Five years ago, Facebook founder, multi-billionaire, and teen heartthrob Mark Zuckerberg donated $75 million to San Francisco General Hospital, which is generally a very nice thing to do. Hospitals help people! But Zuckerberg’s donation came with a catch the city is now debating: they had to name it after him. What’s the point of donating to charity if you don’t get anything out of it?

I live in Minnesota now, but I grew up in Sioux Falls, the sexiest city in Southeastern South Dakota. To me and my once-fellow residents of the Sioux Empire, this story invokes some serious feelings of déjà vu.

My first experiences of Earth (2 ½ stars; it’s fine) were had at Sioux Valley Hospital, the largest health care institution in the region named, like everything else, for the area of the country formerly inhabited by the indigenous Sioux people. It was a pretty good name, I thought. One guy didn’t.

Enter T. Denny Sanford, University of Minnesota alumnus and billionaire who made his hella moneybags providing high-interest credit cards to poor people with bad credit. In 2007, Sanford decided he couldn’t stand the Sioux Valley name and spent $400 million to change it. Some publications would be so generous as to call it a gift, but the cash transfusion came with a pretty huge asterisk: the hospital had to take a new name. Understandably not interested in shying away from a four-tenths of a billion dollar windfall, the hospital administration agreed, and now Sanford Health is a regional medical giant. Throughout the half-decade renaming process, I often joked that all of the sum was going to changing the logos on signs, records, and uniforms. I was a child, and I didn’t really understand money. Now I’m an adult and I understand it less.

But what I do understand, is that spending money and receiving goods in return is known among economics circles as a transaction. When I donate to a children’s hospital, they don’t name a kid after me. The only thing I’m supposed to get is either the warm, fuzzy feeling of helping someone else or a yearlong abatement of guilt for not doing more. When billionaires donate money, they expect fame in return.

Some could argue this point: my twenty dollars don’t go as far as Sanford’s four hundred million. That’s fair. To be even more fair, it’s kinda crazy that the credit card equivalent of a slumlord can spare $400 million for a hospital in the middle of nowhere but the guy who ended democracy can only muster $75 million for the only public hospital in one of the country’s largest and most expensive cities. Either way, though, the semantics are the same: these guys are spending big bucks with the expectation of a pretty huge reward.

So why hospitals? Why not spend your hard-earned money on additional business ventures, like the nation’s only short-lived pawn shop superstore with a deli and in-house tattoo parlor? Hospitals are a much better investment, because we all know they’re where the good guys live and do work. If your name’s on the hospital? Holy shit, you’re a hero. And when the rest of your time is spent raking in poverty dollars or running ads for the nation’s hottest white nationalists, that sort of brand rehabilitation is almost invaluable. Almost. Market value is somewhere between $75 million and $400 million.

But let’s play devil’s advocate. Is it really that bad that billionaires pump cash money into medical institutions? Is a courteous, if uninspired, rub and tug on a billionaire’s ego really that high a price to pay for substantial improvements in medical care? That’s a fair point to argue. While I’d first posit that an injection of big millions could easily miss the vein of substantial improvements in care. In Sanford’s case, the huge monetary boon did lead to expansion and improvement of Sioux Falls facilities, but it also spurred a campaign of massive expansion that made Sanford the largest health provider in not only the Sioux Falls area, but the Dakotas as a whole. That could have led to better care for people, but I don’t have proof that it did.

Meanwhile, the benefits for the billionaire are a lot more clear-cut. They’re nice rich folks, not… robber barons or tech world supervillains. Every action taken by these institutions going forward bears their name. In San Francisco’s case, each patient cared for receives that care under the providing eye of the guy who taught your uncle about QAnon and involved your high school acquaintances in those insane pyramid schemes that promise thirty six packs of adult diapers for each one you send yourself. For the people of Sioux Falls, or, indeed, Saint Paul, where the entrance of the hospital I once worked at also bore T. Denny Sanford’s name, local medical practices are inextricably linked to the name of a benevolent billionaire currently under investigation for possession of child pornography. His legal team is headed by former South Dakota Attorney General Marty Jackley.

Publically, Sanford maintains that all of his $1 billion-plus donations are done for the benefit of the people, particularly children. A piece in ProPublica describes one statue (built next to the sports complex he financed) as “children running toward him with basketballs.” Friends know it as the group of brave kids throwing sports equipment at the local creep.

Sanford’s not all bad, though, the ProPublica piece references a Forbes profile that describes the billionaire as “a colorful boss, gathering his employees in his Phoenix winter home, cooking them breakfast in his underwear”. Boss goals.

I think naming… anything after people, especially living people, is dangerous. The obvious errors of historical figures aside (slavery), humans are dynamic, and irrevocably associating an organization or place with a person who hasn’t thoroughly been vetted by history (and even one who has) bears the risk of backfiring pretty tremendously.

But even ignoring that, we should recognize that these transactions are purpose-built. If your goal is improving health care access, providing opportunities for children, or bettering the world, throwing money at a problem can do that, at least in a way. But if that transaction comes with a catch, one that provides personal benefit to you, the primary goal isn’t charity. That’s just a bonus.

Tagged Billionaires, Sanford, Zuckerberg