Virginia Postrel on Stasis vs. Dynamism
2014-12-20 · Guest: Virginia Postrel (Author and Columnist) · 52:42
Lethal consequences of the federal organ donor compensation ban
Bob Zadek and Virginia Postrel discuss the lethal consequences of the 1984 federal ban on compensating organ donors. They explore the economic benefits of a kidney market, debunk medical myths, and highlight the work of the American Living Organ Donor Fund in supporting donors’ out-of-pocket expenses.
Topics: Organ Donation, National Organ Transplant Act, Kidney Shortage, Medical Ethics, Dialysis, Libertarianism, Bodily Autonomy, American Living Organ Donor Fund
Speakers:
- Bob Zadek - Host
- Virginia Postrel - Author and Columnist
- Mike Mitchelman - American Living Organ Donor Fund
Introduction: A Lethal Federal Statute [00:00]
Bob Zadek: Hello everyone, welcome to the Bob Zadek Show every Sunday at 9:00 AM. I am your eponymous host, Bob Zadek. Thanks so much for listening. We are the only live libertarian talk radio show on the air all weekend. The show of ideas, not attitude. 800-345-5639 to join the conversation at any time. Nice to be back from a short vacation.
Today’s guest is Virginia Postrel, and this is a real treat. Usually, when one is interested in a topic, you look around for a book or a blog or an article that will give you information on the topic. So your search for reading material is topic-specific because you want information about a topic. Every once in a while, however, there comes to us a writer where I find myself searching not for information on a particular topic, but for any information explained to me by a particular writer because that writer is so good and so smart and so informative. Virginia Postrel is just such a writer. When I have my reading time, I don’t look for a topic; I look for Postrel. And whatever she’s writing, I know I’m going to find interesting. And you will share the same opinion today when Virginia and I discuss a topic which not many people know about, but everybody should.
We have a federal statute that kills as many as 15,000 or 20,000 Americans every year. A federal statute that was thoughtlessly put on the books a while ago for the wrong reason, and that statute is killing Americans. What statute is this? What is the topic? You’ll learn about it with my conversation with Virginia. Virginia, thanks so much for joining the show this morning.
Virginia Postrel: Great to be with you.
The National Organ Transplant Act of 1984 [01:20]
Bob Zadek: Now, Virginia, I opened the show with a reference to a federal statute that directly kills Americans, and there is no reason for those Americans to die, as our listeners will learn about this morning. What is the statute, and how did you become interested in this statute?
Virginia Postrel: Okay, well, the statute is the 1984 law that makes it a federal crime to give “valuable consideration” in exchange for an organ—a kidney being the most relevant one. And this was a law, actually sponsored by Al Gore as it happened, that was passed in the midst of a kind of these kinds of moral panics that, you know, somebody does something that becomes controversial, “Oh, we have to pass a law.” People don’t think it through, and you get this law on the books.
What happened was back in 1984, there was a guy who said, “Hey, I’m going to bring over poor people from Pakistan, I’m going to pay them a pittance, get their kidneys, and sell them to the highest bidder.” And people said, “Oh my God, that’s horrible. We can’t have that. Let’s pass a law prohibiting valuable consideration.” So they did. And it was not controversial.
Bob Zadek: Why is there a market? Why is there a demand for kidneys? He wasn’t going to just create the demand or create the market. So what made him come up with this idea?
Virginia Postrel: Well, first of all, I am not entirely convinced that the way he was going to do it, there was much of a market for reasons I’ll explain in a minute. But to answer the question that you’re asking: why might there be a market for kidneys? Kidney failure is a growing problem. And for many people—not every person, but for maybe a third of the people whose kidneys fail—a transplant could essentially cure them, at least for a decade or two. They’d have to have immunosuppressant drugs, but it’s a miracle of modern medicine, as they say. And transplants have gotten much easier and safer also since 1984.
The way I got involved was in 2006, I gave a kidney to a friend, so I know what’s involved. And there are at this point—when I did that back in 2006, there were 66,000 Americans waiting on the official kidney waiting list. And now, almost nine years later, there’s nearly 102,000 people officially waiting for kidneys.
The Economics of Dialysis vs. Transplant [02:54]
Bob Zadek: And these people who are waiting for kidneys, if they don’t get a kidney, or during the waiting period, they are often on dialysis, which keeps them alive, but it’s not a very pleasant regime. And if they don’t get a kidney, they will die.
Virginia Postrel: Eventually they will, generally from kidney failure. I mean, dialysis does keep people alive. It’s grueling. People get sicker the longer they’re on dialysis. And it means that, you know, there are different ways of doing it, but typically three days a week they have to go to a center, they get hooked up to a machine for a length of time that cleans out all the things that their kidneys would ordinarily clean out of their system. And this makes it hard to hold a job, it makes it hard to take care of kids, go to school, all the normal functions of life.
And by the way, there is a federal entitlement. This is the one medical procedure where Medicare pays for everybody. And so this is also a taxpayer issue. By keeping people from getting the kidney transplant—kidney transplant is expensive, but it’s cheaper than dialysis.
Bob Zadek: Much cheaper. Much, much cheaper.
Virginia Postrel: Much cheaper. Even when you throw in the need for immunosuppressant drugs, which are not cheap, going forward and stuff, the taxpayers net save about 100 grand every time somebody gets a kidney transplant. So it’s a big deal. There’s a lot of human suffering involved. There’s a lot of potential economic benefit involved in terms of people being able to work, support themselves, contribute to the economy, take care of their kids, all of these things. And there’s federal dollars involved. So there are a lot of aspects here. And by having this prohibition on valuable consideration, it means that everybody involved in a kidney transplant gets paid except the person that the kidney is coming from.
Bob Zadek: And just to help the audience understand, the federal statute of course allows you—anybody can donate a kidney. Virginia did. So you can give away a life-saving part of your body. And when you give it away, the doctor who removes your kidney makes money, the hospital makes money, the company which transports the kidney makes money, the doctor who implants the kidney in the person who needs it makes money, that hospital makes money. Everybody makes money except the person who started the process. And you are allowed to give away a kidney; you just can’t sell it.
The Libertarian Argument and Medical Realities [04:30]
Bob Zadek: And so the libertarian issue is: should society prohibit a consenting adult—remember, we are assuming informed consent, we’re not assuming somebody is exploited, we’re assuming informed consent, middle-class America, Virginia Postrel—should people go to jail for selling a body part that they do not need? Is that sound policy?
Virginia Postrel: And by the way, okay, let me put a couple of things. First of all, you did say a body part they do not need, and that’s important. I mean, one of the things that people don’t understand about kidney transplants is we treat giving somebody a kidney as if it’s like giving somebody your right arm. It’s major surgery. It has risks. But you know, most of the risks are the risks of anesthesia because, first of all, they give you a tremendous workup before they’re going to take your kidney. I mean, they want to make sure that you’re very healthy, you’re going to be, you know, this is going to work for the person you’re giving to, and also it’s not going to have a bad effect on your health.
And then the other thing is, once you only have one kidney, then the other one takes up the slack. It grows, it takes up the slack of doing the work. And the other thing that people don’t understand, they say, “Well, but I need two kidneys because what if one fails and the other one will take care of it?” Well, the truth is that when kidneys fail, they fail together. You don’t have one kidney fail and the other one takes up the slack. When they fail, they fail together. The only issue is if there were trauma or maybe cancer, and those are the cases where having the backup kidney helps. So that’s an issue.
And the other thing is, you sort of hinted at something. You know, we have these sort of urban myths about somebody wakes up in the bathtub and they’re missing a kidney. I mean, a kidney transplant is an incredibly complicated procedure. There’s a whole bunch of people. It’s actually very impressively organized in hospitals. They’ll have somebody called a transplant coordinator who coordinates all the different pieces of, you know, the two different surgeons, different anesthesia teams, the psychologist or social worker who does the interview with the donor, all of the different tests you have to have. All of these things go on. You can’t just show up at a hospital with a kidney in a cooler and say, “Put this in me.” It’s a very complicated procedure.
So what I would like to see is a state of the world in which hospitals, transplant centers, screened potential kidney—let’s call them vendors—who would be, you know, compensated for it. And it was just part of the system. In other words, it wasn’t like John Doe needs a kidney transplant, he brings a briefcase of cash to somebody in a dark alley. It’s just part of the system so that you would have people who are screened for their mental and physical health and it would just be compensated in the same way everything else is compensated through insurance.
However, we are a long, long way from that sort of situation. And since—and I was like you in the sense I was libertarian, I had this sort of theoretical idea, you know, you should control your body, you should have the right to sell your organs. I believed that if you asked me, but I did not care. I did not care about it. It was a philosophical point of view. Once I got into the system because my friend Sally Satel needed a kidney, and I saw the tremendous amount of human suffering that’s going on needlessly, and also the tremendous amount of misinformation and misunderstanding on the part of the general public about what is involved today in the United States in giving a kidney.
People think of it, first of all, the way it once was, which they used to have to like crack open your ribs and take—it was a huge deal. Whereas now they do laparoscopic surgery using a tiny little camera, and you end up with a scar a couple inches, not even a couple inches long. I mean, just big enough to get the kidney out. And it takes—if you don’t have a job that involves heavy lifting, you can be back at work in a week or two. It’s not the trauma that it once was.
So you’ve got this tremendous growing number of people who are living on dialysis, not able to live as fully as they would like. It’s tremendously expensive and the number is growing, partly because it’s highly related to diabetes among other things, and that’s growing. And also as people get older, it becomes more of a risk. And so we’ve got—I won’t say it’s no big deal because it’s a huge deal for the recipient, but it’s not as big a deal as people think for the donor. We’ve got this need and we’ve got no compensation allowed.
The Objections: Exploitation and the “Ick Factor” [08:20]
Bob Zadek: And what’s really important for our audience and our friends out there to understand is that this is an issue where both sides—the donor or the seller on the one hand, and the buyer or the recipient on the other—both are adversely affected by this thoughtless federal statute. And libertarians tend to focus, or it’s fair to say that the libertarian issue is not so much on the buyer, the one whose life is being saved, although that is profoundly important ethically, but if you simply focus on the seller: what’s wrong with somebody having dominion over their own body and for whatever reason making an informed decision to sell an organ? And even worse, to show the utter idiocy of this federal statute, you can’t even have your parts sold upon your death. So you’re not allowed to have your body, instead of it being cremated or buried, you’re not allowed to upon your death create an estate for your family. And think if you’re a less wealthy or a poorer person, this may be a substantial portion of your estate. You are not allowed to put your organs into the marketplace, even though you will give sight and better health, whatever organ you give, to somebody else and enhance your family members or whoever in the process. The statute cannot be defended, although there are a lot of opponents who oppose the sale of body parts.
Now, Virginia, there is a lot of opposition to the sale of body parts, either from a living person or upon death. Who is opposed to it? It seems such a sound position to take. Who’s opposed to it?
Virginia Postrel: Well, I’d say that there are sort of two very distinct objections, which are often pushed together by the same people. The more persuasive or more sympathetic one is people who are afraid of exploitation. And this is how this law got on the books in the first place. They’re afraid that somehow people are going to be—poor people, usually—are going to be taken advantage of for the benefit of rich people.
Okay, the first thing that you have to understand is, and again, I’m talking about kidneys because that’s what I know and that’s where the biggest need is. People who need kidneys are poor people. They are poor, they are wildly disproportionately black and Latino. A third of the people who are on the waiting list are black. They tend to be lower income to begin with, but the other thing is when you’re on dialysis and you can’t work, surprise, you’re poor because you can’t earn a lot of money. So there’s that.
And if that is your only objection, I can come up with tons and tons of ways—it may not be the ideal utopian or my first choice—but I can come up with a lot of ways to make sure that the only people who sell kidneys are rich people and the only people who buy them are poor people. You know, we can have—because as I say, Medicare’s losing a lot of money. So we can have them say, you know, give a kidney, you get a tax holiday, and then everybody who just cashed in in Silicon Valley and doesn’t want to pay income tax that year can give a kidney and get off. I mean, no one would ever do that, it would be too expensive for the federal government. But you know, we can come up with lots of ways using tax incentives where higher income people were the people giving kidneys.
Secondly, and sort of getting related to that, is if you look at who would be most likely, given the medical qualification requirements, you’re probably talking about young, healthy, likely upwardly mobile in the sense that they may not have big incomes now but their lifetime incomes are pretty good, people not unlike the kind of people who sell eggs. People sell eggs, young college women sell their eggs, they make money, and it’s perfectly legal. And you know, if you’re—in my more cynical days, I say if kidney patients, you know, were affluent professional white and Asian lawyers like the people who buy eggs, we would have a market in kidneys tomorrow. I mean, this is me being more cynical.
So that’s one thing, is this exploitation. The other factor, which is actually a factor that affects a lot of people who are in transplant surgeons who are good people, care about their patients, but you’re somewhere—there’s just a kind of sense that it sort of violates people’s philosophical norms about bodily integrity or something. I mean, it boils down to sort of an “ick factor.” And I can’t argue with that. If you have an ick factor and, you know, I’m probably not going to convince you if you really think that your sort of sense of morality or your sense of disgust or something says, you know, tens of thousands of people should suffer and die to make you happy. I mean, I can’t really give you an argument. I can solve problems of these sort of more egalitarian arguments. We can develop policies that get around those. But if you just think it’s gross for somebody to sell a kidney, well, all I can say is it’s not clear to me why they should be able to do the same thing for free. That your real argument is an argument against transplants when it boils down to it; it’s not about the money.
Incremental Progress and the American Living Organ Donor Fund [13:40]
Bob Zadek: Virginia, we have one minute to go before we go to break for 60 seconds. I just want to remind the audience, this is Bob Zadek. I’m talking with Virginia Postrel. We are asking and answering the question: should Americans, should anybody, citizens of the world, but Americans specifically, be allowed to sell parts of their body, specifically their kidneys, but also bone marrow and blood? 800-345-5639 if you have a point of view you’d like to share. We’re going to take a very short 60-second break. We’ll be back with Virginia Postrel in 60 seconds. Please stay tuned.
[Break]
Bob Zadek: Welcome back to the Bob Zadek Show every Sunday at 9:00 AM. I’m your host, Bob Zadek. 800-345-5639 to join my conversation with Virginia Postrel. We are wondering why Americans should be prohibited under pain of incarceration from making an informed decision to sell parts of their body, specifically their kidneys. There is a profound shortage of kidneys and other body parts in the world and in the United States. Relying upon donors, upon the generosity of Americans, simply doesn’t work. It doesn’t provide sufficient supply, and people waiting for kidneys are dying. And obviously, I say obviously if you have any faith in the marketplace at all, obviously if people are allowed to sell their kidneys either while they are alive or upon their death, that will for sure increase the supply, it will save American lives, and it will along the way reduce the medical cost to society because those who cannot get kidneys are relegated to relying upon dialysis, and the cost of acquiring a kidney in the marketplace and of removing it and placing it in somebody to save their life, that cost is much less than the cost of dialysis. So the recipient benefits by being given a pretty much a normal life, the seller benefits by getting money, society benefits by saving tax dollars, and yet the whole process is prohibited. It’s criminalized; you can’t do it.
Virginia was explaining to us before the break who the opposition is. Some people just have a moral opposition to it. I should also point out, Pope John Paul II once wrote that buying and selling organs violates “the dignity of the human person.” While obviously we can’t debate religious opinions, but that gives you some sense of where the opposition lies. Also, many medical associations are opposed to the sale of body parts. One medical association found it “morally and ethically irresponsible and also inhumane and unacceptable.” Hard to rebut an argument like “unacceptable,” but there you have it. So Virginia, the marketplace would certainly, we believe, increase the supply, would it not, if there was a market, an economic marketplace for kidneys?
Virginia Postrel: Well, yes, I think that’s true. But I want to say, you know, it’s all well and good for libertarians who, you know, believe these things to sit and say, well, my philosophy tells me this is the right solution. But as I said before I got involved in this, you know, I would have said yes, but I didn’t really care because it was a philosophical standpoint. Now I’ve seen, you know, what’s involved in the process and the tremendous need, and I am very concerned in making incremental progress today. In other words, there are 102,000 Americans waiting for kidneys today. I don’t want to wait till we get to libertarian utopia to help those people.
So there’s a number of things that people who care about this have been working toward. One is my friend Sally Satel that I gave the kidney to is very active. She works at the American Enterprise Institute in Washington. She’s a physician originally, she’s a practicing psychiatrist, she still practices a little bit, but mostly she writes books and is a scholar on various health-related issues—not like how do you pay for healthcare, it’s not like Obamacare kind of things, but issues around the way we think about brains and psychiatry and courts and also around organ transplants.
Anyway, so she has been working on the idea of, okay, we believe that this would help, but let’s try some pilot projects. Let’s allow a little experimentation with various forms of incentives that don’t necessarily involve direct payment, an exchange of, you know, cash. Let’s say you could, for living donors, it could be something like a contribution to a retirement plan, or you get health insurance, or you get a college scholarship. Or for in the case of deceased donors, there’s been a lot of—I mean, the state of Pennsylvania wanted to do this some years ago and ran into the federal law—let’s have something that will provide some contribution toward funeral expenses. And let’s see what happens.
Bob Zadek: But all of that, that’s consideration of course, and that would be against the law right now.
Virginia Postrel: That’s right. Exactly. Pennsylvania wanted to do this through a tax credit, I believe it was, and they couldn’t get the federal government to say it would be okay, even though that’s not what people were picturing when they passed this law. But the law is very sweeping. As I often say, you know, you can get paid for blood. That’s not included in this law. But not only can you get paid for blood, even when you donate blood—I live near UCLA, I see, you know, give blood, blood drive, and you get movie tickets and you get cookies. And those things would be illegal for—well, not the cookies maybe, but the movie tickets, you know, the $25 worth of movie tickets they give you for donating blood, that would be illegal if you gave a kidney. So that’s ridiculous. So one constructive approach now is to try to think about could we get some federal waivers of some sort to do some experiments, some trial programs, see what happened. Sky doesn’t fall, you know, let’s see what the disaster is.
The other thing, which is what actually brought me to your show, is a project that works within what is already legal. And I know Sigrid Fry-Revere, you had her on your show one time talking about her book on kidneys in Iran, but she’s now started something called the American Living Organ Donor Fund. It turns out under the law, I cannot give you money for an organ, but it’s perfectly legal for me to pay for your lost wages, pay for certainly for your medical costs. Those tend to be covered. I mean, when I did the donor, when I gave the kidney to Sally, the transplant coordinator said, “You should never see a bill,” and I never did. I mean, everything was covered as part of the transplant expense for all the hospital bills were paid.
But the kind of people who are on dialysis, they tend to be a little lower income. Their friends and families tend to be getting paid by the hour. What happens if they have to take off, you know, two weeks from work? They can’t afford that. Somebody might really want to give a kidney to her sister or her mother, her friend, but can’t afford it. Not because she’s not getting cash money for it, but because she’s having to basically spend money to give a kidney. So what Sigrid has done is she’s started a fund, a private fund, to try to cover some of these out-of-pocket expenses and lost wages that are legal to cover, but that are not covered now in the system, in part because of the sort of ripple effects of the federal law. So she’s got this campaign going on charitable.org, “Save 30 Lives in 30 Days.” So it’s charitable.org/save30livesin30days, where people can give money—it’s tax-deductible—toward helping these sorts of transplants to happen where there is somebody who has stepped up and said, “I’m willing to take the physical risk, I’m willing to do this, I want to help, but I can’t afford the out-of-pocket expense.” And this is something, again, an incremental step that can help within the law.
And I think over time, if this caught on, I think it would help to change people’s minds. And also, I mean, from my experience of going through the process, I came to the conclusion that more than any of, you know, what the Pope says or whatever somebody thinks is worried about rich people and poor people and exploitation, the biggest thing that people don’t understand is that giving a kidney is a thing that a normal, sane person can do. And that it’s, you know, they don’t understand that it has risks but they’re not absurd risks.
Bob Zadek: But even if it has risks…
Virginia Postrel: Well, no, but this is very important because most people are not convinced by your pristine libertarian formula. They think it’s an inconceivable thing to give somebody a kidney. So then they think only a crazy—this is what I ran into when I said to people I was going to give my friend a kidney. They didn’t say, “Oh, that’s great.” They acted like I was an insane person. And I’m talking about my parents, you know, “Oh, do you really have to?” And as long as people think that it’s an inconceivable thing to give somebody who is not, you know, your very closest relative a kidney, to give it, then when we say, well, you ought to be able to get paid to do this, they think, “Oh, it must be somehow coercive because only a crazy person would do that.” So if I’m giving you money, I’m somehow messing with your mind in a dangerous way because they don’t understand that giving people a kidney, being a kidney donor—or in this case, being a kidney vendor—is not a crazy risk. I mean, yes, it is risky, but we don’t say, “Oh, all firefighters should be volunteer firefighters” because we do have a tradition of that, and it’s risky and we wouldn’t want to induce somebody to become a firefighter for money. Well, this is a very similar thing.
Bob Zadek: That’s a great analogy.
Virginia Postrel: You know, as long as people think that it’s an inconceivable thing to do for free, they’re really going to think it’s an inconceivable thing to do for money. So the thing that I took away from my experience as being a kidney donor is that people make too big a deal of being a kidney donor. And we need to first normalize the idea of living donation, and only then are we really going to be able to move toward a system where people can be compensated and we can whittle away at this giant waiting list.
Mike Mitchelman and the American Living Organ Donor Fund [17:31]
Bob Zadek: Virginia, we have a great caller. We have Mike Mitchelman on the phone. He’s with the American Living Organ Donor Fund. And Mike, welcome to the show this morning. Thanks so much for calling in.
Mike Mitchelman: Yeah, thanks for having me on. Hi, good to talk to you, Virginia.
Bob Zadek: Sure, Mike. What’s your point of view this morning on the topic of whether individuals should be legally permitted to sell kidneys either while they are alive or upon their death?
Mike Mitchelman: Right, right. You know, we at the American Living Organ Donor Fund—and Virginia made a great shout-out to the campaign we’re running right now on charitable.org—it’s less about selling your kidney. I’m a three-time transplant recipient, I should put that out there for your listeners, and both two of which have come from cadaveric, one of which a living donor gave to me. And we think it’s less about someone being compensated versus actually doing something and not going into debt for what they’re about to do, right? So most people that we’re talking about are actually about to give an organ to somebody, but they may be ruled out for financial reasons by centers looking for sort of underlying reasons for them not to be allowed to be a donor. So I think the issue is way more complicated than sort of, you know, is this payment or not payment for an organ. You know, and I think Virginia made some really good remarks on it. So we’re not necessarily saying, “Hey, you know, you pay someone $50,000 for a kidney.” You’re talking here about people already wanting to try and be a donor, right?
Virginia Postrel: Yeah, this is really important. And I think it’s really important to say the system we have now, even though it’s perfectly legal to compensate people for their out-of-pocket expenses and their lost wages, the system we have now, the way it’s worked out, it tends to say, you know, you’re going to not only you’re going to lose money giving a kidney. And that discourages people from doing it, either because they just can’t afford it or because, as you say, the centers sometimes will say, “Well, we’re not going to let you do it.” And I think that, you know, I am about actually making progress. I am not about making philosophical points here. It’s all well and good to make the philosophical points, but I want to help people get kidneys. And I think what the American Living Organ Donor Fund is doing within the existing system is really great. I think that people should not—we need to help people be able to—if we’re all for this altruism, we should back it up. And the more people who can become living donors and the more the word can get out that this is something that normal people do, the better. And I think that that—I really want to back this idea of people—another thing, you know, Bob, talk about the libertarian thing, libertarians want to say, well, I want private charity. Well, this is a good example. Help give to this cause and you’ll not only be helping people like you would with any private charity, but you’ll also be ultimately saving the taxpayer money because when somebody gets off dialysis, that saves tax dollars. So if you’re concerned about that, this is a really effective way of helping out.
Bob Zadek: Mike, just give our listeners once again your website and how they can get more information.
Mike Mitchelman: Sure, sure. Our website, the main website is helplivingdonorssavelives.org or alodf.org. But the more pressing one to look at at the moment, our crowdfunding campaign is charitable.org/save30livesin30days. And if you want, just Google “Save 30 Lives in 30 Days” and it will come up right there for you. It’s easy enough to make a donation, share it with your friends, tell everybody you’re donating and helping people. Bob, I’d like to say we’ve actually—we’re actually writing our first two checks to donors. And these are actually people that are about to undergo the surgical surgery with their donor—with them being a donor and with their recipient. And they’ve already been approved, they’re already about to do the surgery, and we’re helping them with lost wages that they wouldn’t otherwise receive so that they can afford to pay their rent for the six to eight weeks or the three to four weeks that they have to be out of work. And I don’t know if you mentioned this earlier, Virginia, but bone marrow is already doing this. So there’s an organization and a lot of states and private companies now, if you’re chosen to be a bone marrow donor, you will get four weeks paid time off. Check out bethematch.org.
Bob Zadek: It’s interesting you mention bone marrow because the Institute for Justice, one of my very favorite libertarian public interest law firms, has been very effective in allowing people to be compensated for the sale of bone marrow. And bone marrow is really interesting because bone marrow, like blood, the body replenishes it. So to prohibit the sale of bone marrow, which again is life-saving—the statute prohibits the sale of bone marrow even though bone marrow can be replaced like blood. So the statute again causes unnecessary death.
Virginia Postrel: Well, they were able to challenge that statute, the IJ was.
Bob Zadek: Exactly.
Virginia Postrel: Based on the idea that bone marrow was not the same and that also the procedure involved today in donating bone marrow is much less intrusive than it used to be.
Bob Zadek: But it took litigation by a very effective public interest libertarian law firm. It took litigation to bring the federal government to their senses and not criminalize behavior that saves lives. That’s the point.
Mike Mitchelman: Exactly, that’s the point. We want to help people save lives. And you know what, they shouldn’t have to be burdened by all kinds of other things. I think that the first time one of these lawmakers actually needs somebody else’s help, then they’ll think differently about the issue.
Bob Zadek: Mike, thanks so much for joining the conversation this morning, Mike, and good luck with your fund.
Mike Mitchelman: Thank you. Thanks for having me on, Bob.
The Black Market and Bodily Autonomy [18:50]
Bob Zadek: You know, Virginia, you mentioned earlier that part of the opposition to the issue of selling kidneys is the fear of exploitation. That of course is such a, in my opinion, non-issue because people who need money more than others are always doing the most dangerous, unpleasant jobs imaginable. Who else would do it? So we countenance exploitation, although that’s not the right word, we countenance that in many areas of society, but for some irrational, insane reason, the federal government has decided to criminalize this single aspect, criminalize in a way that is a death sentence, as you have pointed out, for so many other Americans. The statute itself is in my opinion on moral grounds, on ethical grounds, and on philosophical libertarian grounds, it is utterly, utterly indefensible.
Virginia Postrel: Well, the original, as I said earlier, the original statute was passed in this sort of moral panic moment, and that’s never a good way to pass a law. And people, I mean, I will say that I think the legislators who passed it were picturing a kind of transaction where the donor was not well-informed. And again, once you’ve been inside the transplant system and you see all the moving parts and the tremendous amount of care and coordination that’s required, the idea that somebody would not be well-informed about their risks or that they would—or even the idea that it is exceptionally risky—is not credible.
The other thing is we haven’t talked about the black market. There is, as a result of this law, it’s not like nobody’s—no poor person in a third-world country is ever selling their kidney to some rich American. It’s just that it’s going through a broker and it’s taking place overseas and there’s complications and the broker’s making most of the money, the person who’s giving the kidney is making a pittance. And so what we’ve done, it’s not a huge black market, but there is a significant black market internationally. The part that involves Americans is some of the smaller part of it, but as is always the case when you have a black market, the kinds of people who are getting rich off of it are unsavory characters.
Bob Zadek: You know, a lot of the language you just used in talking about the black market was the same language was used pre-Roe v. Wade in the conversation about abortion. A woman’s body is her own property, she can do with it as she wishes, government stay out of my uterus. That whole movement of keeping people’s decisions about their body private, which is now constitutionally protected, you could take the same argumentative template and apply it to this issue. It’s the same issue.
Virginia Postrel: And it’s much less problematic. And again, as I mentioned, partly because of that legal and sort of attitudinal results of Roe v. Wade and the pro-choice movement and all of that, we in this country have very strong protections for people, for example, who want to sell eggs. The whole reproductive freedom is applied to comparable things. Other countries you can’t sell eggs. Well, why can you sell eggs but not kidneys? You don’t—you have a finite number of eggs. They don’t regenerate. And it’s not a trivial thing selling eggs. You have to take all these hormones and it has some risks. I mean, I had a relative who tried to do it many, many years ago and ended up in the hospital. It’s not a trivial thing, but we allow it because we think it’s important that the woman who’s selling eggs has the decision over her own body and also because people who want to have children and want to have children often at later ages tend to be affluent and influential and be able—if somebody suddenly said that you can’t hire an egg donor or a surrogate mother, there’d be this huge outcry about reproductive freedom. Well, reproductive freedom is a good thing, but why is that the only organ that matters?
Conclusion: The Power of Glamour [20:30]
Bob Zadek: Virginia, we have only a couple of minutes left, and I want to do a great service to our listeners out there. You’ve just written The Power of Glamour. Tell us about that book. We have about a minute and a half left.
Virginia Postrel: So The Power of Glamour decodes and explains what glamour is and why it is much more pervasive and persuasive than you think. It talks about glamour in the traditional old movie sense and fashion and that sort of thing, but it also talks about things like the glamour of technology or the glamour of the future or the glamour of modernity, the glamour of travel, glamour of innovation, and even something that would be of particular interest to libertarians: the glamour of planning. What was this idea in the early 20th century that made people so drawn to the idea of a central plan? And I look at how that related to a lot of other types of glamour. So it’s trying to understand a very pervasive and very powerful form of what I call visual persuasion or visual rhetoric, which is not so much rhetoric that uses words, but uses images. They may be word pictures, but makes us have that feeling of “if only,” “if only life could be like that,” “if only I could be there.” How does that work? And so what The Power of Glamour does is explain what glamour is, what are the elements in all sorts of glamour, and then how throughout history it has been influential.
Bob Zadek: Virginia, thank you so much for sharing an hour of your valuable weekend time with myself and my audience. We certainly appreciate it. Good luck with the book. The book is called The Power of Glamour. The author is Virginia Postrel. It is a must-read. Thanks so much for listening. I’ll be back next Sunday for another hour of libertarian thought and opinion. Please enjoy the rest of your Sunday. This is Bob Zadek and Virginia Postrel. So long for now.