charitable organizations will be [in] competition for donors and offer only care to make donors feel good about themselves. So charities will raise money for extreme cases like the British Charlie Gard and not say reasonable care rural clinics in Kentucky.
I agree that accountability to donors creates distortions. Only in the for-profit sector is accountability to customers a consistent, important factor.
Accountability in government is even less well developed than it is in charitable organizations.
I think that the role of competition and choice in fostering accountability is something that cannot be stressed enough. Instead, people over-rely on the intention heuristic, meaning that they treat charitable organizations and government programs as if their good intentions were sufficient to achieve good results. But good intentions do not substitute for accountability.