This is What Unregulated Capitalism Looks Like

The Feds have ruined the lucrative business of an enterprising man who persuaded ‘hurting’ people to sell their organs to rich buyers.

“One of the reasons it’s so expensive is because you have to shmear all the time,” [organ trafficker] Rosenbaum said on the transcripts, referring to money paid under the table to everyone involved in the deal. “I take care of (the donor) after; after the surgery also… I place him somewhere. You have to babysit him like a baby because he may have a language problem; maybe not.”

He said the donors, all of whom came from Israel, got $10,000 for giving up one of their kidneys. “There are people over there hurting,” Rosenbaum explained.

Maybe Halloween is the time for grue stories. I find this much more scary than people in tents in the park. If you really want some chills, consider that there is a Libertarian brand of Capitalism that has support in high places, and according to their logic there’s nothing wrong with using the poor as organ farms for the rich. In fact, turning the screws on the poor and removing other recourse could improve the quantity and quality of potential donors. The system works automatically, like a giant robot.

In honor of the season, I’m reprinting an essay from the New York Times Magazine, December 2007, where scholar Sally Satel makes a case for opening up the kidney market to free enterprise and profit…

It was a strange experience reading Sally Satel’s essay, Desperately Seeking a Kidney in last Sunday’s New York Times. The writer, a resident scholar at the conservative think tank, American Enterprise Institute, needed a kidney transplant. She offers her personal narrative, and then some proposals for inducing the poor to sell their bodies in a free market.

Ms. Satel begins with her experience as a woman suddenly faced with a life-threatening illness…

Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.

She is a psychiatrist, working in a methadone clinic, and she knew from her medical training what dialysis involves. She dreaded it so much that she chose not to wait on the transplant list, opting instead to search for a live donor. She writes honestly and unsparingly of her failed negotiations with two friends, then with a man she met online. Finally she received an offer from an acquaintance, Virginia Postrel, a fellow conservative writer, and the transplant was successful.

While Ms. Satel calls the gift she received, ‘altruism’ she has a different definition when applied to people outside her circle.

We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind– perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

This is the kinder, gentler version. She is not ignorant of how desperate things can get for the poor in this world…

I flirted with the idea of becoming a ‘transplant tourist’ in Turkey or the Philippines, where I could buy a kidney. Or going to China, where I would have to face the frightful knowledge that my kidney would probably come from an executed prisoner. Grim choices, but I was afraid I could die on dialysis if I didn’t do something to save myself.

In all of this long essay Ms. Satel never wonders what would have happened if she were poor and uninsured. She seems to live in a bubble where the only problem is a lack of donated organs. And she downplays, almost callously, the risk to the donor.

The operation is done by laparoscope, leaving only a modest three-inch scar. She would have been out of the hospital after two or three nights. Most important, the chance of death is tiny–2 in every 10,000 transplants– and the long-term health risks are generally negligible.

This kind of reasoning explains a lot about why conservatives can be persuaded that whatever works for them is just peachy. There is a reason nature gave us two kidneys, a woman with chronic renal failure should be able to figure that out. If you lose one, as did my aunt, to a tumor, or my friend, to a motorcycle accident, you have a spare. And I’m not so casual about the long-term health risks — we haven’t been doing these transplants for all that long. Not to mention the risk of post-surgical infection as antibiotic resistant germs increase. Myself, I would gladly take this risk for love, but god grant I never have to for money.

But back to the kinder, gentler. The mother who sells a kidney so her son can go to college ( no pressure, Sonny), or the eighteen year old who needs cash and feels invincible. Or the man who needs insurance and can’t get accepted on an affordable plan. David Holcberg, of the Ayn Rand Institute puts it a little more frankly. This was printed on the Journal’s editorial page –

A person may reasonably decide, after considering all the relevant facts (including the pain, risk and inconvenience of surgery), that selling an organ is actually in his own best interest. A father, for example, may decide that one of his kidneys is worth selling to pay for the best medical treatment available for his child…

Opponents of a free market in organs argue as well that it would benefit only those who could afford to pay–not necessarily those in most desperate need. This objection should also be rejected. Need does not give anyone the right to damage the lives of other people, by prohibiting a seller from getting the best price for his organ, or a buyer from purchasing an organ to further his life. Those who can afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. And a free market would enhance the ability of charitable organizations to procure organs for them.

Just think, all those deadbeats sitting in the waiting room at Hasbro with their sick kids, they could be persuaded to put out if they want ‘the best medical treatment for their sick child’.

But don’t consider giving free medical care to needy children, or scholarships to hardworking poor students. That would be immoral.

We are really on the edge of a class disparity that is not only about money but blood. We already pay lip service to ‘serving our country’ while dangling cash and scholarships in front of the kids at Central and Hope High. The recruiters know where to go.

No matter how well written, and no matter how much natural sympathy one feels for anyone who goes through a dangerous illness, Sally Satel’s essay is horrible. In countries where desperate people sell their kidneys, you can be sure there will be many who die prematurely when their remaining kidney gives out, and there will be no help for them. I wonder where in the Libertarian scheme of things you put the person who sold a kidney, and now needs one. Do you chalk it up to ‘bad choices’ ? We will be going down a very dark road if we give up the principle of taking care of our own, rich or poor, and instead let the rich use the poor for spare parts.

For another, less temperate, take on this, check out Daily Kos. And yes, I’ve signed a donor card, but they’re not getting them until I’m dead.

I happen to know three people who lost one of their kidneys and are fine because nature gives us two. Two of them are in my family, and none of them could have anticipated the health crisis they went through. I’d encourage everyone to sign a donor card so that some good may come of their passing and the shortage of transplant organs will become less urgent. Let’s put in a word for preventive health care also– the life you save may be your own.

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13 thoughts on “This is What Unregulated Capitalism Looks Like

  1. You wrote a very interesting and thoughtful essay,and then just couldn’t resist suggesting that conservatives don’t want guaranteed medical care for children.
    Shame on you.
    I support full medical coverage for any child under 18.Period.This country can afford it.I don’t think it’s a waste of tax money-we do that elsewhere without a second thought.
    Scholarship programs for poor students exist now.
    What I don’t support is free medical care for some junkie who got themselves into a situation on their own and then ties up the ER with some OD or other self inflicted problem.
    As a pro-life individual I understand that life doesn’t end at birth and society has an obligation to children,who,after all,didn’t ask to be born.
    I am against any illegal alien getting one cent of public money for ANYTHING except a life threatening medical event.No one forced them to come here.Period.I don’t give a tinker’s damn about what the economics are in their country-let them deal with their own government on that.
    If they truly are political/religious refuges there is a procedure for that now.
    You really seem to hate conservatives and never miss a chance to demonize them.

    • Full medical care for children under 18 did not happen under 8 years of President Bush and is still stalled out in states that don’t take full advantage of a federal program called SChip. Why?
      Rhode Island does pretty good with RiteCare, and Mass has almost 100% insurance.
      The only real answer is universal coverage.

      • I don’t think universal coverage is going to happen any time soon.
        Just for starters,if a person isn’t legally here,they’re entitled to exactly nothing except life saving intervention.
        The country is too divided over this issue(universal coverage)and BTW the insurance I have to carry so my wife is covered goes up every year.
        Obama apparently lied through his teeth about lower premiums.
        Ritecare is a good program and I would not want to see it reduced at all.
        I really have no good answer to the health care dilemma.You’re in the field and I’m not so I guess you know more about it.

  2. “consider that there is a Libertarian brand of Capitalism that has support in high places, and according to their logic there’s nothing wrong with using the poor as organ farms for the rich.”

    I don’t think that’s a fair characterization at all. You find it repulsive that there could be a ‘market’ for organs, and most Americans agree with you (because of the same superstitions that prevent people from ending their own lives with dignity, marrying each other if they are the same gender, and aborting fetuses). SO here we are, in a place where we ban the market, so virtually NOBODY participates and there’s shortages for rich, middle, and poor alike.

    If places with organ markets, there are organs available.

    Saying that ‘the rich’ want to turn ‘the poor’ into ‘organ farms’ is just so far off-base from reality, especially in a country like ours where health plans would broker the whole thing.

    Your philosophy on this issue, as with so many other things, is ‘If everyone can’t have it, nobody can’, which ultimately leads to an order of magnitude more suffering. Is equality worth universal suffering?*

    * Day three without nicotine. I am grumpy.

    • It’s interesting that there’s not supposed to be ‘gummint interference’ to keep people well, but there’s an automatic assumption that the government will make buying organs safe.
      My modest proposal is that universal health insurance would keep more people from needing kidney transplants in the first place, and that everyone should sign a donor card because you don’t need to pee when you’re dead.
      Interestingly, when kidney dialysis was first developed, it was seen as such a miraculous benefit that a government program was instituted to cover those in need, and many poor people are on that program today. Two causes of kidney failure, diabetes and medication side effects, could be lessened with good primary preventive care.

      • I wish I could be an organ donor but cannot due to my medical history,anyway as a long term diabetic,who’d want any of ‘em anyway?Maybe corneas,but they won’t even take those because I have a bad cancer history.
        I recall that when dialysis came out,there was actually a form of triage as to who would get it due to availability being limited.
        Some consequences of diabetes like CAD are unavoidable.Same with neuropathy which has left me unable to walk any distance without a cane(sucks).
        People on lithium get a lot of kidney failure.
        Liver disease is frequently hereditary-more people develope cirrhosis who aren’t drinkers than are due to this.Or so I was told by a medical professional.

      • “there’s not supposed to be ‘gummint interference’ to keep people well, but there’s an automatic assumption that the government will make buying organs safe.”

        I don’t think any sane person is for massively deregulating the medical industry. There are some things that could probably be ratcheted-down in a way that respects a balance between costs and safety, but not massive deregulation.

        “universal health insurance would keep more people from needing kidney transplants in the first place”

        I’m not so sure about that. Maybe it would help a tiny bit, but not enough to solve the problem. It’s been shown over and over that it actually costs more to provide health coverage than not. Preventative care doesn’t actually lower costs in the long run, since people consume the savings on other care. I’m NOT saying that we shouldn’t have preventative care, I actually support universal health care, just that it’s not going to lower costs until it’s a full-blown single-payer system.

        “when kidney dialysis was first developed, it was seen as such a miraculous benefit that a government program was instituted to cover those in need, and many poor people are on that program today.”

        That program is widely considered one of the biggest failures of government health care among policy wonks and economists. I wouldn’t point to it as an example. Basically, the story is:

        Government: “Wow, this new treatment saves lives in the rare case that it’s needed, we should just make it universally available!”

        Market: “Yay! Here are several times more people than you expected who need it, and for longer periods than you ever expected! Enjoy!”

        Government: “Crap. Who knew that giving something away would create more demand?”

  3. Mangeek, is it a bad thing that so many people didn’t die of kidney failure? And how do you back up your statement that prevention wouldn’t make much difference? Two major causes are diabetes and drug toxicity. You think we can’t do anything about those things?

    • “is it a bad thing that so many people didn’t die of kidney failure?”

      I don’t think we’re working on the same level here. What I’m saying is that the treatment of end-stage renal failure in the USA basically -is- ‘universal health care’, but it’s been wedged-in to a system that’s not designed for it, so the incentives are totally out-of-whack. I’m not really going to respond to a human argument (e.g. “So you want more people to die?”) for what is really a policy question (“Are we spending in ways that respects ALL the needs given limited resources?”).

      “prevention wouldn’t make much difference? Two major causes are diabetes and drug toxicity. You think we can’t do anything about those things?”

      I want to say again that I support a sort of universal care, something much closer to Canada than what we have now. Still, saying that extending care to the uninsured will -save money- via prevention has been shown to be untrue in several studies. Only a small portion of the population doesn’t have health insurance, and when those people get it, they spend much more than they would have before, even factoring-in the savings from prevention. What -would- save money is a beefy Public Option that was opt-out from birth, had market features like partial cost-sharing, required every provider to use some standard filing system, and also required them to publicly post their metrics.

      Contrary to popular belief, the skyrocketing costs of health insurance aren’t being driven by Emergency Room visits by the uninsured; they’re being driven by insured folks trying to maximize the utility of their benefit and providers maximizing their profit (more the former than the latter, by far).

      I’ll be totally honest, I don’t think someone who leans as far left as you do has the chops to do Public Policy. I’m not sure you’re able to make the decision to cut one program’s budget and ‘lose a life’ and reallocate the money to another to ‘save two’. I suspect that faced with that decision, your answer will invariably be ‘we need to find someone to pay to save ALL the lives’. This extends beyond healthcare and into your beliefs on all sorts of things you write about.*

      * I’m still in nicotine withdrawal. Sorry if I seem confrontational.

      • mangeek-it IS a “progressive” blog after all.
        I don’t expect to change anyone’s mind here-I’ve actually met both people who run this blog and they are as set in their ways as anyone like me who mostly disagrees with them.
        I think what bothers me most about progressives is their belief in social engineering;their view of the world in terms of group dynamics(often by ethnicity);and their view of the individual as important only as an archetype.
        Of course not every progressive is the same,and if I claim they are,I’m doing exactly what I say they do.
        How anyone sees nobility in someone sneaking into the country or abusing a visa and then claiming it’s a right is beyond me.
        I’m not pointing necessarily at this blog in that respect.

  4. Lithium, for bipolar disorder, has to be monitored very carefully or it can lead to kidney failure. Even Ibuprofen is not safe for everyone and should not be overused.

    • Yeah-I think I referenced lithium above.I have a friend who has no hypertension,no diabetes,etc and has partial kidney failure from previous use of lithium-she also has been on antipsychotic drugs for years on end.
      I know about ibuprofen(naproxen sodium isn’t too great for kidneys either).I am allergic to the former so I don’t use it anyway.

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