Paper short abstract:

Innovations in crowdfunding medical expenses have grown rapidly. However, as views of moral worthiness determine donations - rather than need - what emerges is the assetization of 'virtue'. Are we therefore witnessing modes of governance and philanthropy that risk exacerbating health inequalities?

Paper long abstract:

Crowdfunding for personal medical expenses (CPME) is now a multi-$B industry, powered by Silicon Valley start-ups, venture capital, and social media. Historically, philanthropy has fostered notions that petitioning aid requires not just demonstrating need, but also moral worthiness. In this US, this has influenced healthcare governance, oscillating between free market principles v. ethical obligations of state to citizenry. Pushed to extremes, medical expenses prove the single largest cause of personal bankruptcy. CPME has emerged in response, reducing friction between widespread need and altruistic aspirations. Advocates proclaim to 'disrupt giving', upending traditional philanthropy through for-profit models. However, because personal judgments of moral worthiness are the primary determinant of donations - rather than need - what emerges is the assetization of virtue. Also, only certain health conditions are likely to acquire funding; 'crisis' conditions fare much better than chronic illness, or conditions associated with vice. Governing bodies nonetheless support crowdfunding, perhaps for devolving state duties while reaffirming familial/community ties. Yet, around 90% of US-based campaigns fail to reach funding goals, and success depends on pre-existing social and cultural capital. Hence, while already marginalized subjects are turned for profit, those even further marginalized are not heard at all. This creates injurious metrics of life's worth. What burdens are imposed in compelling subjects to plead for life itself in hyper-competitive attention economies? Are we witnessing, framed in egalitarian rhetoric, governmentalities that exacerbate health inequalities? The reframing of vulnerability as entrepreneurial possibility, implying those who prove themselves deserving will be redeemed through market-based mechanisms?