September 23, 2012
If I ruled the world: Michael Sandel
It is time to restore the distinction between good and gold.
Michael Sandel in Prospect:
If I ruled the world, I would rewrite the economics textbooks. This may seem a small ambition, unworthy of my sovereign office. But it would actually be a big step toward a better civic life. Today, we often confuse market reasoning for moral reasoning. We fall into thinking that economic efficiency—getting goods to those with the greatest willingness and ability to pay for them—defines the common good. But this is a mistake.
Consider the case for a free market in human organs—kidneys, for example. Textbook economic reasoning makes such proposals hard to resist. If a buyer and a seller can agree on a price for a kidney, the deal presumably makes both parties better off. The buyer gets a life-sustaining organ, and the seller gets enough money to make the sacrifice worthwhile. The deal is economically efficient in the sense that the kidney goes to the person who values it most highly.
But this logic is flawed, for two reasons. First, what looks like a free exchange might not be truly voluntary. In practice, the sellers of kidneys would likely consist of impoverished people desperate for money to feed their families or educate their children. Their choice to sell would not really be free, but coerced, in effect, by their desperate condition.
So before we can say whether any particular market exchange is desirable, we have to decide what counts as a free choice rather than a coerced one. And this is a normative question, a matter of political philosophy.
The second limitation to market reasoning is about how to value the good things in life.
More here.
Posted by S. Abbas Raza at 11:28 PM | Permalink
Comments
If I ruled the world it would be a lot like Sweden. Public goods - health care, education, daycare, clean air and water, etc would be the top priority. The free market would take care of private goods. Progressive taxes would be very high and the Gini index would show little economic inequality. In short, eveyone would have a good middle class standard of living and no one would be very poor or very rich.
Posted by: Reader | Sep 24, 2012 10:32:58 AM
First, what looks like a free exchange might not be truly voluntary. In practice, the sellers of kidneys would likely consist of impoverished people desperate for money to feed their families or educate their children. Their choice to sell would not really be free, but coerced, in effect, by their desperate condition.
Coercion is when you compel someone to perform an action by the threat or use of force. Right now, anyone who want to sell an organ is denied the opportunity to do so by force -- the legal power of the government to bind them, jail them or extract fines by the threat of force. That's coercion. We all have to sell something to survive.
Posted by: Faze | Sep 24, 2012 5:06:10 PM
Extreme poverty can be a coercive force.
Posted by: Louise Gordon | Sep 24, 2012 7:57:43 PM
It's not at all obvious to me that third parties have a generic right (much less a duty) to intervene and stop coercive transactions absent schemes that would strengthen the would-be coerced party so as to render him less vulnerable to that coercion to begin with.
Posted by: prasad | Sep 25, 2012 12:49:05 AM
Prasad, I think you are right. I would go further, and say you shouldn't persuade a poor man selling his kidney not to do so unless you can give him the same sum to keep it.
Posted by: Elatia Harris | Sep 25, 2012 1:00:30 AM
We discussed this topic at some length on our blog a while back.
Posted by: Ruchira | Sep 25, 2012 1:51:35 AM
If the poor were not so desperately poor, they would not want to have surgery and sell their organs.
Of course, there is also the black market in organs to consider. People kidnapped and forced into surgery against their will.
http://www.theatlantic.com/health/archive/2012/03/living-cadavers-how-the-poor-are-tricked-into-selling-their-organs/254570/
Posted by: Louise Gordon | Sep 25, 2012 2:05:12 AM
"If I ruled the world, it would be a lot like Sweden"
@Reader, How will you find enough Swedes to populate the world? And what will you do with the rest of us non Swedes? On second thoughts, forget I asked that.
Posted by: Sundar | Sep 25, 2012 7:43:35 AM
If I ruled the world, I would make sure Michael Sandel was not allowed to write these silly articles.
Posted by: Sundar | Sep 25, 2012 7:44:36 AM
Elatia: what I understand you to be saying is that it is ok for a poor man to sell his kidney if he wants to. Would you say it is also ok for someone to put a gun on the poor mans head and force him to give his kidney as long as he pays him for it? Isn't poverty that gun on the poor mans head?
Posted by: Raza Husain | Sep 25, 2012 9:28:01 AM
Raza, you miss my point. Which was about not leaping to prevent a desperately poor man's action in this way unless you were prepared to give him the money yourself, without taking his kidney. Nothing about this is okay. Not any part of it. But people who are outraged at poverty don't want to get in the position of bulldozing a lean-to on the grounds there _should be_ safe and sound housing for the family that sleeps there.
I worked for years with a down and out population -- homeless mothers -- and I have had a chance to see the difference between what helps and what is merely high-minded bullying. Before jumping in, I believe, to enforce your ideas about exploitation and coercion, it's good to ask if your thinking reflects your personal distaste at the exigencies of poverty, or if it offers alleviation of poverty, or if it addresses the root causes of poverty. It's really important not to further punish poor people hurrying to reduce their options to do things you wouldn't do.
Posted by: Elatia Harris | Sep 25, 2012 10:59:29 AM
Half of $1,150 is not enough to alleviate poverty.
From the Atlantic article:
"When they returned to their daily lives, the kidney sellers reported that their economic conditions deteriorated, despite the small influx of cash. Only two of the 33 sellers used the money responsibly. Others were handicapped by the experience, and found themselves unable to do the manual labor they were used to. In the end, the brokers won, earning about $5,000 per transaction."
Posted by: Louise Gordon | Sep 25, 2012 11:15:47 AM
Sundar,
Good questions. Since I'm blond I think I have a head start. I also enjoy saunas and skiing, if you count watching skiing on TV.
Posted by: Reader | Sep 25, 2012 11:35:38 AM
Doesn't seem to be working out too well for the impoverished:
http://www.mohanfoundation.org/organ-donation-transplant-resources/economic-health-consequences-selling-kidney-india.asp
Posted by: Louise Gordon | Sep 25, 2012 11:48:51 AM
People who have a high interest, whether theoretical or through activism, in helping the poor not to be exploited need to be certain of something important -- the difference between poverty and desperate poverty. Jim Kim, Tom White and Paul Farmer have had thoughts about how to turn desperate poverty into "decent poverty" -- Tom White's term. The desperately poor "live in dirt" as Dr. Farmer puts it, and eat only if there's food, which is not a given. If this is who you're talking about -- as an individual, not as a group -- the very least you can do is to refrain from observing that 500 USD won't alleviate that man's poverty. Your approval or non-approval of how he got the sum is a little beside the point.
Posted by: Elatia Harris | Sep 25, 2012 1:46:55 PM
Elatia, exactly. It's not like one rejoices to see a poor person considering a kidney-sale to furnish basic needs. But my moral instinct is that someone who wants to forbid that sale had better take positive actions first to ensure that this poor person is no longer desperate enough to sell kidneys for food. Or at least make a decent case for restrictions - one example might be a minimum wage type price floor to boost the bargaining power of the poor. Instead forbidding something that makes one uncomfortable, then turning away "mission accomplished", leaving people worse off than they'd be minus intervention, this strikes me as morally appalling.
Posted by: prasad | Sep 25, 2012 2:55:03 PM
Only two sources, but both say that the kidney "donors" health deteriorated post-surgery, as did their economic circumstances.
You believe that this is helping the desperately poor?
Posted by: Louise Gordon | Sep 25, 2012 3:11:55 PM
The "right" to sell one's organs is made moot if everyone has the "right" to health care, which is how things should and could be organized.
Posted by: Reader | Sep 25, 2012 4:00:03 PM
To be sure, organ sales to dying First World swells should not be considered an anti-poverty measure at the policy level -- anywhere. They happen in fact however, so it's probably best to get in place the highest number of protections possible. Is this "help" in the sense that education, food assistance, micro-loans, wells and basic sanitation are help? No, it isn't. It's a short term survival maneuver -- the kind that people who work in hideously dangerous conditions that threaten their long term well being make every day. If you have a bare sufficiency, you think about the long term: getting, over time, better and better jobs; making every economy you can, like always going a little hungry rather than disastrously hungry, so that your children may have shoes for school; disdaining to eat found meat because you can bear hunger better than encephalopathy, and so forth. If there is no bare sufficiency, you might not think of your best interests a few years or a few weeks out. This is why strategic anti-poverty measures often fail to catch on among exactly the population they are aimed to help -- people have lost the luxury of thinking of their ultimate good. In this environment, 500 USD may enable immediate survival and make your family more secure for now -- like the job you do that will undermine your health. These are tragic trade-offs. But let's not be pith-helmeted about it, and put personal distaste ahead of the survival needs of others.
Posted by: Elatia Harris | Sep 25, 2012 4:34:12 PM
Prasad: " .......positive actions first to ensure that this poor person is no longer desperate enough to sell kidneys for food"
Would you also say that " ....... positive actions first to ensure that this poor person is no longer desperate enough to steal or kill for food" ?
What I am objecting to is the emphasis on first as this ensures that kidney selling will go on forever.
Posted by: Raza | Sep 25, 2012 4:44:29 PM
The desperately poor are worse off post-surgery than they were beforehand. How is that helping them?
http://www.theatlantic.com/magazine/archive/2012/04/what-isnt-for-sale/308902/
I was hoping to buy ten pounds of love here today, but no one has offered any for sale. Makes me think of Oscar Wilde.
Posted by: Louise Gordon | Sep 25, 2012 5:01:56 PM
Reader, the people who buy kidneys are those with money to step outside the queue for a transplant OR those who have been declared a poor risk for a transplant, so that a doctor will not risk a kidney that could actually save another patient to do surgery on them. This latter group may want the surgery anyway, and will pay for it. Typically they have access to good medical care -- they are afraid of dying from the wait, and/or they want to try to live even if they are poor candidates for the transplant. This is not about good health care, but about buying your way out of the least attractive situations good health care can land you in. While I do not say that buying an organ is moral behavior, it is less awful to use your own money to step outside the system than to bribe your way to a higher place in the queue within it, when the latter would push aside another patient in need as dire as yours.
Posted by: Elatia Harris | Sep 25, 2012 5:02:34 PM
Elatia, tell us why your rationale is not a perfect fit for human trafficking as well?
Posted by: Raza | Sep 25, 2012 5:05:12 PM
Raza, you're not suggesting that a poor person selling his -own- kidney is committing a moral wrong similar to that of someone who in that same exigency resorts to theft or murder, right? I don't understand the force of your question. Yes, as it happens I do think we should try make it so no-one needs to steal simply to avoid hunger. My point from earlier simply applies with extra force to anyone who doesn't want to spend/support taxes for such purposes.
Posted by: prasad | Sep 25, 2012 6:56:20 PM
It's big business:
http://www.scottcarney.com/category/red-market/
Posted by: Louise Gordon | Sep 25, 2012 7:29:31 PM
My comment seems to have disappeared.
It's big business:
http://www.scottcarney.com/category/red-market/
Posted by: Louise Gordon | Sep 25, 2012 7:32:03 PM
Raza, I don't get it. If you mean, would I so rationalize human trafficking on the grounds that "it happens" so it should be made nicer, then you're off-base. The rights of children and of extremely young women barely at menarche are not in the same moral universe as an unsavory transaction between a dying rich man and a very poor healthy one. Hankering after sex with kids and paying for it is perhaps more swinish than trying everything money will buy to live? Selling your very own kidney is not the same as looking the other way while your nine year old daughter is taken from you for a tiny price. Please don't try to defeat my arguments by making like the poor are without moral agency.
Posted by: Elatia Harris | Sep 25, 2012 7:36:30 PM
I appreciate Michael Sandel using organ trafficking to explore the limits of the economic model. Last year I wrote a book called "The Red Market: On the trail of the world's organ brokers, bone thieves, blood farmers and child traffickers" which detailed illegal supply chains for ten types of human tissue. Since then I've been in non-stop arguments with economists who honestly and earnestly believe that regulated markets for human flesh could, indeed, function better than the current system.
Sandel hits the nail on the head when he says that these exchanges--even when agreed upon--are fundamentally exploitative. We should not apply the same market logic to body parts that we do to the manufacture of shoes.
Take for instance the big business of human eggs and surrogate wombs. It is already common to hire a surrogate mother in India to bear a child for a western couple. Meanwhile competition between clinics to lower prices means treating those women more and more like cattle. Their rights to the cells in their womb steadily retreating in front of a corporate and legal onslaught.
This year there will be about 5000 such pregnancies. In ten years it might be 50,000. What does it say about humanity that we have moved in this direction?
Here's a link to my book. It's worth a read. You can also find it illegally online if you are into that kind of thing. http://www.amazon.com/The-Red-Market-Brokers-Traffickers/dp/0061936464
Posted by: Scott Carney | Sep 25, 2012 7:53:37 PM
Scott Carney at Brandeis:
http://www.youtube.com/watch?v=SUSAwsHbdYg&feature=relmfu
Posted by: Louise Gordon | Sep 25, 2012 9:43:58 PM
Prasad, It is not the poor person selling the kidneys that is morally wrong, it is the person buying that is morally wrong ( as is clear from my first post on this). And yes it is worse than stealing because the poor guy has the gun of poverty pointed on his head to give away irreversibly a part of his body, and yes it is murder if he dies doing so.
Elatia, I am sorry but I don't consider organ trafficking just an "unsavory transaction" as you say. I consider it the same as human trafficking. And are you saying that human trafficking is wrong only when "children and extremely young women" are involved?
Posted by: Raza Husain | Sep 25, 2012 9:57:12 PM
Raza, this thread is getting close to book sales, so without suggesting the book being marketed here is not in every way excellent, I do want to get uninvolved.
First, though. If organ trafficking is not an unsavory transaction, I don't know what is, I'm sure. It is many more things than that, but it is surely an unsavory transaction. To classify it with systematic child prostitution, however, or with womb surrogacy, seems a little like something you would do to sell a book.
Let's also take one look at whether non-cadaver organ _donation_ is any good. If I donate to my beloved sister one of my two healthy kidneys, and hope we both will live, I am a good sister, am I not? If I provide a surrogate womb -- mine! -- to my infertile sister, so that she may know the joys of motherhood, I am altruistic and empathetic and capable of taking on great complexity and some risk for a person I love, am I not? If on the other hand I give my sister a kidney because she has long supported me and my family and she had better not die or I'm on my own, that muddies the picture, right? If I provide my sister with a surrogate womb because her husband will lose his inheritance if there is no child of his marriage, and I, too, am dependent on that inheritance, because he supports not only my sister but me, and I intend that support to continue, I am not really acting selflessly, am I? Can these ulterior motives exist in the presence of love? Sure they can. Even within the same in-group, ambiguities are abundant. Would you like to make sure organ donors and women volunteering for surrogacy are acting from pure love? That will be very difficult.
I am not sure why you want child prostitution rings in the same conversation. Wouldn't you say there was nothing ambiguous about protecting children from sexual abuse, whether at the hands of a "loving" parent or through commerce so brutish it cannot be told from slavery? We could never say, however, that sex between adults has to be free of the faintest transactional vibe to "count," could we?
Posted by: Elatia Harris | Sep 25, 2012 11:34:33 PM
One can always check the book out of the library.
I think this book would be very helpful in understanding the fate of kidney sellers, both before and after their surgery.
Posted by: Louise Gordon | Sep 26, 2012 2:18:35 PM
While all of you very self important "intellectuals" are busy railing against the market in organs, people are dying. Quoting John Goodman: "People die when markets are suppressed".
http://www.nytimes.com/2012/09/25/opinion/discarded-kidneys.html?partner=rss&emc=rss
Now, back to your regularly scheduled circle-jerk.
Posted by: Sundar | Sep 26, 2012 2:25:49 PM
Correction: I think you mean pseudo-intellectuals on 3QD, the most egregious example being the "case Against Kids" from last April.
Posted by: Reader | Sep 26, 2012 2:47:43 PM
Sundar, The NYT article Discarded Kidneys recommends:
"The more profound need is to encourage a lot more people to register to donate organs after they die. That’s the way to increase the number of kidneys available."
It is not recommending live people to have surgery and sell one of their kidneys.
Actually, the intellectuals seem to be supporting the market in organs.
Posted by: Raza Husain | Sep 26, 2012 3:40:03 PM
Sundar, "People die when markets are suppressed".
So is there anything wrong with a poor but healthy person with five starving children to voluntarily undergo surgery and sell his heart for transplant to a dying rich person. Six lives have been saved, one life lost. The unsuppressed market works.
Posted by: Raza Husain | Sep 26, 2012 4:01:49 PM
http://jobs.aol.com/articles/2012/09/27/organ-donor-network-used-atrocious-practices-former-worker-cl/?icid=maing-grid7|main5|dl25|sec1_lnk3%26pLid%3D211797
Posted by: Louise Gordon | Sep 27, 2012 2:50:17 PM
@Sundar: In case you missed my prev comment, I was hoping you would be able to clarify the moral dilemma posed there.
Thanks!
Posted by: Raza Husain | Sep 28, 2012 1:57:43 PM
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