I remember reading a WSJ article about plasma donation like thirty years ago. All the donors were homeless people. That doesn't necessarily mean plasma sales should be illegal, but it's certainly not something people do to bootstrap themselves out of poverty. It is an act of desperation to keep people scraping by.
I don't think it's irrational to ban paid surrogacy on the grounds that we shouldn't be allowing people to rent out the inside of women's bodies for a process with massive complications risk.
I agree with Matt's general outlook here, but let me play devil's advocate and point out one potentially valid objection to having free markets in everything: an objection I don't think I've ever seen explicitly stated. The argument doesn't seem to apply to the specific cases Matt has cited but it applies very clearly to another one.
Suppose that exchanging sex for money were completely legal. And suppose, moreover, that it were not just legal but completely free from social stigma. Would that only have the effect of making life easier for professional prostitutes and the people who want to hire them?
Or would it end up changing everyone's sexual behavior? In other words:
- would it change the way you normally respond when someone you don't find attractive propositions you on Tinder or Grindr?
- would it change the way you normally follow up when you proposition someone on an app and get turned down?
I tend to think that it would, and that at least some of the feminists who oppose legal prostitution have these concerns in the back of their minds, even when they express them in the misleading language of gender exploitation.
There's a type of externality here, in other words, but I don't think it's one that economics textbooks describe. You can identify many individual cases where unblocking a sex-for-money transaction is welfare-improving for both parties, but that misses the fact that if exchanging sex for money becomes normalized, sex will become *a different kind of thing*: something that most people might not want it to be.
This argument can be used in a lot of places, & I think it plays better elsewhere. Plasma makes sense, but you can't use it for things people can't give up (eg, a liver transplant). For organs, it would be better to just make being an organ donor the default--which people could opt out of. There would be more than enough organs to cover everyone's needs without any living person losing a kidney.
Re: "I’ve been mind-boggled all pandemic by the fact that nobody has been able to organize challenge trials for Covid-19 vaccines."
I had ZERO doubt that the US Navy would find a few good men (and women!) to conduct challenge trials as an alternative to 'fighting sick" or taking aircraft carriers out of service for a month or two at a time.
Fortunately, no one was willing to bet me on it.
Worth adding that with Paxlovid available as a therapeutic, the ethics of challenge trials for new-ish variant-adjusted vaccines may now be favorable.
There’s an unstated premise that poor people are morally obligated to do everything in their power to help themselves, and don’t deserve our help until they’ve exhausted all these options. Creating the option for someone to help themselves in a particularly icky way (bodily integrity, etc) thus moves her from a state of virtuously deserving public support to shamefully unwilling to do what’s necessary. In a climate where the child tax credit is held up over lack of a work requirement, I think it’s a well founded worry that some future Manchin will hold up similar programs unless they are conditional on already having sold your organs.
"This idea is, however, hideously unpopular to the point where it’s probably not worth bringing up in public (don’t tell anyone I brought it up)."
Too late - I told my wife and my cat. My wife doesn't care but my cat is furious and started a 'Cancel Matt Yglesias for his hot Kidney compensation takes' Facebook group.
What is particularly appalling about the entire organ market is that everybody involved in the chain (middlemen, medical industry, patients, etc.) profits and benefits from the organ donation and transplant -- EXCEPT the person who provided the organ, who gets nothing.
This is incredibly, fundamentally wrong.
You could increase the supply of organs just by telling people "can we BUY your organs when you die" (and pay your surviving family), instead of just "will you donate them?"
It's also strange/funny that we will say "oh no, what about poor people who feel they have no alternative other than selling organs to get by" and find that terrible...but presumably we'd be OK with someone who sold a kidney so they could buy a car or take a vacation. Similar arguments for sex work, too.
Or the usual capitalist critiques of "selling your life and/or time".
We could also address some of these concerns by attacking poverty directly and aggressively. Having more organs available for people who need them and have no alternative is a net social good if we think saving lives is important.
Surrogacy and kidney donation are hard questions because I believe it is reasonable to ask if people should be able to trade future bodily risks for cash now.
Surrogacy also comes with emotional risks--can women accurately judge how hard it will be to give an infant up? Women who’ve done adoption have reported extreme distress in some cases.
And what happens if the new family changes their minds? Nevermind the pay issue, what happens to the baby?
OTOH, paying people to sit with a needle in their arm for an hour and deal with the resulting acute effects (I passed out in the lobby 10 minutes after it ended) seems reasonable, especially in a country with better welfare than the US.
One thing would be if journalists would ask the people who block [sticking with COVID] what are prima facie positive net benefit "transactions" (not necessarily monetary) -- human challenge trials, fractional vaccine dosing and increased spacing while there was still a shortage, paying people to get vaccinated, restricting development of screening tests -- WHY they are doing it, and not letting the duck by saying that is would be "unethical."
Side note, when you force the kids to leave the factory floor instead of schools they can and do end up in worse situations. Such as child prostitution.
I favor kidney reimbursement. No question. But it's worth remembering that economic coercion is not the only form of coercion. And the danger of actual force being used is higher, in part, when the amount of force necessary is lesser. For example, the amount of force and attention needed to force a woman to carry a surrogacy to term is greater, because it needs to last longer, than roofie-ing some schmuck and having him wake up in a bathtub full of ice in Reno.
Also, personally, my understanding was that sweatshop labor was often forced, not just economically coerced.
Finally, although I hate slippery slope arguments, what's to stop me from selling, say, the opportunity to cut off my pinky? In terms of bodily autonomy, that doesn't seem to be much of a difference.
The whole "someone stole my kidney" stuff is addressable. You only pay for kidneys removed in approved facilities with a chain of custody. I do not think anyone can seriously think it is going to be like catalytic converters where shady people are just showing up with a van full of frozen kidneys. This is one of the easiest issues to resolve. Today's system more or less works like that -- everyone knows where the kidneys come from, who provided them, when, and why.
Why shouldn't you be allowed to sell the opportunity to cut off your pinky? We currently let people get pregnant for money, or get tattooed in exchange for free food or other compensation, or run a marathon for charity, or do other things to themselves for money they might regret later.
The last point you touched on with respect to people needing more constructive outlets for demonstrating courage and being compensated thusly, whether financially or with praise, is of profound importance to a lot of things right now. I think I've read it phrased as "opportunities for heroism" on certain corners of Twitter.
Lots of stories we've seen lately from the retiring Alabama deputy running off with a convict and then shooting herself, to volunteers dropping comfy lives in the US to go fight in Ukraine, to much more destructive tacks like joining ISIS or trying to go out in a blaze of glory via mass shooting, et al. all harken back one way or another to this oft-unappreciated deprivation.
On the flipside, this might be why superhero films, video games - especially war simulators like Call of Duty, lots of anime and manga - especially isekai ones in which some loser or salaryman gets transported to a fantastical realm and thrust into a reluctant hero role, are all so insanely popular in recent years. If all else fails, we can go the keyboard warrior route to dump our idiosyncratic thoughts like I'm doing right now, or fight some simulation of the ideological battles of the past century.
The blockades on paying people for their kidneys or blood is just a glimpse of how society is primed overall. We can't take matters into our own hands (often for good reason) in terms of preemptive defense of self or others, since that's vigilantism and illegal. We can't alter others' property or public property for the sake of clearing a hazard out of fear of getting sued. We can't even let our kids outside for more than like five minutes unsupervised before DFCS is called in certain jurisdictions, which inculcates the maximum-caution mode in said kids really early in life. At best, we can typically look forward not to praise but to "you're an idiot" or "that was so stupid of you!" for trying to flex some kind of bravery a vast majority of the time.
So many of us have defaulted to doing nothing in almost every unforeseen situation out of fear of running afoul of the law in some fashion, or if not that then out of fear of ridicule or ostracism. I know a lot of the quasi-new age gurus on the Right like Jordan Peterson and trollier "real man" figures like Matt Walsh make these same arguments repeatedly, pointing to a Crisis of Manhood or some such. It seems the only ones calling it out with any prominence tend to be doing it for some of the worst possible reasons or for deeply reactionary causes like those guys, which is a huge shame. Granted, this issue is obviously not an issue that only impacts men, but we all know what the stubbornly lingering expectations and assumptions are for each gender overall.
Anyway, yes...more constructive outlets to pave the way for more opportunities for heroism is probably called for, and opening up organ markets sounds like as good a first step toward that as any. Tragically, people are literally dying until we collectively figure that out.
I prefer the sort of wish-fulfilment isekai series where the premise is "I was reborn in another world and now I can buy a house and not work myself to death." :)
The German method of compensating kidney volunteers is a good illustration of how you make changes in a world where the main objections are moral and ethical (at least at first). You do it through incremental change, modifying the terms of debate, so that in the end you can move to another moral/ethical equilibrium. It's slow boring, in other words. It makes sense to pay people to donate kidneys, in a utilitarian way, but the ruling moral/ethical landscape is not prepared to accept it. So you don't pay people. You "compensate" them for their time -- and who could object to that? Then you compensate them more generously (as this post lays out). Soon enough compensation and a straight market price are indistinguishable.
It's like gay marriage. It was repugnant to most of the population. Then a couple states did things and the world didn't collapse. And there were some gay people on TV that folks came to look on affectionately. Writers slaved away making moderate -- and not radical -- sounding arguments (e.g., bringing gays into marriage is a conservative act, and the most radical gay rights people hated gay marriage efforts). And when finally the Supreme Court closed the deal, the ground was well tilled and everybody was ready to write "fin" to the argument (well, we'll see post-Roe).
If you want to make big changes, start small. And don't tell anyone what the final destination is.
I’m still annoyed we didn’t do human challenge experiments because I do think it might have moved vaccines and therapeutics along faster.
One thing that is under appreciated is that we would have to do some preliminary experiments to determine what dose is necessary and how to most effectively infect people (most people who get infected with this coronavirus don’t infect anyone else even a household member so just sticking people in a room with an infected person won’t work reliably), but the information from those experiments would also be very valuable.
I did notice that there was some concern that some of the volunteers might not fully understand what they were getting into. One way of dealing with that would be to do the initial challenge experiments on people working in biomedical research who would absolutely understand the risks.
As an aside, I would volunteer to be infected with sars-cov-2 way before I’d volunteer to be infected with norovirus.
I do think that we'd gain some useful information about what sort of dose and setting produces infection. I don't think we would have gained that much more information about vaccines in a relevantly faster way. We might have moved approval forward a few weeks at best, but we were already dose-limited within a few weeks of the starts of the vaccination campaign, so all that would have happened is a few hundred thousand people got their first dose a few weeks earlier, not hundreds of millions of people getting doses months or years earlier.
I remember reading a WSJ article about plasma donation like thirty years ago. All the donors were homeless people. That doesn't necessarily mean plasma sales should be illegal, but it's certainly not something people do to bootstrap themselves out of poverty. It is an act of desperation to keep people scraping by.
I don't think it's irrational to ban paid surrogacy on the grounds that we shouldn't be allowing people to rent out the inside of women's bodies for a process with massive complications risk.
I agree with Matt's general outlook here, but let me play devil's advocate and point out one potentially valid objection to having free markets in everything: an objection I don't think I've ever seen explicitly stated. The argument doesn't seem to apply to the specific cases Matt has cited but it applies very clearly to another one.
Suppose that exchanging sex for money were completely legal. And suppose, moreover, that it were not just legal but completely free from social stigma. Would that only have the effect of making life easier for professional prostitutes and the people who want to hire them?
Or would it end up changing everyone's sexual behavior? In other words:
- would it change the way you normally respond when someone you don't find attractive propositions you on Tinder or Grindr?
- would it change the way you normally follow up when you proposition someone on an app and get turned down?
I tend to think that it would, and that at least some of the feminists who oppose legal prostitution have these concerns in the back of their minds, even when they express them in the misleading language of gender exploitation.
There's a type of externality here, in other words, but I don't think it's one that economics textbooks describe. You can identify many individual cases where unblocking a sex-for-money transaction is welfare-improving for both parties, but that misses the fact that if exchanging sex for money becomes normalized, sex will become *a different kind of thing*: something that most people might not want it to be.
This argument can be used in a lot of places, & I think it plays better elsewhere. Plasma makes sense, but you can't use it for things people can't give up (eg, a liver transplant). For organs, it would be better to just make being an organ donor the default--which people could opt out of. There would be more than enough organs to cover everyone's needs without any living person losing a kidney.
Re: "I’ve been mind-boggled all pandemic by the fact that nobody has been able to organize challenge trials for Covid-19 vaccines."
I had ZERO doubt that the US Navy would find a few good men (and women!) to conduct challenge trials as an alternative to 'fighting sick" or taking aircraft carriers out of service for a month or two at a time.
Fortunately, no one was willing to bet me on it.
Worth adding that with Paxlovid available as a therapeutic, the ethics of challenge trials for new-ish variant-adjusted vaccines may now be favorable.
There’s an unstated premise that poor people are morally obligated to do everything in their power to help themselves, and don’t deserve our help until they’ve exhausted all these options. Creating the option for someone to help themselves in a particularly icky way (bodily integrity, etc) thus moves her from a state of virtuously deserving public support to shamefully unwilling to do what’s necessary. In a climate where the child tax credit is held up over lack of a work requirement, I think it’s a well founded worry that some future Manchin will hold up similar programs unless they are conditional on already having sold your organs.
"This idea is, however, hideously unpopular to the point where it’s probably not worth bringing up in public (don’t tell anyone I brought it up)."
Too late - I told my wife and my cat. My wife doesn't care but my cat is furious and started a 'Cancel Matt Yglesias for his hot Kidney compensation takes' Facebook group.
What is particularly appalling about the entire organ market is that everybody involved in the chain (middlemen, medical industry, patients, etc.) profits and benefits from the organ donation and transplant -- EXCEPT the person who provided the organ, who gets nothing.
This is incredibly, fundamentally wrong.
You could increase the supply of organs just by telling people "can we BUY your organs when you die" (and pay your surviving family), instead of just "will you donate them?"
It's also strange/funny that we will say "oh no, what about poor people who feel they have no alternative other than selling organs to get by" and find that terrible...but presumably we'd be OK with someone who sold a kidney so they could buy a car or take a vacation. Similar arguments for sex work, too.
Or the usual capitalist critiques of "selling your life and/or time".
We could also address some of these concerns by attacking poverty directly and aggressively. Having more organs available for people who need them and have no alternative is a net social good if we think saving lives is important.
Surrogacy and kidney donation are hard questions because I believe it is reasonable to ask if people should be able to trade future bodily risks for cash now.
Surrogacy also comes with emotional risks--can women accurately judge how hard it will be to give an infant up? Women who’ve done adoption have reported extreme distress in some cases.
And what happens if the new family changes their minds? Nevermind the pay issue, what happens to the baby?
OTOH, paying people to sit with a needle in their arm for an hour and deal with the resulting acute effects (I passed out in the lobby 10 minutes after it ended) seems reasonable, especially in a country with better welfare than the US.
One thing would be if journalists would ask the people who block [sticking with COVID] what are prima facie positive net benefit "transactions" (not necessarily monetary) -- human challenge trials, fractional vaccine dosing and increased spacing while there was still a shortage, paying people to get vaccinated, restricting development of screening tests -- WHY they are doing it, and not letting the duck by saying that is would be "unethical."
Excellent well reasoned article.
Side note, when you force the kids to leave the factory floor instead of schools they can and do end up in worse situations. Such as child prostitution.
Unintended consequences are a bitch
I favor kidney reimbursement. No question. But it's worth remembering that economic coercion is not the only form of coercion. And the danger of actual force being used is higher, in part, when the amount of force necessary is lesser. For example, the amount of force and attention needed to force a woman to carry a surrogacy to term is greater, because it needs to last longer, than roofie-ing some schmuck and having him wake up in a bathtub full of ice in Reno.
Also, personally, my understanding was that sweatshop labor was often forced, not just economically coerced.
Finally, although I hate slippery slope arguments, what's to stop me from selling, say, the opportunity to cut off my pinky? In terms of bodily autonomy, that doesn't seem to be much of a difference.
The whole "someone stole my kidney" stuff is addressable. You only pay for kidneys removed in approved facilities with a chain of custody. I do not think anyone can seriously think it is going to be like catalytic converters where shady people are just showing up with a van full of frozen kidneys. This is one of the easiest issues to resolve. Today's system more or less works like that -- everyone knows where the kidneys come from, who provided them, when, and why.
Why shouldn't you be allowed to sell the opportunity to cut off your pinky? We currently let people get pregnant for money, or get tattooed in exchange for free food or other compensation, or run a marathon for charity, or do other things to themselves for money they might regret later.
The last point you touched on with respect to people needing more constructive outlets for demonstrating courage and being compensated thusly, whether financially or with praise, is of profound importance to a lot of things right now. I think I've read it phrased as "opportunities for heroism" on certain corners of Twitter.
Lots of stories we've seen lately from the retiring Alabama deputy running off with a convict and then shooting herself, to volunteers dropping comfy lives in the US to go fight in Ukraine, to much more destructive tacks like joining ISIS or trying to go out in a blaze of glory via mass shooting, et al. all harken back one way or another to this oft-unappreciated deprivation.
On the flipside, this might be why superhero films, video games - especially war simulators like Call of Duty, lots of anime and manga - especially isekai ones in which some loser or salaryman gets transported to a fantastical realm and thrust into a reluctant hero role, are all so insanely popular in recent years. If all else fails, we can go the keyboard warrior route to dump our idiosyncratic thoughts like I'm doing right now, or fight some simulation of the ideological battles of the past century.
The blockades on paying people for their kidneys or blood is just a glimpse of how society is primed overall. We can't take matters into our own hands (often for good reason) in terms of preemptive defense of self or others, since that's vigilantism and illegal. We can't alter others' property or public property for the sake of clearing a hazard out of fear of getting sued. We can't even let our kids outside for more than like five minutes unsupervised before DFCS is called in certain jurisdictions, which inculcates the maximum-caution mode in said kids really early in life. At best, we can typically look forward not to praise but to "you're an idiot" or "that was so stupid of you!" for trying to flex some kind of bravery a vast majority of the time.
So many of us have defaulted to doing nothing in almost every unforeseen situation out of fear of running afoul of the law in some fashion, or if not that then out of fear of ridicule or ostracism. I know a lot of the quasi-new age gurus on the Right like Jordan Peterson and trollier "real man" figures like Matt Walsh make these same arguments repeatedly, pointing to a Crisis of Manhood or some such. It seems the only ones calling it out with any prominence tend to be doing it for some of the worst possible reasons or for deeply reactionary causes like those guys, which is a huge shame. Granted, this issue is obviously not an issue that only impacts men, but we all know what the stubbornly lingering expectations and assumptions are for each gender overall.
Anyway, yes...more constructive outlets to pave the way for more opportunities for heroism is probably called for, and opening up organ markets sounds like as good a first step toward that as any. Tragically, people are literally dying until we collectively figure that out.
I prefer the sort of wish-fulfilment isekai series where the premise is "I was reborn in another world and now I can buy a house and not work myself to death." :)
The German method of compensating kidney volunteers is a good illustration of how you make changes in a world where the main objections are moral and ethical (at least at first). You do it through incremental change, modifying the terms of debate, so that in the end you can move to another moral/ethical equilibrium. It's slow boring, in other words. It makes sense to pay people to donate kidneys, in a utilitarian way, but the ruling moral/ethical landscape is not prepared to accept it. So you don't pay people. You "compensate" them for their time -- and who could object to that? Then you compensate them more generously (as this post lays out). Soon enough compensation and a straight market price are indistinguishable.
It's like gay marriage. It was repugnant to most of the population. Then a couple states did things and the world didn't collapse. And there were some gay people on TV that folks came to look on affectionately. Writers slaved away making moderate -- and not radical -- sounding arguments (e.g., bringing gays into marriage is a conservative act, and the most radical gay rights people hated gay marriage efforts). And when finally the Supreme Court closed the deal, the ground was well tilled and everybody was ready to write "fin" to the argument (well, we'll see post-Roe).
If you want to make big changes, start small. And don't tell anyone what the final destination is.
This is going to be a hot piece to reference once Cronenberg's Crimes of the Future hits theaters/starts trending on Twitter.
I’m still annoyed we didn’t do human challenge experiments because I do think it might have moved vaccines and therapeutics along faster.
One thing that is under appreciated is that we would have to do some preliminary experiments to determine what dose is necessary and how to most effectively infect people (most people who get infected with this coronavirus don’t infect anyone else even a household member so just sticking people in a room with an infected person won’t work reliably), but the information from those experiments would also be very valuable.
I did notice that there was some concern that some of the volunteers might not fully understand what they were getting into. One way of dealing with that would be to do the initial challenge experiments on people working in biomedical research who would absolutely understand the risks.
As an aside, I would volunteer to be infected with sars-cov-2 way before I’d volunteer to be infected with norovirus.
I do think that we'd gain some useful information about what sort of dose and setting produces infection. I don't think we would have gained that much more information about vaccines in a relevantly faster way. We might have moved approval forward a few weeks at best, but we were already dose-limited within a few weeks of the starts of the vaccination campaign, so all that would have happened is a few hundred thousand people got their first dose a few weeks earlier, not hundreds of millions of people getting doses months or years earlier.
Yeah good point. The supply was a main limit for vaccination. And there was a shortage of raw materials and even the glass vials to put them in.