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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.

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