[darawk]

a) This article purports to answer the question of why medical care costs so much, collectively. Its answer: 'prices'. But it does basically nothing to interrogate why prices are high, despite claiming to at several points.

b) One extraordinarily simple thing we could do to deflate medical costs in this country that would have essentially zero negative effects would be to create a market in kidneys. Medicare currently spends 90k per patient per year on dialysis. Allowing people to sell a spare kidney would completely and totally solve this problem, essentially overnight. Everyone currently on dialysis would get a transplant, and the costs would go to zero. 7% of Medicare's budget would evaporate instantly, and the numbers would probably be similar for private insurers.

[zaptheimpaler]

Wow. Incentivizing people who need money to sell their organs has "zero negative effects"? Really?

[darawk]

Let's actually talk this through. What do you think the negative effects are?

[zaptheimpaler]

Consider a poor or indebted person that owns a car, and needs some benefits from social security. Many republicans would argue (as they do now) that they should "lift themselves by the bootstraps" and sell their car, use public transit instead as a first step to increasing their income right ? Now what do you think will happen when that poor person suddenly has the option to sell their kidney for $50k? The same thing. Their KIDNEY will be considered a "luxury" that they should part with rather than something a little more important than that. Think about the same narrative around "millenials should just stop eating avocado toast" vs. the real problems of wage stagnation or college debt.

What if debt collectors could one day consider a kidney a monetary asset like a house, and force them to give it up? How would you feel, if you sold a kidney at 30, and now you're 70 and your remaining kidney fails?

What if the social security basket shrinks proportionally because 10% of people now opt to sell their kidneys and take less social security- is that REALLY better than letting them keep their damn kidney and paying a bit more taxes on social security? A purely economic perspective would say yes...

Broadly speaking, you are reducing a much bigger problem into a small "economics 101" lens.

[darawk]

Ok. And then what? Where do the problems start?

[zaptheimpaler]

Doesn't seem like you even read my response but if you see no problems in the scenarios I described then i'm not wasting any more words.

[darawk]

No, it doesn't seem like you read anything that i've said thus far. You have not articulated any problems. You have gestured at them. Someone's kidney being removed is not, in and of itself, a problem. Play the scenario all the way through. Where do the problems start? You seem to want to imply that there will be latent health consequences to the people doing this. But even the slightest amount of research would quickly dispel that myth.

So, i'll ask again: What if any, specific, negative consequences will accrue to individuals or society at large as a result of a market in kidneys?

[JoeAltmaier]

Really. Done all over the world.

[epmaybe]

It's also condemned by the World Health Organization unless totally altruistic because organ trafficking and human trafficking are intertwined with the politics of organ transplantation.

Living donor programs already exist in many states and hospitals - If you want to help reduce medicare spending by donating your organs, go for it! But don't expect to get paid for it any time soon.

[JoeAltmaier]

It has negative externalities as well. The poor cannot afford to donate kidneys - the time out of work, the lifetime extra health maintenance and checkups. So it becomes a rich person's prerogative.

And it remove a source of cash from an entire population, with all that entails.

[epmaybe]

I'm not surprised - you probably didn't even look into the living donor programs available in the US.

Many hospitals will cover most if not all of these costs, including your wages, health maintenance, checkups, etc. If the hospital near you won't cover these things, the National Living Donor Assistance Program will help.

> And it remove a source of cash from an entire population, with all that entails

There's something like 100,000 people on the kidney donor list right now (UNOS). Maybe 20,000 of these get a kidney donation per year. It's not really that much of lost productivity, and as we have already explained these costs are usually covered by programs for living donors.

You're acting like this isn't a solved problem, when it is except that people are attached to their own body parts. I for one don't really want to give my kidney away unless I'm already dead. Maybe we should argue for opt-out deceased organ donation programs nationally, instead of this asinine idea that we should allow poor people to sell their kidneys.

[JoeAltmaier]

That 'asinine' comment seemed out of place. 80,000 people die, and the problems with 'poor people having a source of cash' is the bigger issue? I honestly don't understand the emotion surrounding this.

I can sell my life (ok, 8 hours of every day) and no problem.

[basementcat]

Why stop at organs? Why not sell entire persons?

[JoeAltmaier]

Hyperbole. You can give a kidney and live a fine life.

[fluentmundo]

a) You must not have read the piece: "the bills are high because of who is paying them"; "insurance companies spend some eighteen cents for every dollar they collect in premiums on administration costs: 'marketing, determining eligibility, utilization controls (e.g., prior authorization of particular procedures), claims processing, and negotiating fees with each and every physician, hospital, and other health care workers and facilities.'"

[JoeAltmaier]

18% is surely not the whole issue with inflated medical bills. If medicine in the US were only 18% higher than elsewhere, we'd all call the problem 'solved'.

[fluentmundo]

The author doesn't say that's the whole issue. He also says the private system drives hospital consolidation, which in turn gives them higher bargaining power to demand higher prices. My point was, OP is wrong that the author "does basically nothing to interrogate why prices are high."

[darawk]

That is not an argument, it is an assertion that offers no real explanation whatsoever. An argument would connect who is paying to the high prices, this article fails to do that.

The 18% overhead of insurance companies, just like the overuse of care argument rebutted in the article, does not explain the high relative cost of care in the US.

[fluentmundo]

Of course it is part of the explanation. That administrative overhead — the bureaucratic army it pays for and marshals as a lobbying and negotiating tool — encourages hospital monopolization, which gives providers greater bargaining power, driving up prices.

[darawk]

Yes, but per the article itself it only explains 18% of cost. And overhead is never going to be zero, so you can maybe, what cut that in half? At best? That's not even close to explaining the discrepancy between US per capita spending and other countries.

[gregw134]

It's easy to imagine someone being forced to sell a kidney because they're down on their luck. Doesn't seem ideal.

[darawk]

Ok. So a person is forced to sell a kidney because they're down on their luck. That person then becomes less down on their luck because they have received money for their kidney. Where do the problems start?

[SketchySeaBeast]

What sort of money are we assuming these individuals will get? In your plan is this $100? $1,000? $10,000? With the ratio of the desperate to people who require kidneys, suddenly organs become a buyers market.

[darawk]

Ok, again. Let's play this all the way through. Let's say they get $1. If I choose to sell you my kidney for $1, because i'm desperate and I think that that $1 is worth more to me than my kidney, where do the problems start?

[antisthenes]

On the off chance you're not trolling (assume best intent and all that). The answer is trivial:

The problems start because 99% people aren't educated on the true value of their kidney.

They are not in an adequate position to judge the value of an essential organ and the ramifications for missing it for the rest of their life. Because they are not doctors and not experts.

It's immoral, because in this exchange exists information asymmetry, where the kidney seller is not informed enough.

[darawk]

> The problems start because 99% people aren't educated on the true value of their kidney.

And which problems are those? There are no significant issues that arise from having one fewer kidney.

> They are not in an adequate position to judge the value of an essential organ and the ramifications for missing it for the rest of their life. Because they are not doctors and not experts.

Sure, but that problem exists in tons of market interactions that we solve in various ways. Information disclosure and education, certification programs, etc..This is a very, very easy solve.

[SketchySeaBeast]

Why draw the line at kidneys? Why not create a whole system of voluntary for-profit organ harvest? Anything you got two of, might as well sell one. No one needs two lungs, or two eyes.

[darawk]

I think that'd be great. But kidneys are an easy starting place because you genuinely do not require two kidneys.

[SketchySeaBeast]

A major surgery like that isn't low risk - the chance of major complications is quite high. You're asking people to put their lives at risk in a very real way to make a quick buck, which probably isn't actually solving any long term problems as it's a single cash infusion and not any sort of actual revenue stream they can rely on.

And, as I asked elsewhere - how much money are you expecting these organs to be sold for? There are far, far, far more desperate individuals than those who need kidneys - it'd be a buyers market for human organs.

[darawk]

> A major surgery like that isn't low risk - the chance of major complications is quite high. You're asking people to put their lives at risk in a very real way to make a quick buck, which probably isn't actually solving any long term problems as it's a single cash infusion and not any sort of actual revenue stream they can rely on.

So, you think people are incapable of making this decision for themselves? Or perhaps that, in general, the government should step in to prevent people from taking undue risks in exchange for money? Should we therefore criminalize dangerous jobs like alaskan crab fishing too?

> And, as I asked elsewhere - how much money are you expecting these organs to be sold for? There are far, far, far more desperate individuals than those who need kidneys - it'd be a buyers market for human organs.

a) It doesn't really matter what the equilibrium price ends up being.

b) We don't need to speculate. Iran has a legal market in kidneys: https://en.wikipedia.org/wiki/Kidney_trade_in_Iran Their equilibrium price is about $4,000.

$4,000 seems like a perfectly reasonable and fair price for someone to undertake the risks associated with kidney donation.

[SketchySeaBeast]

> Or perhaps that, in general, the government should step in to prevent people from taking undue risks in exchange for money?

Yes, literally why OHS exists and should continue to exist.

> $4,000 seems like a perfectly reasonable and fair price for someone to undertake the risks associated with kidney donation.

Who is going to need that sum, but also afford all the post-op medical care and time off? In case of complication, who is responsible? Something tells me if you're needing that sum, you're not going to have the medical coverage required to take care of yourself. Iran seems to have a higher level of general healthcare coverage than America [1].

[1]https://en.wikipedia.org/wiki/Healthcare_in_Iran

[darawk]

> Yes, literally why OHS exists and should continue to exist.

I'm not familiar with any agency by the name of OHS. Do you mean OSHA? Because they don't regulate employees, they regulate employers.

> Who is going to need that sum, but also afford all the post-op medical care and time off? In case of complication, who is responsible? Something tells me if you're needing that sum, you're not going to have the medical coverage required to take care of yourself. Iran seems to have a higher level of general healthcare coverage than America [1].

First of all, 'time off' isn't a thing for many people. Many people are unemployed, so time off costs them nothing. Secondly, obviously the person purchasing the kidney would cover all aspects of care related to the operation.