We have long been pointing out that the solution to the shortage of kidneys available for transplant is to offer to pay those donors who might be willing to donate one. Adter all, it’s not exactly a new insight that increasing prices brings forth more supply. And the sort of levels of payment necessary are in fact cheaper than the cost to the NHS of dialysis. The New York Times has a nice piece on how this works elsewhere:
Iran’s system has many deficiencies — not least that the very idea clashes with ethical norms observed in many other countries — and the program varies greatly from region to region. But its chief advantage is this: People who need kidneys get them rapidly, rather than die on the waiting list.
In the vast majority of cases, donors know in advance what they will be paid and receive appropriate screening and good medical care before and during the operation. And by getting patients new kidneys instead of keeping them on dialysis, the society saves a lot of money and avoids much misery.
Whatever anyone’s doubts about whether people ought to be paid for organ donation there’s no doubt that it does actually work.
“We should ask ourselves why some people find accepting money to donate a kidney and save a life repugnant, but accepting money for being a policeman or miner or soldier — all of which are statistically riskier than donating a kidney — is O.K.,” said Mohammad Akbarpour, a research fellow in the Becker-Friedman Institute of the University of Chicago. “Is there a fundamental difference?”
It could be that people simply don’t understand how low that relative risk is.
Commercializing kidneys calls up images of a filthy, makeshift clinic, a rich traveler with a wad of cash, a desperately poor donor tricked into selling an organ, and a broker who keeps 90 percent of the money. India, Pakistan, the Philippines, South Africa and Indonesia, among other countries, are known for this type of trafficking in organs, and wealthy Americans, Israelis and Europeans are known for buying them.
But in Iran, the legal market pre-empts these abuses. To prevent kidney tourism, recipients in Iran have to share the nationality of their donors, and Iran recently banned kidneys for all foreigners except refugees in Iran from Afghanistan. “The rate of people who die in surgery is much, much lower in Iran than in other developing countries — all the transplants are under supervision,” said Farshad Fatemi, an assistant professor of economics at Sharif University of Technology in Tehran, who studies the kidney market. “If this regulated market weren’t in place, we might have organ trafficking here. We might be more like India or China and have illegal clinics, a black market where nobody looks after patients and donors.”
And there we have something that we have again been saying repeatedly. Markets are going to exist where human desire is great enough. It happens with sex, it happens with drugs, it is happening with organ transplants. In all three we argue that said market will be safer, will work better, if the activity itself is legal so that regulation, if that’s necessary, is possible. Insisting that these things are illegal is part of what makes them so dangerous.
So, given that we’ve got the example of the one and only place in the world where people do not die waiting for a transplant, when are we going to institute our own paid market in them? For it really is true that people die, in great pain, each and every year simply because of some squeamishness about introducing filthy lucre into the proceedings.
As ever, there really are some thing so important that we must have markets in them.
Milton Friedman was born on July 31st 1912. He was one of the two most influential economists of the 20th Century, the other being John Maynard Keynes, and he promoted monetarism as an alternative to Keynesian orthodoxy. His economic scholarship was unimpeachable, and won him the award of the Nobel Memorial Prize in Economics in 1976.
He was no less influential in promoting free market economics as an alternative to the once fashionable mixed economy consensus that prevailed in the post-war era. He did this at a popular, as well as at a scholarly, level, with a series of articles in Newsweek and other popular journals. He was an excellent communicator, able to explain complex ideas in simple, easily understood language. His “Capitalism and Freedom” remains a classic to this day, still relevant, still persuasive.
His TV series, “Free to Choose,” together with the book he co-authored with his wife Rose, were immensely popular, and were hugely influential in gaining popular support for the economics of free enterprise, choice and incentives, and a widespread skepticism of government intervention.
He pioneered many ideas that eventually gained traction, including an end to military conscription in the US, floating exchange rates, and school choice amongst many others. His monetarist views influenced the Federal Reserve’s response to the 2008 financial crisis.
He was a supporter of the Adam Smith Institute and took a keen interest in its work in translating sound economic ideas into viable policy options. He addressed ASI meetings, and regularly chatted with its members at meetings of the Mont Pelerin Society, which he continued to attend until his death in 2006. He went out of his way to help others, to support student groups and to lend his wisdom and advice to free market organizations. He even acted as my referee when I applied to Cambridge, with a hand-written note endorsing me.
He was engaging, personable and likeable, nearly always with a smile on his face and a twinkle in his eye as he corrected economic nonsense from his opponents. Happy birthday, Milton; we miss you.
You may or may not be aware of the provisions of the Dodd Frank act over conflict minerals. These were pushed by the Enough Project and Global Witness as a way of reducing the violence associated with the mining of tin, tantalum, tungsten and gold in the Eastern Congo. We were originally told that this would cost some $10 million, one cent on each mobile phone made, and pacify the region. Even the SEC says that this has cost some $4 billion just in its first year of implementation. And it appears that it doesn’t in fact work either:
There is widespread belief that violence in poorly governed countries is
triggered by international demand for their natural resources. We study the consequences
of U.S. legislation grounded in this belief, the “conflict minerals” section of the 2010
Dodd-Frank Act. Targeting the eastern Democratic Republic of the Congo, it cuts
funding to warlords by discouraging manufacturers from sourcing tin, tungsten, and
tantalum from the region. Building from Mancur Olson’s stationary bandit metaphor, we
explain how the legislation could backfire, inciting violence. Using geo-referenced data,
we find the legislation increased looting of civilians, and shifted militia battles towards
unregulated gold mining territories. These findings are a cautionary tale about the
possible unintended consequences of boycotting natural resources from war-torn regions,
and the use of international resource governance interventions.
The money quote:
The evidence suggests the legislation significantly increased the incidence of
looting and the incidence of violence against civilians by at least 291 and 143 percent
Lord preserve us from well meaning Social Justice Warriors, eh?
Currently Dodd Frank applies only to listed US companies. Global Witness is among those campaigning to have the same provisions written into European Union law for all companies, even down to the level of sole traders.
Should increase the level of violence they say they want to reduce quite nicely that, eh?
Sweatshops are awful places to work. But they are often less awful than other jobs sweatshop workers could take. And this is the basic argument in defence of sweatshops. When people argue against them, the question we should ask is: “Compared to what?”.
Most evidence suggests that sweatshops pay better than the alternatives. It’s hard to collect reliable data in many poor countries, but Ben Powell and David Skarbek’s 2006 paper “Sweatshops and Third World Living Standards” uses wage data given by anti-sweatshop campaigners to estimate wages for sweatshop workers in ten countries compared to average National Income. This, if anything, should underestimate sweatshop workers’ earnings.
Again, it’s difficult to know how many hours the average sweatshop worker does every week, but most anti-sweatshop campaigners suggest that it is more than 70 hours per week. The results should be taken with a pinch of salt, but Powell and Skarbek found that sweatshop wages exceed average income in between eight and ten out of ten countries surveyed, depending on how many hours were worked.
In nine out of ten countries, “working ten-hour days in the apparel industry lifts employees above (and often far above) the $2 per day threshold.” And “in half of the countries it results in earning more than three times the national average”! (Powell’s defence of sweatshops, here, is excellent. His book on the topic is self-recommending.)
Critics of sweatshops point to the 1,000+ people killed and 2,500+ people injured by the collapse of the Rana Plaza sweatshop in Bangladesh in 2013. This was indeed grotesque, and evidence of the poor conditions that many sweatshop workers have to work in.
But what is their next-best alternative? Subsistence farming still dominates many of the countries that sweatshops operate in – in Vietnam, 59% of workers are self-employed in farming; 1.5% work for businesses owned partially or fully by foreign firms. And farming – particularly subsistence farming – is one of the most dangerous occupations in the world.
The International Labour Organisation estimates that agricultural workers suffer 250 million accidents every year, and say that in some countries the fatal accident rate is twice as common in agriculture as in other industries. “Out of a total of 335,000 fatal workplace accidents worldwide,” say the ILO, “there are some 170,000 deaths among agricultural workers.” As horrendous as the Rana Plaza incident was, anti-sweatshop campaigners have not shown that sweatshops are more dangerous than sweatshop workers’ next-best alternative.
Sweatshops seem to have good impacts on women in particular. A study by researchers at the Universities of Washington and Yale that I blogged about last year looked at different villages in Bangladesh – some close to sweatshops, some not.
In the villages close to sweatshops, girls were substantially less likely to get pregnant or be married off (28% and 29% respectively, and this effect was strongest among 12-18 year olds) and girls’ school enrolment rates were 38.6% higher. The authors say that these effects were likely due to a combination of wealth effects (richer families need to marry off their daughters less early, and can afford to send their daughters to school for longer) and the fact that garment factory jobs reward skills, increasing the value of education.
And what do workers themselves think of sweatshops, given not just wages but other non-monetary compensation as well? Using field interviews with thirty-one sweatshop workers in El Salvador, David, Emily, Brian and Erin Skarbek found that “workers perceive factory employment to provide more desirable compensation along several margins.”
This is not to condemn all work done ‘against’ sweatshops. Using data from Indonesia, the World Bank’s Ann Harrison and Jason Scorse found that 1990s campaigns to improve conditions for sweatshop workers in the developing world seem to have led to real wage increases without significant unemployment effects, though some smaller factories did close.
The lesson here may be that work that focuses on improving wages and conditions for sweatshop workers, not closing down sweatshops and trying to wash our hands altogether, may be the best approach. Persuading consumers to continue buying things from sweatshops, but to pay a higher price to give those workers a better wage, might be a decent way of essentially ‘bundling’ a charitable donation into a normal purchase. Unfortunately, most campaigns in Britain seem to be straightforwardly anti-sweatshop.
And even the most noble-seeming campaigns can backfire. UNICEF argues that early 1990s campaigns to reduce child labour in Bangladesh’s formal economy led to children looking for income in much worse places: stone-crushing, street hustling, and prostitution.
It is understandable that anti-poverty campaigners find sweatshops appalling, and work done to improve conditions in sweatshops might be valuable, but too often people forget that blunt campaigns against sweatshops probably end up hurting people. Instead, people should use the awfulness of sweatshops – and even greater awfulness of other jobs – as proof that we need to do more, much more, to give better options to poor people in other countries.
One option might be guest worker programmes, targeted at people from the poorest countries in the world, to allow them to come and work in the developed world so that they can send more money back home for investment. And lower trade barriers to goods from poor countries would help them grow, too.
Sweatshops are particularly horrifying because they make us feel complicit in the suffering of the poor. They are not a good option, but they are the least bad option currently available to many people. Washing our hands of the situation and just closing the sweatshops would make their workers worse off, potentially much worse off. If we want to help people, we should give them new options, not take away existing ones.