Tina Rosenberg on Kidneys in Iran
The main reason I have not posted much on Russ Roberts’s excellent Econtalks is that my commute is so short (about 11 minutes) that the hassle of connecting my iPhone with my old car’s system made the cost too high. But with my new car with Bluetooth, I get in, turn on the radio, and push a button to start the podcast.
I’ve already listened to 3 whole podcasts over the last 10 days. 11 minutes here, 11 minutes there, and pretty soon you have an hour. (With apologies to the late Everett McKinley Dirksen. By the way, the modern version you’ll hear about Dirksen is that he is alleged to have said “A billion here, a billion there, and soon you’re talking real money.” No way does it make sense for him to have said it. For most of his years in the U.S. Senate, the federal budget was below $100 billion. So everyone then thought of a billion in government spending as “real money.” It makes much more sense for him to have said “A million here, etc.”)
I loved the podcast that was Russ’s interview of Tina Rosenberg, who wrote a piece in the New York Times on the market for kidneys in Iran. I won’t highlight a lot of things because the whole thing is worth listening to.
Instead, I want to highlight three things.
First, and most impressive, is Ms. Rosenberg’s discussion of her assumptions going in and how she changed her mind in response to the evidence. Here’s an excerpt from the transcript:
Roberts: Let’s move to the United States. So, you talked to these folks in Iran and talked to a lot of doctors, and some patients it sounds like. And as you said a few minutes ago, it seems there’s nothing really immoral about it. Did you have that feeling coming into this? And how if anything did your feelings change through these conversations?
Rosenberg: Oh, they changed a lot. I came in, I had two assumptions that I think I no longer hold. And one of them is that paying donors is necessarily exploitative. And the second one is: There are serious moral and ethical reasons not to pay donors. I no longer believe either of those things.
Then she comments on why she doesn’t have the same moral/ethical views she had going in:
Roberts: Let’s get to the moral issues. Why do people object to the morality of it? What is the moral objection?
Rosenberg: Several reasons. First of all there’s the idea that this is your body, and we’re going to pay you to sell me a part of your body. That’s a big one. And the answer to that in a sense is, ‘Well, we do that in some ways.’ People get paid for donating plasma in the United States, and in fact because of that we provide plasma to the world. We get paid for donating sperm; we get paid for donating eggs. So, that train has left the station, in a way. And in some ways the ethical and moral issues involved with egg donation are far more fraught than this should be about a kidney, because you are not producing another human being. Then there’s the issue of, well, you know, this is really dangerous work and you are exploiting the poor by taking advantage of their poverty to lure them into doing this for money. And some people go so far as to say we shouldn’t allow poor people to donate kidneys. We should only allow middle class people to donate kidneys. And the response I think to that is people do dangerous things for money all the time. There’s a lot of jobs that are pretty dangerous, and people wouldn’t take them unless they felt the money was worth it. Donating a kidney is far less dangerous than many other jobs. So, what’s wrong with that?
On her last 4 sentences, I just want to say “Brava.” Also, notice that she could have done that reasoning without ever having investigated kidney sales in Iran.
I was particularly impressed with her taking on the sacredness of one’s body as an argument against kidney sales:
Roberts: But anyway, going back to the kidneys, so, as you point out, these moral issues, to a large extent, at least for you are not decisive any longer. But for many people they are. It’s just awful–to encourage people to cut themselves open for money is disgusting. It’s bad especially for poor people. Your body is a special, holy, sacred thing. And therefore it’s just off the table. And I think that’s true, by the way, for people whether they are religious or not. A lot of people feel that way. Now that you feel differently, do you find yourself in conversations with doctors and medical folks–which we’ll talk about from your article–but they haven’t seen the world the way you see it. And how is that–what’s it like for you to deal with that?
Rosenberg: Well, I just want to add one more piece of this. Which is that, yes, if your body is a sacred temple, then let’s spare some thought to the thousands of people who die waiting for a kidney. I mean, yes, it might be: let’s stipulate that it’s okay; it’s morally repugnant to pay someone for donating a kidney. It is certainly more morally repugnant to let someone die because they don’t have one.
Note also by the way, although she didn’t mention it, if one’s body being sacred is an argument against slicing into it for a kidney for sale, it’s just as strong an argument against slicing into it for a kidney to donate.
The second is her discussion with Russ about whether allowing kidney sales would make doctors better off or worse off. Russ argues (around the 48:00 point) by analogy with college sports, that allowing kidney sales would reduce incomes of nephrologists. His argument is that because college athletes are not allowed to be paid anything more than tuition and room and board, the competitive pressure shows up as higher incomes for college coaches. It is quite striking that some college coaches make 7-figure incomes, not even counting income from promoting products. So, he argues, it would make sense that because the only way for the competitive pressure to show up, when kidney sales are banned, is in the incomes of doctors and hospitals.
I confess that I always thought the way Russ thinks about the effect of the ban on paying college athletes, but I think Rosenberg schooled both him and me in economics.
Rosenberg (at about the 49:20 point): You think their salaries would go down if there were more kidney transplants. (emphasis hers)
Russ immediately sees her point: with more kidney transplants, there would be more demand for doctors. He hedges, but she actually convinced me that doctors would do better with more demand for their services. Now I’ve got to reconsider my views about college coaches.
The third is Rosenberg’s hilarious point about fighting over estates. She recalls (at about the 54:00 point) a discussion with someone whose objection to selling the kidneys of dead family members was that the family would fight over the money. She says:
Yeah, this would be the first time that a family has fought over who gets the money from a deceased person. We have a time-honored tradition of that in the United States.