Organ Harvesting--Again

This is interesting. Megan McArdle is still trying to convince the world that organ harvesting is a good idea. Does she have some kind of financial stake here, or is she just ideologically wedded to the idea of cutting up the poor? Let's try to find out while examining her argument.

McArdle's underlying assumption, so favored by conservatives in general and Bushies in particular, is that people disagree with conservatives just because they haven't heard the right argument yet. She assumes that other people are exactly like her, and that their reasoning is based on emotion like her reasoning. Therefore if she can just find the right emotional button to push, she will succeed. She starts with the title: The Politics of Ick. Conservatives sometimes make important policy decisions based on the ick factor. Gay sex is icky, so gays shouldn't legally be able to have gay sex. (Unless they're pretty young women and conservatives are paying to watch it, of course.) So liberals must be against organ harvesting because it's icky, not because it could have concrete repercussions.

Or perhaps, McArdle asks, liberals think that making it legal to sell organs will make it seem like it's okay to buy the poor's organs. Of course it will, but McArdle assures us that just as needle exchanges help drug addicts from catching diseases, selling their organs will help the poor because "the good will outweigh the bad." To create this good situation out of a bad situation McArdle has to do a certain amount of libertarian fantasy world-building. (Has anyone thought of buying up a ton of Sims City games and giving them to all the libertarians, thus providing them with a chance to create their imaginary world without involving the rest of us?) In her world, the government will evidently conduct this organ harvesting program, despite the fact that McArdle has venomously and relentlessly declared that the government is too incompetent to do anything at all. Her statements here are so full of weasel words and evasions that they need to be examined in detail.

I wonder if this isn't the same class of objection that many of my interlocutors have about paying for kidneys. A lot of people framed the idea as "rich people buying the poor's kidneys", even though the actual proposal on the table is for the government to pay a bounty to kidney donors in the name of anyone who happens to need one. (Since my impression is that kidney failure disproportionately strikes the poor, the net effects are, I think progressive.) But it is true that probably more people who sell kidneys will be in the bottom half of the income distribution.

And yet when I look at what progressives would usually regard as the objective outcomes--certainly if they were assessing a needle exchange--the net goods obviously outweigh the net bads. For most people, kidney donation is not very risky. They lose some small utility from surgical recovery, the ability to drink a lot of alcohol at once, and have a risk of losing the other kidney so small that it doesn't register in the mortality statistics for kidney donors. (This may be because outside of trauma, a disease that is going to kill one kidney will probably kill both). And if the program results in a lot more kidney donors, the risks attendant upon losing your one remaining kidney presumably fall sharply.

People don't reason, they "frame the issue," which is what she is trying to do. People don't pay money to kidney sellers, they pay a "bounty" to "kidney donors," as if the word donor doesn't have an actual definition. The kidney sellers will be in the "bottom half of the income distribution," which is people who make under $44,000. Does McArdle think the middle class will sell their kidneys and eyes and other organs? McArdle has forgotten all about the free labor market, which she just explained was an opportunity for foreigners to become middle class. There would be almost no Americans selling their organs because the free market is full of brown foreigners who will do it cheaper, just like our factory work. It would be cheaper to fly an organ seller to the US, put them up in a hotel, remove their organs and fly them back than to get an American to sell his organs. Why would they let it go for less than, say, $5000 when organ selling advocates are promising them over a hundred thousand? There are more weasel words, of course. People won't experience pain and discomfort and loss of general health, they "will lose some small utility." If a donor is injured and loses his remaining kidney, well, too bad. You can always buy another, although presumably you are still to poor to do so.

McArdle still hasn't addressed the issue of who will pay for the organ. If she expects insurance companies to do so, they will pay the absolute minimum they can get away with. If she expects the government to pay for the organs, she might as well advocate for national health care as well. It's not like she can still say that government is too incompetent to run an organ donation system. And a libertarian telling the tax payer that he has to pay to replace the liver of someone who drank excessively is just funny.

McArdle, having disposed of any caveats to her satisfaction, asks if any reasons remain to continue the ban on organ selling.

Because it feels like ratifying the fact that the poor in America need money more than the wealthy. It feels like creating injustice.

Interestingly, I note that we only feel this way because we already banned the practices we're discussing. If it were legal to purchase syringes (and I can't tell you the libertarian indignation that filled my heart as I typed the word "if"), then allowing the distribution of clean needles to addicts would have very little expressive value. Because you need a government waiver to do this, allowing it seems to put our stamp of approval on it. "Go shoot up! Just be safe!" Whereas, to use Gerson's metaphor, no one feels like the government has put its stamp of approval on binge drinking merely because the bartender gives you a fresh glass every time you order a new drink.

You see, progressive don't want to keep the ban for fact-based reasons. It just feels bad to them. The thought of poor people makes their bleeding liberal hearts bleed, and also fills them with more of their envy and hatred of the rich. If they could just forget about their concerns and think about the money that would be sloshing around for the grabbing instead , they would agree that McArdle is right.

These framing effects seem pretty powerful to me. And it's another reason to legislate carefully--to err on the side of doing too little rather than doing too much. Once we've enacted a law, undoing it has powerful expressive connotations. The resistance to actively participating in something that we might very well tolerate can lead to some very bad outcomes for the people we're all presumably trying to help.

And we end with McArdle's habitual threats. Since she can't do what she usually does--advocate doing nothing because everything's too hard to figure out--she handily reverses herself and says that doing nothing will harm us instead.