Response to: “Cash for Kidneys: The Case for a Market for Organs”

Economists Gary S. Becker and Julio J. Elias propose in the Wall Street Journal that they have calculated a system of legal payments for kidney donations that would cut costs and reduce shortages in America.

doctorsThe authors propose a system in which making it legal to pay someone for one of their kidneys is economically feasible on a national scale, while dramatically cutting down the time patients would need to wait for a matching donor. At face value, the proposal sounds good. However, as someone who studies the plight of the most vulnerable and exploitable, I must say that such a system would need to be accompanied by highly stringent informed consent safeguards — probably more stringent than the informed consent envisioned by the authors.

Hypothetical scenarios that are formulated in a “vacuum” where all things are equal often grossly underestimate the ingenuity of the underground business world. Organized criminal activity has an uncanny ability to coerce or exploit the most vulnerable in societies — much like organized criminal activity that exploits business ethics on Wall Street.

According to the authors,

We have estimated how much individuals would need to be paid for kidneys to be willing to sell them for transplants. These estimates take account of the slight risk to donors from transplant surgery, the number of weeks of work lost during the surgery and recovery periods, and the small risk of reduction in the quality of life.

Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney. That estimate isn’t exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate wouldn’t increase the total cost of kidney transplants by a large percentage. Read More 

The authors state that “the sale of organs would make them more available to the poor, and Medicaid could help pay for the added costs of transplant surgery.” This statement serves to suggest that a system of legal payment for kidney donations would benefit not just the rich, but the poor. While there is merit to this statement, it is worth noting that the authors’ definition of “poor” involves the word Medicaid.

This qualifier excludes the vast majority of poor people in the world, the very people who would be exploited by illegal organ traders. And, in light of the authors’ statement that “today, the rich often don’t wait as long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical sector,” I see evidence of the very concern I am here presenting.

The authors’ proposal is very noble and I think that it is worth considering. They are conscientious about weighing costs in a situation that presents multiple moral dilemmas. However, as with any market where there is already evidence that the most vulnerable are exploited, we must proceed with caution.

The Good, the Bad, and the Ugly of Medicare

by Britney Wiggins, BSW Candidate

One of the most important steps when enforcing any type of intervention, especially in social work practice, is to examine how effective the program is in accomplishing its goals.  Federal legislation, particularly social welfare programs, must also be examined in terms of strengths and weaknesses so that the policy can be modified to better accommodate the beneficiaries that are often heavily dependent on these programs.  A program’s weaknesses can also result in its own demise if left untreated.  Exploring how an intervention can be improved is critical if any program is going to survive in the American political system.  Given our current political atmosphere and the focus on budget cuts, it is imperative that Medicare determine what areas it can improve on.

Medicare-Policy-Making-198x198Arguably one of Medicare’s greatest successes is in the overall support and approval it receives from its beneficiaries.1 Medicare has changed the way older adults approach retirement.  The financial support made available for medical costs allows older adults to use their monetary resources for other necessities.  Another reason that Medicare is heavily favored among eligible older adults is because of the portability of the program.  Regardless of where a beneficiary resides, their eligibility and benefits remain the same because the program is federally regulated.  The benefits, in fact, are responsible for much of Medicare’s glory.  It was originally designed to provide affordable healthcare to seniors and it has succeeded in that effort.  Despite the rising cost of Medicare throughout the years, the increase in the cost of private insurance has continued to ensure that Medicare is the better deal.2 With Medicare acting as a healthcare safety net, it is no surprise that Medicare continues to be one of America’s more popular social welfare policies.

Medicare’s popularity does not negate the fact that there are problems present.  While the program does help cover many healthcare costs, it also has relatively high deductibles, no limit on out-of-pocket spending, and a coverage gap – the “donut hole” – in the prescription drug plan that will exist until 2020.3 Medicare also fails to cover long-term care costs.4 While these issues do represent some of the weaknesses currently present in the program, they are not the focus of recent political talks.  Congress is far more concerned with addressing growing concern over how Medicare will continue to be funded in light of the federal deficit.

It has become almost impossible to talk about Medicare without also mentioning the Baby Boomers.  It is estimated that there are over 70 million Baby Boomers – individuals born between the years 1946 to 1964 – expected to enter into the Medicare system throughout the next decade.5 As the number of beneficiaries grows at an unprecedented rate, there is a reasonable fear that funds from taxpayers will not be able to keep up with the growing demand.  The national government will be forced to pick up the slack during a time when the country is already facing a trillion dollar deficit.  Politicians are racing to find a balance between maintaining a popular welfare program and reducing the national debt.  While Medicare is not in danger of being completely demolished, there are concerns over how changes to the policy will impact consumers and taxpayers.

The issue over Medicare funding is made more complicated by disagreements between the two main political ideologies over how the deficit should be corrected.  Republicans tend to favor cutting government spending, which could result in less federal monetary support for Medicare.  Democrats, on the other hand, favor an increase in taxes.  This alternative places a heavier burden on the taxpayer during an economic period that still finds many people recovering from the recent economic downfall.  Neither solution offers a comprehensive solution.  Rather, the two groups will have to reach a compromise if Medicare is going to continue providing cheaper insurance options for the growing elderly population.

14Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from

2Dugan, J. (13, June 2011). Private insurance vs. Medicare: truth in numbers. Retrieved from

3The Henry J. Kaiser Family Foundation. The Kaiser Foundation, Medicare Policy. (2012). Medicare at a glance. Retrieved from The Henry J. Kaiser Family Foundation website:

4Centers for Medicare and Medicaid Services. (3, August 2012). Long-term care: what is long-term care?. Retrieved from

5 Haaga, J. (2002, December). Just how many baby boomers are there?. Retrieved from

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