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Organ Markets

The NYT editorial board is concerned about the shortage of kidneys for transplants. As one might expect, the most obvious solution to the problem is automatically dismissed:

While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways to increase the supply without paying for human organs, which is prohibited by the 1984 National Organ Transplant Act and generally opposed by the World Health Organization.

Most of the NYT editorial focuses on technical issues (e.g., how to assure that organs are not wasted) but there is some limited attention to incentives. Some proposals are modest (e.g., covering the expenses incurred by live donors). But as the benefits increase (e.g., proposals for “a tax credit, college tuition, early access to Medicare or a contribution to a retirement fund”) the NYT’s enthusiasm disappears for a simple reason: these latter benefits “clearly have monetary value” which might induce the poor to sell organs.

I remain convinced that the best means of securing live organs for transplants would be the creation of markets. If two adults voluntarily consent a transaction (money for a live kidney—and a life is saved in the process—where is the harm? For extended development of the case for organ markets, see the citations at the end of this post.

Outside of live donations, one could get the incentives right by making organs for transplantation a club good available only to adults who have signed an organ donation card (and their minor dependents). Although such a system would work the best if universalized, one example of a group that has pushed forward more modestly on this front is LifeSharers (its advisory board includes Richard Epstein, David Henderson, and Alexander Tabarrock, among others; I am a member). Lifesharers members get priority access to organs from other members, in essence, jumping the cue that is filled with many who have never agreed to donate their organs.

Bottom line: in organ donations—as in so many areas of life—one can make remarkable progress if one gets the incentives right.

For a useful overview of the issue, see Alex Tabarrok, “Meat Market” (WSJ).

For an analysis of a functioning kidney market, see Nejamin E. Hippen “Organ Sales and Moral Travails” (Cato).

For an interesting analysis of the impact of monetary incentives, see Gary S. Becker and Julio Elias, “Introducing Incentives in the Market for Live and Cadaveric Organ Donations.”

 

International relations scholar William Ruger has a nice review of Barry Posen’s book Restraint in The American Conservative that is well worth checking out. Posen’s book is an attempt to sketch out a hard-nosed, moderately noninterventionist grand strategy for the United States. Excerpts:

Restraint, Posen’s alternative to liberal hegemony, is developed in the second chapter. He begins with a discussion of U.S. security interests—which include “sovereignty, safety, territorial integrity, and power position”—and then carefully considers potential threats and how to meet them. Primary among these would be “the rise of a continental hegemon” that upsets the “Eurasian” balance of power; nuclear weapons, especially in the hands of terrorists; and “terrorist organizations that have global ambitions.”

[...]

Posen proceeds to define what restraint would look like in the various regions. In Europe, he believes it is “past time to realize the dividends” of our Cold War victory. This means the U.S. can withdraw its forces, transfer NATO-related institutions to the European Union, and rework NATO itself—or even let it lapse.

His analysis identifies East Asia as the “most problematical region” in which to implement restraint, especially with China rising, and he believes that the U.S. has an interest in maintaining a regional balance of power. Yet Posen is not worried about China becoming as big a threat as the Soviets were, and he argues that a Cold War-style approach is unnecessary. Instead, the U.S. should “encourage its allies to assume more responsibility for their own defense,” while maintaining a security-assistance relationship with states like Japan.

In the Middle East, Posen argues that the U.S. should reduce its “salience” in the region in general and in the Israel-Palestine conflict in particular. This means going “offshore” while maintaining an absolute minimum land presence to keep the oil flowing and prevent any single state from dominating the region. It means the U.S. stays out of the region’s civil wars and focuses on naval power in the Gulf. In the case of Israel, Posen thinks the U.S. should “move deliberately” in reducing its subsidy of Israeli policies that are often not in our interests. To him, this means going back to the America’s pre-1967 Arab-Israeli War position, in which Israel received less military assistance and had to fund its own arms purchases.

[...]

Posen’s insight into the destabilizing effect of rapid change in international politics shows in his preference for a slow, deliberate transition away from liberal hegemony. But one might be concerned that the U.S.—with an open political system responsive to domestic interest groups—will not be able to stay the course. Given the realities of American politics, it may then be better to err on the side of speed in moving towards restraint. Either way, for restraint to succeed, it will take a serious commitment by a broad enough swath of the foreign-policy elite to see it through without backsliding. This is going to require educating a new generation of thinkers about the perils of liberal hegemony and the virtues of strategic restraint. The battle of ideas will be critical, and Restraint is a major salvo in that war.

On August 7, Robert Draper (New York Times) asked: “Has the ‘Libertarian Moment’ Finally Arrived?” One excerpt:

Libertarians, who long have relished their role as acerbic sideline critics of American political theater, now find themselves and their movement thrust into the middle of it. For decades their ideas have had serious backing financially (most prominently by the Koch brothers, one of whom, David H., ran as vice president on the 1980 Libertarian Party ticket), intellectually (by way of policy shops like the Cato Institute and C.E.I.) and in the media (through platforms like Reason and, as of last year, “The Independents”). But today, for perhaps the first time, the libertarian movement appears to have genuine political momentum on its side.

Draper quotes Senator Rand Paul as saying: “there was a time, maybe 30 years ago, when ‘libertarian’ was a term that scared people. Now I think it seems more like a moderate point of view. So I think the term is something that is definitely attracting, not repelling people.”

Unfortunately, if the term no longer scares people, it may be because they don’t understand the term or its implications.

Yesterday, Pew Research released a report “In Search of Libertarians.” Pew found that 14 percent of the respondents described themselves as “libertarian.” When asked (in a separate multiple choice question) to specify what was meant by “libertarian,” Pew concluded that only 11 percent of the population claimed to be libertarian and knew the definition of the word. In case you are wondering, Pew defined libertarian as “someone whose political views emphasize individual freedom by limiting the role of government.” While 57 percent identified this statement as libertarian, 20 percent identified it as “Progressive,” 7 percent as “Unitarian,” 6 percent as “Authoritarian” and 6 percent as “Communist.” It is hard to imagine that 12 percent of the population actually believes that communists or authoritarians want to reduce the role of government and emphasize individual freedom.

Alright, maybe only 11 percent claim to be libertarian and know what the term means. Maybe the “libertarian moment” is a small one. However, there is more bad news. On most policy issues, those who claim to be libertarian (and understand the term) were only modestly different than the public as a whole. Sometimes, these differences were not what one might expect. For example:

Libertarianism is generally associated with a less activist foreign policy, yet a greater share of self-described libertarians (43%) than the public (35%) think “it is best for the future of our country to be active in world affairs.”

I am not certain what to make of these results. Perhaps self-proclaimed libertarians have failed to reflect sufficiently on libertarianism’s policy implications (libertarianism, after all, is not simply reducible to being “cool” with gay marriage and legal weed). Perhaps some subset of “libertarians” are identifying as such to signal their distaste of the major parties. Whatever the answer, if the Pew results are correct, it seems unlikely that we are experiencing much of a libertarian moment.

As part of a new paper, I’ve been doing research on decentralization in Aceh, Indonesia. Bringing to a conclusion an approximately 20-year insurgency, the Free Aceh Movement (GAM) and Indonesian government came together in a spirit of comity following the devastating Indian Ocean Tsunami and signed a peace deal giving the region ample new autonomy. Or so the usual story goes.

Here’s the reality. GAM came to terms with the Indonesian government because a brutal military offensive, paired with the imposition of martial law, had reduced their numbers significantly. Still, giving up their dream of independence for Aceh was a bitter pill. In the end, they agreed to the Helsinki Memorandum of Understanding, which provided for the laying down of rebel weapons and new autonomy for Aceh.

That Memorandum of Understanding was never implemented in full. In particular, two provisions – the ability of Aceh to enact primary legislation without central government veto and the ability of Aceh to veto Indonesian treaties and other laws under certain circumstances, were not included in the final bill passed by the Indonesian legislature. In addition:

The Free Aceh Movement (GAM) and dozens of NGOs complain that the new law falls short of the autonomy provisions in the 2005 accord and allows considerable interference by the central government:

Central government powers: Article 11 stipulates that the central government sets the norms, standards and procedures and also monitors all affairs of the Aceh regional administration.

Control over natural resources: Aceh is to retain 70 percent of revenues from its natural resources. But Article 160 stipulates that the management of oil and gas resources in Aceh will be done jointly by the provincial administration and the central government. This is a departure from earlier pledges by Indonesian lawmakers that the Acehnese administration could manage its own resources.

Role of the Indonesian military: The peace accord stipulated that the Indonesian military would be stationed in Aceh only for national defense and would not participate in provincial affairs. But Article 193 of the law gives the army powers within the province.

Human rights: Perpetrators of human rights violations will likely escape justice. An ad-hoc tribunal (Article 215) will only hear cases that occur after its establishment, rather than having retroactive powers.

Aceh even lacks the ability to levy its own taxes, apart from a trivial “alms” tax for poor relief. Thus, Aceh’s autonomy is far less than that enjoyed by, say, Rhode Island. The only new autonomy Aceh received in the peace deal was the right to form local political parties. Otherwise, the main provision was to transfer significant hydrocarbon revenues to the province. With one hand, the Indonesian government double-crossed the former rebels and took away their ability to go their own way on economic policy, and with the other, they bought them off — but of course, that bribe comes with an implicit threat: behave or else we take it back.

How did the Indonesian government get away with the double-cross? Simple: Continue Reading »

George Will (Washington Post) has an interesting essay on “progressivism’s ratchet.” His “Cupcake Postulate” illustrates the dynamic: federal school lunch subsidies lead to regulation of food content,which justifies the regulation of competing foods from vending machines, and—finally—whether cupcakes sold at bake sales meet federal standards. Government authority spreads—“the cupcake-policing government” finds “unending excuses for flexing its muscles”– and soon we enter a world where officials exercise little discretion or forethought.

Swollen government has a shriveled brain: By printing and borrowing money, government avoids thinking about its proper scope and actual competence. So it smears mine-resistant armored vehicles and other military marvels across 435 congressional districts because it can.

For those interested in the connection between the regulation of school bake sales, police force militarization, and skepticism regarding foreign policy, Will has some worthwhile insights.

Charting Regulation

Much of the work I do is in the area of regulation. It is always a challenge to convey how much the regulatory state has grown (yes, I know, we can count the pages in the Federal Register). Two scholars as the Mercatus Center (Patrick McLaughlin and Omar Al-Ubaydli) have developed RegData, a wonderful tool for measuring the size and scope of the regulatory state. The updated version of the program (currently in beta) allows one to chart the growth in regulatory restrictions between 1997 and 2012. For example, here is the chart representing the growth of regulations on an economy wide basis:

regData-number-of_restrictions

One can also examine regulations on specific industries and compare industries. For example, here is a chart on the growth of restrictions in (1) Primary and Secondary Education and (2) Scientific Research and Development Services.

regData-growth-of_industry_regulation_(%_relative_to_1997)

As you will note, the charts do not include a legend—a flaw that I hope can be remedied. Here is a simple question on the above chart: which line represents education and which line represents scientific research and development? Hint: in one of these two sectors, the US a world leader. In the the other, it is a laggard. I wonder if we could move toward developing some testable hypotheses?

For a discussion of RegData 2.0, you can see a piece by Patrick McLaughlin at The Hill.

The War at Home

Images of warfare abound these days, from Syria, Gaza, northern Iraq…and Ferguson, MO. As Dylan Scott (TPM) notes, the images out of Ferguson have been “harrowing.” “American law enforcement decked out in military fatigues, patrolling the streets in armored vehicles that look like they were plucked out of Afghanistan or Iraq.” 

I have blogged in the past about the distribution of war surplus to domestic police forces via the Department of Defense’s 1033 program (here and here).  Unsurprisingly, Ferguson and St. Louis County have both benefited from the 1033 program. Although precise information is difficult to come by—the Pentagon only releases information on tactical equipment for counties—USA Today has a partial list for St. Louis County, which includes twelve 5.56 mm rifles, six .45 caliber pistols, night vision equipment, vehicles, a trailer, and a generator.

National Journal has some images of the police response in Ferguson, in a piece aptly titled: “What a Militarized Police Force Does to a City.” Terrence McCoy (Washington Post) has an article on the use of tear gas in Ferguson. As McCoy explains:

Despite its ubiquity across the globe and in United States, tear gas is a chemical agent banned in warfare per the Chemical Weapons Convention of 1993, which set forth agreements signed by nearly every nation in the world — including the United States. The catch, however, is that while it’s illegal in war, it’s legal in domestic riot control.

Sven-Eric Jordt, Yale School of Medicine, is quoted as saying: “Tear gas under the Geneva Convention is characterized as a chemical warfare agent, and so it is precluded for use in warfare, but it is used very frequently against civilians. That’s very illogical.”

It is also illogical to provide police forces with military grade equipment based on the urgency of the war on drugs or the war on terror. As recent stories reveal (recounted in a fine piece by Radley Balko, WSJ), SWAT teams and the technology they have been provided through 1033 and Homeland Security grants have been used judiciously to break up illegal poker games at VFW halls, to stop underage drinking in a New Haven bar, and to apprehend Tibetan monks whose visas had expired in Iowa.

Balko concludes: “What would it take to dial back such excessive police measures? The obvious place to start would be ending the federal grants that encourage police forces to acquire gear that is more appropriate for the battlefield. Beyond that, it is crucial to change the culture of militarization in American law enforcement.”

Until that occurs, one fears, the war at home will continue.

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