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« Franzen's momma (prasad) | Main | A Question of Crime (Sujatha) »

March 16, 2012


If your preference is widespread, Prasad, then why isn't there a market mechanism for preemptively silencing Sandel's kind of talk? A pool of contributors could pay The Atlantic not to publish the next Sandel column. Anyway, here he reads like a two-bit blogger. Assuming reasonably that he was compensated more than two bits for his efforts, we have here a good example of market failure, right? A sign of an opinion bubble?

I don't want to defend Sandel. His account is too simplistic and, contrary to his thesis that we lack vigorous discussion about where markets ought to operate, a little tired. We do have that discussion, endlessly these days it seems (Blackwater? Medicare?), but the results aren't the ones Sandel would choose. I don't think, though, that even Sandel believes that markets are amoral. After all, he talks about the "moral limits of markets," implying that to work best markets and morals can mix it up, but just so far.

When he writes, "Markets don't wag fingers," I take him to be saying pretty much what you offer as a corrective--not, as you suggest, that they have no values, but that the attraction to "market reasoning" is its relegation of value making and measuring to the transacting parties. Market reasoning lets me sell my Gutenberg Bible to you for two dollars, a transaction in which I have pretty clearly acted upon an unworthy preference. In this view, the market is no more than a tool, a mechanism, not an anthropomorphized schoolmarmish tsk-tsk'er.

Here's where I think the problem resides, and neither of you quite gets to it. We can spend all day gauging the "ick" factor of countless hypos involving individuals A and B exchanging body parts or precious bodily fluids or newborns or you name it. The fact that surrogate mom B agreeing, free of coercion, to be compensated by wanna-be mom A can be viewed as a worthy transaction, despite our initial queasiness even considering it, fails to take account of the risks of abuse and, yes, corruption, of promoting a robust market of these transactions. There is no assurance that transactions between C and D, E and F, X and Y (or B and C, then B and D, then B and E...) will go right. This surely accounts for your own preference for focusing on regulation. But read charitably, Sandel is on to something about corruption, which is his vague, moralistic way of expressing fears about harms and indignities that markets have a tough time including in their calculations. In fact, his fear of corruption sounds a little like your disdain for his imposition of virtues, otherwise known as expressing an opinion.

"If your preference is widespread, Prasad, then why isn't there a market mechanism for preemptively silencing Sandel's kind of talk? A pool of contributors could pay The Atlantic not to publish the next Sandel column."

Right at the first line I'm lost. I don't understand which of my preferences in the post you have in mind, why I should consider it widespread, why the market ought to gratify only "widespread" preferences, why there would necessarily be a "mechanism" corresponding to a given preference, or why I or anyone else would want to "silence" Sandel. I entirely fail to understand the thought process behind such a question!

FWIW, I don't want to silence him, I just think he's wrong, as I tried to explain, and I want others to agree with me and disagree with him. Where is this "silencing" stuff coming from? I don't see anything I said that leads there. Quite to the contrary - I suspect Sandel is rather more interested in "public deliberation" based speech suppression of various sorts than I am.

Re amorality of markets, I suppose I'm looking at his last four paragraphs in the article, starting from "In hopes of avoiding sectarian strife." You point to "moral limits" and indeed he says "A debate about the moral limits of markets would enable us to decide, as a society, where markets serve the public good and where they do not belong." I took him to be saying that's a debate that isn't happening, and markets minus moral limits currently intrude into everything. I'm saying:
- the market intrusion *as it is* isn't amoral,
- that discussion about markets of a broadly liberal sort (focusing on fairness, harm and autonomy in terms of Haidt's moral foundations) sort happens aplenty and the rest (I think what's relevant here is purity and deference to authority), well, that's *exactly* where I want him not to win, so to speak. Hence my disagreements with his post.
- his particular examples of bad places for markets to be are bad. Most of them aren't specifically defended at all as it happens. Indeed I defy you to defend his view that carbon taxes are morally bad.

Anyway, I'm not gonna read tea leaves. If Sandel does think the market has ethical values, he might do a better job of articulating them and saying what's wrong with them, instead of bemoaning the *lack* of public moral discourse about markets.

Re risk of abuse harms and indignities, in surrogacy - I think this is quite a bit of tactical evasion on your part! Sandel's position is not that it should be prohibited altogether *because* well-regulated markets can't exist. He says there's something crass/crude/abominable/corrupt about the buying and selling of wombs, period. Sandel doesn't tell me *why* it's abominable besides that he thinks it is, still less does he weigh the ick-factor against welfare-enhancing considerations of the sort I mentioned.
FWIW, $8000 in India for a pregnancy is SEVEN times the per capita GDP as of 2011 (much more if you also take into account PPP considerations) so it seems like already many of the regulations I'd favor might be falling into place. I'm quite surprised things are that good in fact; maybe 8k is the total price paid, to doctors, middlemen and the woman. Don't know. If you have any sense about Sandel that he's willing to countenance even the American surrogacy market at 24k a pop, point me.

"his fear of corruption sounds a little like your disdain for his imposition of virtues, otherwise known as expressing an opinion"

Maybe some clarity can be found here. I read him as supporting the proscription of certain transactions based not on welfare or exploitation etc but because they demean the dignity of man. If he merely wants to persuade/shame women into not buying and selling wombs, more power to him.

I don't want nags like him deciding to impose his "virtues" upon me.

I may be a Dean, but I'm no Jonathan Swift. I was mocking how blithely we (not you and I, but that fungible mass of us out there) resort to market "solutions" to supply our demands.

I agree that he isn't articulating a position very well, but then he says as much, too. I guess I read him differently. Except for his vague reference to corruption--which he explicitly qualifies--I don't read much in the article about purity or deference to authority. You're leveraging semantic play to get from corruption to crassness and sin. When we talk about an "ick" factor, we're remarking upon the initial, visceral response we have to a circumstance. It's a symptom of any of a number of conditions: our invalid prejudices, our reasonable but illegitimate defenses, our moral dogma, but also our well-grounded intuitions.

I'm also not so sure that he isn't concerned about welfare or exploitation, for which dignity might serve as a kind of catch-all (but them maybe I'm playing fast and loose with semantics). He wants to "grapple more explicitly with competing notions of the good life." That doesn't sound to me like a basis for banishing everything he finds icky.

Yea, the satire was too subtle for me. I didn't understand the question at all.

Re. corruption and semantic play, maybe. The dignity/degradation as reason to stop people from doing what they want (and dignity-is-what-Sandel-says-it-is) stuff does seem to me to be solidly enmeshed in the text. I do agree he's not as much a repugnance-basher as a sancity-pusher, but in whichever form it's been central to his oeuvre going back at least to his Bush bioethics days. His community talk pretty much always devolves to dignity talk, and dignity talk then basically always involves keeping things as they are. On a range of technological, economic and cultural issues at the edges of public acceptability, you'll find Sandel making vague, portentous, sonorous pronouncements - invoking hubris, arrogance, humility and such - where the dignity jazz curiously enough always happens to support some amalgam of presentism, anti-autonomy and populism. He dislikes expansion of markets (as here), cost-benefit analysis, nuclear power, globalization, emissions trading, the recognition of experts and expertise. The bio-stuff is particularly predictable - body modification, suicide, genetic engineering to enhance abilities, doping or brain doping, lifespan extension, you name it, he has a hubris-objection to it. An Adam and Eve type, shall we say, not a Promethean. And a crowd-pleaser to boot. Gah. I think of him basically as a more suave, but essentially sanctity/piety/awe soaked counterpart of the repugnance/abhorrence obsessed Leon Kass. I've always found him a very easy thinker to dislike, as you can tell. Anyway, I'll re-read in a few days.

PS: I was googling to find the surrogacy prices currently, and it looks like the women themselves make ~5-7.5k, something like two-thirds of the total paid out. If so, this might be the next big thing after fair-trade coffee…women in the States get to agonize over whether to go to India for baby-making, and there's free (libre) cash transfer in the right direction, plenty of fodder for articles and discussion of the sort I like, everyone wins!

So it sounds like Sandel is what we call a public intellectual. That's enough to damn him in my book.

I don't have time now to get into this discussion. Just want to say that not everything is a commodity, and when things that aren't commodities are treated as such, their value can decline. See the Gift Relationship.

Louise, I'm not buying Titmuss's cross-national (blood quality in UK vs US) comparison per se, plus you have to consider quantity as well.
But I do remember a very interesting result of this type (maybe it's the same guy?) - when you give people a modest sum of money to donate blood, they donate slightly less than when they're just thanked. Instead give them a small 'token of appreciation' and they give slightly more.

I'll try to come back later in the week to discuss this, Prasad.

Meanwhile, listen to Marglin on how economics undermines community:

You might also like David Graeber's Debt: The First 5,000 Years.

Prasad, you and Dean remind me of Oscar Wilde: "A man who knows the price of everything and the value of nothing."

What about buying organ transplants?

If everything is for sale to the highest bidder, what happens to community? To people doing things for one another because they are friends and give one another gifts. Then life becomes a race to the empty top, king of the mountain winning all the good stuff, and the 99% left as the 99% are now.

I'm quite surprised that you and Dean see Sandel's arguments the way you do, as if he is a stodgy moralist.

Think of all the free software, such as Linux. I think this is the wave of the future, not a dystopian Ayn Rand world, where the market determines nearly everything.

Louise, I think Dean sees something valuable in Sandel's work that I don't, but he should elaborate etc.
For my part, yes, I think a regulated market in organ sales would be a - very - good thing. It'd save many, many lives while transferring money from the rich to the poor. As a more "pragmatic" point, it happens anyway; at least in a regulated market you can a) increase the size of the cash transfer through legal mechanisms b) monitor and ensure safety etc, you know, the sort of argument also available for legalizing drugs, or prostitution.

Or abortion, for that matter. Even some people mildly opposed to abortion come on board with legalization because you don't want these things happening in back-alleys.

Prasad, I think this approach just leaves every individual scrambling to make the most money, which seems to be what is wrong with societies now, especially if you judge from OWS.

I think inequality is a pretty important thing, but I guess I don't see how my views here tend to increase it. *Most* clearly with organ sales or surrogacy or paid drug trials I think - the rich are no more plentifully organ-endowed than anyone else, and at the very least, the proximate impact of transactions here is money going from rich to poor.
I'd have thought the more common secular reasoning in opposition would be some Kantian people-as-means stuff. Indeed, with my cynical hat on, it seems like a pretty common feature of things Sandel wants to keep from being monetized - bodies, sex, pollution trading, citizenship - is that nice bourgeois types have average initial endowments comparable to those of the poor.

Money going from a few rich to a few poor, unless the poor end up dead.

I don't think selling bodies, blood, organs or volunteering for drug trials is a good way to overcome poverty. And if you look at sex trafficking, it's not the sellers of sex who end up with money. Often people are kidnapped and kept as sex slaves, beaten and ill treated. Sometimes the captive sex workers are children.

What you have is wealth preying on desperately poor people, not helping them.

Louise, no of course it's not going to "overcome poverty."

Also, I think the 'predatory rich' storyline here is distorting moral intuitions considerably. it's hard for me psychologically to regard someone dying of organ failure as 'predatory' - no amount of money would induce me to swap places with him if it meant dying in six months - for wanting a kidney that he's willing to pay for. To me the organ sale scenario is morally cleaner, less clouded, than the surrogacy one. When I look at this situation, I see *TWO* unfortunate people, each of whom can be made better off by what the other has. Seems like the perfect situation to allow overseen exchange in.

No, it wouldn't overcome poverty, but a little would trickle down, right?

So the wealthy person with a failing kidney gets to go the head of the line. Why is that? Because everything is measured according to the value of money?

I hope you haven't been reading Ayn Rand.

If there were a nationalized tax funded organ service where the state paid people 50k for a kidney, and handed them out to dying people, I'd be quite fine with that. "Lines?" "Trickle down"? You're basically completely misdiagnosing my beef here; it's NOT about whether liberals or libertarians are right about economic policy. That's why I keep stipulating regulation and such. (And since a well-regulated market clearly isn't "enough" for you, I want to ask what further sacrosanct *liberal* principle you're safeguarding by protecting people against doing with their bodies as they please, to the tune of forbidding them from doing what seems best to them.) It's about pushing against numinous, airy talk about dignity, which is fine with keeping people worse off through meddling than they would be with even non-interference. I think Peter Singer would be just fine with the argument here.

Rand? That's just uncharitable. When i need my libertarian fix, I think there are plenty of smarter libertarians around than THAT. On organ donation specifically, you might find Virginia Postrel worth reading.

Have you ever seen a "well regulated" government market?

livingdonor.101 commentary on Postrel's article:

"Every study done in a country (pakistan, india, etc) with legal or illegal kidney sales has the same conclusion: the kidney donor/vendor suffers increased health problems, greater financial difficulties, and a reduced quality of life post-donation (years after). Offering incentives benefits the recipient, the surgeon, and the transplant industry - everyone EXCEPT the person relinquishing the organ. The living public deserves to be treated as more than walking organ incubators."

Golly, that sounds great, doesn't it?

"Have you ever seen a "well regulated" government market?"

Now who sounds like Ayn Rand :) But yea, I think markets, including in things much more susceptible to abuse, can be regulated effectively and well.

I guess he offers no citations so he's hard to argue with, but even so one claim (offering incentives benefits everyone except the donor) is incoherent, while another (that getting money causes "greater financial difficulties") is at least wildly implausible, in addition to establishing no more than a need for higher compensation. Also, such arguments would seem to weigh against organ *donation*, establishing the wrongness of making a person worse off to help another, while doing nothing to raise him above his previous indifference curve.

Maybe the well-regulated market in organs would work as well as it did in mortgage derivatives.

He offers this as his citation: "See for references to every statement made in this post."

I don't think the donor's financial straits is incoherent, especially if ill health sets in post-donation. What's more, if these statements are factual, why should the government help one citizen reduce his lifespan in order to extend the lifespan of another citizen? Because the one in need of a kidney is wealthy?


I think when it comes to markets and the nexus of exploitation, free exchange, welfare, regulation and taboo, I've put pretty much all my cards on the table. I think it would be helpful if you (if schematically) did the same, or at least presented a cohesive argument outlining the nature of your view.

As things are, you've implied variously, that:
1) Organ sales would increase inequality
2) That regulated and unregulated markets are essentially the same, and indeed, that governments cannot regulate markets.
3) That support for markets in organs has to emerge from a portion of libertarian thought that diverges from liberalism.

It seems to me all these positions (arranged in decreasing order of obviousness to me) are false, so I'd like to see some light on these points. Also, you could take on my positive arguments to you:
- that current laws reduce the welfare of *both* participants in a would-be transaction.
- disbelief that a government, or anything else, can fail entirely at regulation but succeed at instituting bans.
- Tell me why you think all the dangers of organ extraction (assuming you really think they're intrinsic to kidney removal and not to the unsafe, illegal/underground conditions they're currently performed under) shouldn't lead to their being banned (or at least strongly counseled against) for *donations* and not just sales, especially between people who aren't related. Why shouldn't Postrel have been strongly urged not to make a donation to save her friend? Shouldn't every would be donor have to watch a scary video explaining how his life is going to shit because of his goodness? How can the thing be good if and only if the person making the sacrifice, facing all that risk, gets nothing for his troubles?

There's not much point in just calling me a Randian and expecting me to see the light.

What would happen to one of the 45 or so million Americans who don't have health insurance? Would they qualify for a donated transplant? Or would being without insurance disqualify them for the surgery?

What would happen if the donor spent his 50k on prostitutes and ended up poor again, and in ill health?

What about quality of organs? Who assures that donated organs will be functional? Just buy and sell them the way people buy and sell commodities futures? Subject donors to tests before yanking a kidney?

I think the quality would go down and the donors would be worse off, maybe very sick, despite their initial cash bonus for their risk taking.

I also believe that putting a price on everything under the sun is a way to diminish the value of that which is offered. I know that you don't "buy" the polluted blood bank saga, but I do. Hepatitis, etc.

How about buying and selling children? Do you think that's OK?

Or how about intentionally having a deaf child? Or a star athlete? Should these traits also be for sale?

I will answer your questions as best as I can. Will you answer mine... :)

45 million uninsured -> this proves too much. It'd also apply to any number of procedures, medications or diets that are legal but which they can't pay for. Also, the way to fix insurance is to, well, fix insurance, not to see to it that such benefits as can't accrue to them in the current situation can apply to no-one.

Donors spending their 50k unwisely -> well, I don't want to taboo this thought, but it seems more fitting coming from Rush Limbaugh's mouth. Am I to take it you disapprove of all schemes to give the poor money excepting that they first prove themselves worthy?

Quality / functionality of organs -> I'm not sure I see why you think *THIS* problem of all is unfixable or even hard to fix, even in your world of absent/pointless regulation. Surely predatory rich dude has every reason to want his wicked money's worth from his wickedness?

Tests before donation -> in a Darwinian world with disease, not to mention simply tissue and blood compatibility, I can't imagine why, independent of pricing, anyone would want organ transplantation to happen without extensive medical tests.

Polluted blood -> I actually thought that earlier link about blood donation in the UK was very useful, despite the caveats I also raised. I believe cash payment in that case reduces donation, while repackaging money as presents or in-kind payment increases it. Such empirical matters fall under the purview of any cost-benefit analysis which one might want to see undertaken. It could easily be that the optimal pricing strategy for blood in UK is to give gifts while to increase it in India you should give ten kilograms of rice or clothes or immunizations (or money!)

Your second comment raises interesting questions, which however seem to me to have relatively little to do with money, or markets.
- Selling children as suicide bombers: I disapprove of suicide bombing, so much more so when the bomber's a child. I do so whether the child is paid, gets an honorarium, has life insurance etc or whether instead he does it from the goodness of his handler's heart. Ditto for camel racing, which actually happens a fair bit. I suppose there is an abstract question as to whether a person should be allowed to sell a child for *benign* purposes - say you sell a child to an infertile couple. Since I believe people own themselves (including children, parents before majority are for me trustees and guardians, not owners) no-one else should be allowed to sell them. I suppose there is a further, even more abstract, question as to whether sound adults ought to be allowed to sell themselves into servitude for a period of time in exchange for money. My first instinct is to say no (basically, I'm analytically continuing from the view that you can't buy someone to take on your guilt or prison sentence. I want to say you can't squander your own agency as a loophole for money, or for anything else. You're "stuck" with your rights in virtue of being a certain kind of entity, as it were) but it's not an issue I care much about, or a position I'm deeply wedded to. I think there are actually a few wonky philosophical debates on that question if you do find it interesting.

- There have been well publicized cases involving deafness and the deaf community, it's a very interesting issue. I would disapprove of a couple deliberately creating a deaf child or withholding treatment, but I don't find it as easy to condemn them as you seem to. I myself take for granted that Deaf culture is basically a coping mechanism, that if technology (like cochlear implants) can make the problem go away the culture has lost its long term raison d'etre. I am aware of analogies that community has raised to the gay community, and I suppose if I squint a certain way and try somewhat hard I can see where they're coming from.

- As it happens, yes, I dislike Sandel's views on biotech and human enhancement even more than his attitudes toward taboo markets, but it seems like a distraction, at least I see only the connection that both ping certain conservative taboos.

I was not saying the poor must prove themselves "worthy" of a cash benefit. I was referring to the Atlantic article that had this to say:

"Sharing a joint, the two men told me that they were paid $1,000 after their kidneys were taken, in 2006. Prakash said he had been lured by a man posing as a contractor who offered him a month-long painting job for $4 a day. He was put up in a high-rise apartment in nearby Gurgaon with other workers. The next day, he was taken for an ultra­sound and a blood test—and even though he found this puzzling, he went along for fear of losing the job. He was then tempted with more cash in exchange for his kidney. The surgery took place nine days later. With a sheepish grin, Prakash said he had spent all the money on alcohol and prostitutes."

I'd say that's a tough position to be in, especially if one is sick.

Do you think children should be allowed to sell themselves? Maybe upgrade to spiffier parents?

You also spoke of getting paid for being in clinical trials, ignoring the article I posted on how many people in India have ended up dead because of them.

Remarkably enough, sometimes it even happens in the States:

And yet we are supposed to believe that with selling organs, this sort of thing would not happen. Healthy organ donor, healthy transplantee. But like the case of purchased blood, things can go wrong. Might not be as smooth a sale as you envisage.

I think I've run out of steam on this thread. You believe that anything at all is subject to cost-benefit analysis and I don't. Give me ten pounds of love and I'll give you two cows. Life isn't like this, Prasad.

Further, I do like Sandel's views on biotech and human enhancement. So I think we have to agree to disagree.

Great post and discussion. I should probably have weighed in. But I am not at all sure that I would have contributed anything of substance. You see, before I launched A.B. I guest posted on a blog called Dissemination (2004 - 2005) that was the brain child of my daughter and some of her law school friends. Organ donation was a frequent subject on Dissemination. We had looked at it from almost every possible angle - morality, the dangers and the cost-benefit ratio. We couldn't come to any satisfactory conclusion. Some people favored reciprocal donations, others were for purely voluntary-social-responsibility approach and some supported a well regulated market.

I guess if we can mentally overcome the ghoulish-vulturish aspect of organ donation, we will be able to discuss the matter with greater clarity. For people like Louise (and me, to some extent) the fact that in a legalized organ market, the seller is almost always likely to be someone who is poorer than the recipient becomes an uncomfortable-making aspect of the trade. On the other hand, that kind of trade occurs all the time in other situations. Soldiers, miners, fire-fighters and others who do hazardous jobs for our benefit, are being paid to take risks which often end up in the loss of their limbs and sometimes their lives. That too is a trade of sorts but we try to make it fair by putting regulations in place.

I am providing some links here to the writings of Frank Pasquale, a law professor and blogger who writes thoughtfully on the ethics of health care and its business aspects. Pasquale is very liberal on most issues and quite suspicious of the "market." It is therefore notable that he reluctantly concludes that organ sales may be supported if proper safe-guards are put in place.

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