Podcast Summary

Podcast: New Books Network
Host: Dr. Miranda Melcher
Guest: Dr. Nora Kenworthy
Episode: Crowded Out: The True Costs of Crowdfunding Healthcare (MIT Press, 2024)
Release Date: October 30, 2025

Episode Overview

This episode features Dr. Nora Kenworthy discussing her new book, Crowded Out: The True Costs of Crowdfunding Healthcare, which investigates the realities of using platforms like GoFundMe to pay for healthcare in the U.S. The conversation explores the hidden costs, inequities, and social implications of medical crowdfunding, revealing a system that reflects and amplifies broader structural issues rather than providing an equitable safety net.

Key Discussion Points & Insights

1. Genesis of the Project

• Dr. Kenworthy describes her dual background in public health and medical anthropology and recounts how the project began after encountering GoFundMe campaigns in their early days.
  • She was struck by the personal nature of the stories, and over time, recognized deeper systemic inequities that these platforms reflect.
  • Quote: “What looks on the surface like a really interesting system for connecting people with help is instead a system that amplifies and exacerbates inequities, both social and health inequities.” (03:19)
• The book seeks to go beyond quantitative research and statistics, weaving in qualitative, lived experience to illuminate the real human effects of crowdfunding.

2. Research Questions & Methodology  [04:40–07:01]

• Early on, the main questions were about who uses crowdfunding and how it works.
• As research evolved, qualitative interviews with campaigners became central, revealing:
  • Many campaigns fail altogether (30–40% raise no money).
  • Profound differences exist between the public narrative (“success stories”) and individual realities, including the experience of campaigns going viral for the wrong reasons.
• Quote: “What’s it really like when you have a campaign that raises $0 ... or what’s it like to go viral when you don’t want to because of a medical need?” (06:08)

3. The Social and Economic Environment of Crowdfunding  [07:51–12:34]

• Crowdfunding emerged post-2008 financial crisis, in an era shaped by the gig economy, predatory capitalism, and structurally unequal US healthcare.
• Platforms function within—and reinforce—existing ideologies of neoliberalism and racism.
• The logic of crowdfunding reduces social welfare failures to problems of individual deservingness and marketability, calling upon people to craft narratives that appeal to donors.
  • “Much of the opposition that we see to expanded notions of a more universal healthcare system…is really rooted in people’s belief in a free market … but also in long standing racist notions...” (09:52)
• Dr. Kenworthy clarifies she does not believe GoFundMe’s founders set out to amplify racism, but the platform nevertheless does so by reflecting societal scripts about worthiness and charity.

4. Deservingness & Meritocracy: Who Gets Help?  [12:34–20:28]

• Crowdfunding enforces and amplifies cultural ideas about who is “deserving” of help.
  • Example: Trevor, a single dad, judged his situation as not “tragic” enough to seek help, internalizing shame and ultimately receiving nothing.
  • Quote: “Instead of concluding, ‘Oh, this is a place where I could get help,’ he instead concludes, ‘This is not a place for me. This is not something that I deserve.’” (15:30)
• Campaigns often selectively present information to bolster perceived deservingness (e.g., omitting negative details that might lessen sympathy, as in the story of Hannah and Alison).
  • Quote: “…they felt like if they shared that [her husband was the driver], people wouldn’t be as willing to donate. And so they withheld it.” (18:30)
• Meritocratic and “morally toxic” narratives shape who receives aid.

5. The Myth of Democratization  [20:28–24:47]

• Despite claims of democratizing charity, crowdfunding platforms perpetuate inequalities in both visibility and success.
  • Quantitative data: Most viral campaigns benefit young, white men with cancer; Black women are sharply underrepresented.
  • Quote: “I think to conflate [these shifts in giving] with democratization is really dangerous because... not just who gets to give…but also who gets to be seen as a legitimate recipient…” (21:07)
• Crowdfunding catches people already in crisis, diverting attention from broader, preventive societal solutions.

6. Can Individuals Control Success on Crowdfunding?  [24:47–28:54]

• While some campaigners seek “the formula” for success, outcomes are primarily shaped by social network size, donors’ disposable income, media access, and social status.
  • Those with affluent, well-connected networks are far more likely to succeed.
  • Quote: “At the end of the day, so much of the success of a campaign has to do with who’s in your network, who’s willing to help you.” (26:51)
• Social science confirms this dynamic—"homophily" (networks mirror the campaigner's own background).

7. Other Measures of Success: Social Support vs. Financial Gain  [28:54–31:00]

• Platforms can offer social connection and allow people to provide tangible help even from afar.
• However, campaigners may withhold bad news, feel compelled to curate positive narratives, or experience increased shame rather than support.
  • Quote: “The way that crowdfunding can cultivate a certain type of affect or narrative can also limit what people can express in that space and what kinds of help that they can access.” (30:45)

8. Broader Societal Impact & Normalization  [31:00–36:39]

• The explosion of crowdfunding has normalized it but increased competition, making most campaigns unsuccessful and creating a public misconception about likely outcomes.
  • Median raised per campaign: $265 from five donors; a third receive zero donations. (citing 2020 study)
• Platforms mirror—and may reinforce—political shifts towards selective charity based on power and allegiance.
  • Example: Trump’s flood relief campaign channeled relief to political allies, echoing the dynamics of selective help on crowdfunding sites.
  • Quote: “Powerful people … have the right to decide who deserves help and who doesn’t, and … the best way that we can ensure our survival is to show fealty … That’s a very, very dangerous notion...” (35:45)

9. Takeaway Lessons & Hopeful Notes  [36:39–39:34]

• Positive: The widespread desire to help each other persists and is visible in thriving mutual aid efforts.
  • “If you take the platform out … people are still trying to figure out how to support each other…”
• Crowdfunding is not a permanent feature—platforms and norms can (and should) be challenged and changed in response to public pressure and advocacy.
  • Quote: “Platforms are not forever… just because [they] are a specific way right now … doesn’t mean that they will always be that way.” (38:40)

Notable Quotes & Timestamps

• “What looks on the surface like a really interesting system for connecting people with help is instead a system that amplifies and exacerbates inequities, both social and health inequities.” — Nora Kenworthy (03:19)
• “What’s it really like when you have a campaign that raises $0 ... or what’s it like to go viral when you don’t want to because of a medical need?” — Nora Kenworthy (06:08)
• “Much of the opposition... to a more universal healthcare system... is really rooted in people’s belief in a free market... but also in long standing racist notions...” (09:52)
• "Instead of concluding, ‘Oh, this is a place where I could get help,’ he instead concludes, ‘This is not a place for me. This is not something that I deserve.’” — Nora Kenworthy (15:30)
• "If they shared [that her husband was the driver], people wouldn’t be as willing to donate. And so they withheld it." — Nora Kenworthy (18:30)
• “[To] conflate that with democratization is really dangerous because … who gets to participate? … who gets to be seen as a legitimate recipient?” (21:07)
• “At the end of the day, so much of the success of a campaign has to do with who's in your network, who's willing to help you.” — Nora Kenworthy (26:51)
• “The way that crowdfunding can cultivate a certain type of affect or narrative can also limit what people can express in that space and what kinds of help that they can access.” — Nora Kenworthy (30:45)
• “…Powerful people… have the right to decide who deserves help and who doesn’t… That’s a very, very dangerous notion of how societies should work…” — Nora Kenworthy (35:45)
• “Just because [crowdfunding] platforms are a specific way right now…doesn’t mean that they will always be that way.” — Nora Kenworthy (38:40)

Timestamps for Key Segments

• [02:21] — Introduction to Dr. Kenworthy and her research inspiration
• [05:04] — Research questions and methods
• [07:51] — Economic and social context for crowdfunding’s emergence
• [12:49] — Deservingness, meritocracy, and moral scripts in campaigns
• [20:51] — Democratization: myth versus reality of access and representation
• [25:09] — Individual control over campaign success
• [28:54] — Non-monetary forms of support and limitations
• [31:41] — Societal normalization, misconceptions, and political parallels
• [36:39] — Takeaway lessons and future directions

Future Projects Teased

• Participatory research with chronically ill and disabled communities on digital tools for care navigation (e.g., Facebook groups, Reddit, Google Sheets).
• Exploration of digital polarization in U.S. public health thinking and its societal effects, as part of a Carnegie Fellowship.

Conclusion

Kenworthy’s work pulls back the curtain on the celebrated narrative of medical crowdfunding, laying bare deep-seated social inequalities and the limits of individualized charity in addressing health care needs. The episode closes with a cautious optimism: people’s drive to help each other is real, and both platforms and societal responses can evolve if the public demands more just alternatives.