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Not to call out anyone personally, but two responses to my kidney article are telling. The first is from the spouse of a friend, who upon reading it said, “It just feels wrong.” That does not surprise me – it is hard to get one’s mind around markets in organs. What does get my knickers in a bunch is the refusal of the person to consider it – or to propose something that would work better, or even nearly as well. It hasn’t happened – and will not happen.

The bigger question comes from a close friend of mine who wrote:

I guess my concern with eliminating the first come first served approach and making it more market-oriented (in my view, kidneys to the highest bidder) simply means that poor people won’t get kidneys and rich people will. do rich people receive better health than poor people right now? sure. but rich and poor are treated equally re: bullet wounds and ER rooms.

This is a typical response from people whose political beliefs make them suspicious of anything resembling capitalism. My response to him follows. Had I more space i would have incorporated it into my original article.

Dear Friend:

  1. Current rich people are in a better position to “plead” for kidneys on a donor basis – the poor have no such mouthpiece.

  2. The cost of a kidney would be about $15,000, while the total cost of the operation exceeds $100,000. Thus, the kidney cost is a small share of the overall cost. There is no difference in the poor’s ability to pay whether there is a market system or a UNOS system – in either case they cannot afford it.

  3. You are ignoring the most important economic part of this – that the supply of kidneys would increase substantially. And more kidneys means more poor people can get them.

  4. The biggest real factor however, is that the cost of treatment and dialysis of current kidney diseases far exceeds the costs of the transplants. The poor are in no position to incur those larger costs over longer time periods – particulalry since their job situation does not allow them the “luxury” of time off to do it. If all kidney patients went off dialysis and drugs and had transplants, the total cost of incurring a kidney disease would fall dramatically. How are the poor currently paying the hundreds of thousands of dollars for these treatments? Would that money NOT be available to help them with a transplant?

Using the poor as a way to keep market forces from improving medical care is a straw man.

And using a least common denominator in terms of access to medical care is an awfully stingy way to look at things – and awfully short sighted in an economic sense. If a new drug is invented tomorrow that costs $2,000,000 per pill and which cures all kidney ailments, you would propose making it illegal because the poor couldn’t afford it. But, having Alonzo Mourning be able to buy that treatment gives other drug companies an incentive (and the means) to find ways to produce this more cheaply. Without the rich first buying such a drug, it would NEVER ever have a chance to make it to the point that the poor could afford it. This has happened with thousands of goods and services through time and very few people have appreciated it. One easy to see example is thepersonal computer – an IBM 286 desktop in 1985 would cost the equivalent of over $6,000 in today’s dollars. Without the “rich” buying these things up, today’s poor would have no chance to purchase a new Dell for $400 – and the machine is immeasurably better than the IBM 286 that the poor unfairly could not buy.

Inequality between rich and poor has in fact enabled the poor to consume things that over time that they could only have dreamed about in the past.

Of course, I get no response back to this … just a pithy note saying I need to read more closely later.

It is easy for many to throw out liberal aphorisms to make people like me seem reprehensible. But few people I kmow are willing to spend the intellectual energy to make reasoned arguments. Which makes me want to expend more intellectual energy exposing this weakness.

13 Responses to “But What About the Poor?”

  1. Patrick Carter says:

    It seems to me that if anything allowing a market on organs would drive prices down somewhat. If kidneys were so expensive that only the rich could afford them, and there was a large number of people attempting to sell their kidneys (well hey, they’re worth a lot, right?) then people would want to sell their kidneys for cheap in order to make sure to get a market. I would predict that at first however because there is a huge backlog of people waiting for kidneys there would indeed be a raise on the price of kidneys, but once the backlog was eliminated somewhat then things would sort of even out at a more reasonable price. Just because its a kidney instead of a car you’re selling it doesn’t mean that the laws defining how it is sold would change. A car dealership can’t just sell a car for however much he wants. (That would be great! I would totally go into automotives!) I would also say that as the societal block against selling organs (i.e. once its no longer such a ‘weird’ or almost taboo thing) the number of people selling kidneys would increase even more.
    Of course, as you said in your article the cost of a kidney is negligible compared to the cost of the operation anyway. Maybe we need more doctors who can perform such operations. I wonder if that’s why the operations are so expensive, is there some sort of cost inherent in machinery or supplys or something, or is it because there is a scarcity of doctors? My guess would be the latter.
    Someone gave you a pithy note saying you had to read more closely? Haha, sounds more like someone else has to read their economics more closely…
    On the other hand, I bet there are still reasons why people would oppose organ markets. I suppose if you are religious then the selling of body parts might possibly be offensive to you. Also, a market on organs could open up a variety of new problems. Would the government start taxing the new kidney market? How about people who want to give up their organs, would they have to pay more in health insurance from then on (I don’t know the science behind this however, does it make you more likely to get sick later on if you gave up an organ? I bet there are statistics on those who donated organs to family members etc somewhere out there…) How about the operation to remove your kidney, would the price of that go up as more and more people wanted it? Or would kidney-transfering doctors be paid so much that the next generation of kids grew up dreaming of a prosperous career in the organ transfer industry? Hey, it could happen!
    What’s the difference between selling organs and selling blood plasma, when you get down to it? I suppose organs don’t replenish, but still. And why can’t people sell their blood either? There’s a huge shortage of donated blood in the hospitals, if you gave people more of an incentive then cookies and apples juice maybe they would donate more blood. People always underestimate the need for blood too, I was in the hospital and I needed a blood transfusion and it was AMAZINGLY helpful. Having all the blood your body needs=priceless.
    But I guess I came off the main topic. Ah well, I’m out of time or I would do some research on the interrnet…

  2. James Oswald says:

    Why does the selling of kidneys have to be connected to *buying* kidneys? If the objection is that the poor could not afford it, then don’t make them pay. A charitable organization could buy the kidneys at the market price from willing donors, and then hand them out for free to patients waiting for transplants. This charitable organization could focus only on poor recipients, if that is more politically palatable. The framing of a solution is just as important as the solution itself when people are biased by crude “morality”.

  3. Sean says:

    “If a new drug is invented tomorrow that costs $2,000,000 per pill and which cures all kidney ailments, you would propose making it illegal because the poor couldn’t afford it. But, having Alonzo Mourning be able to buy that treatment gives other drug companies an incentive (and the means) to find ways to produce this more cheaply.”

    I think this is a great argument and reflects the exact same process that investors are using to get commercial space flight off the ground: 10 minutes of weightlessness will cost you about $200,000 or $2,000,000, whichever it is and therefore is prohibitive to all but only the richest in our society. But their risk taking and big money spending will bridge the gap to what will ultimately be affordable space flight for all.

  4. […] (freely buying and selling kidneys). I don’t want to rehash what I think about the issue (but see here for a hashing), rather I want to emphasize two important points I want to get across from such an […]

  5. […] a market in these things it is exploitive not just because the poor cannot afford those things (that is a discussion for a different day), but because the poor are “forced” to sell these things (or at least there are more […]

  6. KevinH says:

    You were doing really good until you started talking about innovation, where your argument loses its focus. Drugs come down in costs because there is a high research cost associated with creating the drug but little cost involved in producing it. Computers have come down in cost because of both one time research costs and we have discovered cheaper more efficient ways of manufacturing. Neither of these arguments holds for human kidney donation.

    If there is innovation to be had in the kidney sphere, it will be in non-human production of kidneys. Humans won’t respond to market forces by growing a third kidney, or innovating basic biology.

    You could even argue that increased supply of kidneys now would suppress the overall motivation to find innovative solutions. Only way to counter that would be to assume that a decent percentage of the people on the kidney donor list that won’t end up getting them would help stem cell research if they were given a kidney, which is probably unreasonable.

    So, kidney markets would almost undoubtedly help in the short run, but probably delay the development of stem cell or synthetic kidneys. I’d still say the trade off would be worth it, but you could easily make an argument the other way.

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