeptical.
When a colleague emailed the founders of Watsi regarding the ethics of using the developing world as a test bed for innovation, especially when lives are at stake, it prompted this reply (the bolded text is my emphasis):
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?
This belief that an innovative yet unproven idea will inevitably make people better off is exactly the ruse that Y-Combinator/Watsi is trying to sell. Through “experimentation” they assume they’ll find a scalable, sustainable solution that will make universal health coverage attainable. But what happens when the government can’t afford to train an entire country’s-worth of doctors and healthcare workers on this new system? What happens when the government can’t afford to procure and distribute the technology needed to use this platform? Where does that leave patients in the long run?
This new model for healthcare financing could be revolutionary. But rolling out an untested, unproven, and currently unsustainable model in low-income countries that will have a hard time saying no to externally-funded solutions could do more harm than good for patients.
If YC and Watsi are truly committed to ensuring their model really does leave patients better off, allow me to offer a few suggestions:
- Test the waters first. While I appreciate your enthusiasm and confidence in your solution, if it does indeed fail — or creates externalities that cannot justify its continued implementation- you’ll have a lot of unhappy patients and healthcare workers to answer to. Start small with a randomized control trial in one or two countries. Analyze the results. Identify where you can do better. Go back to the drawing board. Test again. People’s lives are at stake.
- Stop pimping out patients. 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.
- Work yourself out of a job. 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. It also means developing a sustainability plan with clear targets for progressively phasing out your support.
Take this advice to heart and we’ll all be better off.
Disclaimer: The views, thoughts, and opinions expressed in this article belong solely to the author, and not necessarily to BRIGHT Magazine.
