Book Review: Crowded Out

By guest contributor Sydney Pope In recent years, crowdfunding has become an expected part of the response to any crisis, whether a…

The post Book Review: Crowded Out appeared first on Speaking of Medicine and Health.

By guest contributor Sydney Pope

In recent years, crowdfunding has become an expected part of the response to any crisis, whether a personal crisis like a cancer diagnosis or a global crisis like COVID-19. When people feel called to action in response to a tragedy or injustice, they often turn to crowdfunding sites like GoFundMe. Dr. Nora Kenworthy’s book Crowded Out: The True Costs of Crowdfunding Healthcare examines how crowdfunding could be causing more harm than good. Drawing on more than a decade of research, Kenworthy shows readers how crowdfunding reinforces racial and economic inequalities and distracts us from examining the root cause of the financial struggles we see in crowdfunding campaigns.  

The book’s argument is structured around the “moral toxicities” of crowdfunding, which Kenworthy defines as “harmful ideas, rooted in widely shared social values, about whether and under what conditions people deserve help, healthcare, and social protection.” The primary moral toxicities of crowdfunding are free-market ethics, selective deservingness, rugged individualism with false meritocracy, and downstream solutions.

Kenworthy credits neoliberalism and racism as the primary contributors to our current healthcare system, which is highly marketized and lacking in social safety nets. In a free market system, corporations heavily influence the price of healthcare and the policies that maintain the system that generates their profit. This is what Ruth Wilson Gilmore refers to as organized abandonment. Corporations profit from a broken system that keeps Americans unhealthy. GoFundMe was not founded as a healthcare solution. It is a for-profit company that benefits from and upholds the values that undermine efforts to expand healthcare coverage and social safety nets. Racial resentment and fear of losing their place at the top of the racial hierarchy leads many white people to oppose more robust social programs even as they struggle to afford healthcare themselves.

Selective deservingness, the idea that not everyone is equally deserving of support, is a prominent value in United States social policies, such as work requirements for welfare recipients and restrictive income limits for Medicaid eligibility, and it is a value reflected in crowdfunding. Kenworthy coins the term “deserving popular” to describe the belief that some crowdfunding campaigns are successful simply because the beneficiary is a good person whom people want to help more than others. This idea disregards factors, like the size and socioeconomic status of one’s social network, that greatly influence the amount of money a person can raise. The more we feed into the narrative that only “good” people deserve support, the further we move from the idea that everyone has a right to adequate healthcare regardless of who they are.

Rugged individualism is the belief that people are responsible for themselves and failures should be blamed on individual fault rather than outside factors. Crowdfunding websites like GoFundMe promote the idea that persistence and hard work yield successful campaigns. The reality is that most crowdfunding donations come from one’s existing social network, or as a former crowdfunding campaign success consultant put it, “Crowdfunding is not about the kindness of strangers. It’s about the kindness of your crowd.” In crowdfunding, the size and financial means of one’s social network are the main determinants of how much support they are entitled to. Rugged individualism causes people to feel ashamed to ask for help when they need it and embarrassed to accept the help they deserve. Crowded Out details the experience of Trevor, a single dad with type 1 diabetes. He created a crowdfunding campaign when his insulin became so expensive that he was in danger of losing his house. He was too ashamed to share the campaign, so it received zero donations. In chapter four, Trevor reveals his income is low enough to qualify for Medicaid. Still, he prefers to pay hundreds of dollars a month out of pocket for his insulin because of his strong opposition to “handouts.” This example illustrates how rugged individualism is so ingrained in our society that people risk everything rather than accept something they don’t think is earned.

Crowdfunding normalizes focusing solely on downstream solutions without investigating the cause of the problem and how it could have been prevented. The practice is so ubiquitous that governments worldwide have crowdfunded for public goods to address problems initially caused by government inaction. Donating to crowdfunding campaigns has become the go-to way to practice care and advocacy or to deal with collective guilt over injustices. Making small donations to individuals addresses the symptoms of the broken system rather than the cause and allows people to avoid their social obligations to one another. Crowdfunding distracts from the critical work of dismantling and rebuilding unjust systems by offering people a simple, feel-good “solution” to the world’s problems.  

Throughout Crowded Out, Kenworthy repeatedly calls the reader’s attention to the racist roots of our broken system and how crowdfunding reinforces those racist ideals, as well as how structural racism makes it more difficult for historically marginalized people to succeed in crowdfunding. The racialized history of economic exclusion in this country has resulted in white people holding the majority of wealth. Regardless of how supportive their social networks are, historically marginalized people are typically at a disadvantage compared to those soliciting donations from social networks that have access to generational wealth. There is no equal opportunity in a system that is founded on discrimination. Kenworthy offers a crucial analysis of the ways in which crowdfunding upholds white supremacist social values and demonstrates that there is no equal opportunity in a system founded on discrimination.

Kenworthy and her colleagues conducted valuable original research on an understudied topic. They intentionally centered the perspectives of a diverse sample of people who used crowdfunding for various reasons with differing levels of success. Insights gathered from focus groups and interviews with crowdfunders allow the reader to see the shocking effect moral toxicities have on our perception of deservingness and our sense of humanity. Through a combination of quantitative and qualitative methods, Kenworthy and her team masterfully captured the story behind crowdfunding pages.  

Rather than leaving the reader feeling powerless to combat this growing problem, Kenworthy offers concrete and practical ways to work toward repair. She emphasizes that crowdfunding can be part of larger mutual aid projects that focus on upstream issues while simultaneously working to meet people’s immediate needs. These projects differ from crowdfunding alone because they focus on building solidarity and empowering people to fight for change at the highest level. The popularity of crowdfunding grows out of a desire to make positive change, and that desire can be channeled into more effective forms of care. Crowded Out will inspire readers to go beyond crowdfunding by strengthening community connections and investing in long-term structural change.

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