A frequent topic of conversation lately here at The League is compensation for organ donors. Sally Satel, a recipient of an uncompensated donation, recently made the case for compensated donation at Slate. This post isn’t about the merits of that particular argument (so please, let’s not rehash it). Rather, it’s about this passage:
Kidneys can be donated by the living. Indeed, roughly half of all donors are friends or loved ones of recipients. To induce more strangers to save a life, compensation could again be provided by a third party and overseen by the government. Because bidding and private buying would not be permitted, available organs would be distributed to the next in line—not just to the wealthy. By providing in-kind rewards—such as a down payment on a house, a contribution to a retirement fund, or lifetime health insurance—the program would not be attractive to desperate people who might otherwise rush to donate on the promise of a large sum of instant cash.
One of the concerns about compensated donorship is that it would end up preying on the poor and desperate. I have my doubts that it would, but it’s a concern sincerely felt. And there are a number of reasons you would want to keep financially desperate people out of the loop, not the least of which is that they’d be more likely to lie on their application so that they would be accepted. Satel’s proposal would indeed sidestep this by forgoing the promise of cash and in favor of things that would be more appealing to middle class folks and less appealing to the hard-up.
As I said, though, this isn’t about compensated donation specifically. Rather, it’s about some of these incentives and why I am less than sure about them.
By virtue of being (until last Friday) a physician trained for rural medicine, Clancy is eligible for all sorts of loan repayment programs. Which, since we’re in the upper five-digits in debt, sounds nice. One problem with this, though, is that the pay in the places that offer these incentives are typically low and by taking a job in a less rural, wealthier place would mean more money with which to pay back the student loans to begin with. You could up the student loan repayment, except for a couple of things.
First, the faster the student loan is repaid, the quicker the doctor is likely to leave. Which sort of becomes self-defeating, in a way. I mean, when the repayment is done, they actually take a hit in pay.
The second is that programs like this encourage weird financial behavior. It would be in the Himmelreich-Truman household’s best interest to pay off the loans as quickly as we can. Wouldn’t it? The bank gets its money and we don’t have to worry about interest payments and everybody is happy. It doesn’t make sense to hold on to the money while owing others… except that under these programs it starts to make sense.
Let’s say that we cut a check right now for the entire balance of the student loan debt. But then, the job she next takes has a loan repayment system. Well, that money is not transferrable into cash. So, in essence, by having made good on our debt, we’d be forgoing future income. Yet if we don’t pay off the debt, or as much as possible, and there is no repayment system in whichever job she takes, then that’s cost us money, too.
Yet if loan repayment were converted into cash, it would become even more apparent that the inducement is insufficient for the money-motivated. And, of course, it would also end up going to those who aren’t in it for the inducement who know just shrug off the student loan repayments that they aren’t getting. And lastly, in the same way that we like actual gifts better than cash at Christmastime, there is something nice about getting something specific. So maybe, as inefficient as it is, loan repayment works as well as the alternative anyway.
At least, until or unless we come up with a system that more genuinely and thoroughly rewards physicians for working in places that physicians don’t generally want to work. That would require an overall that the PPACA debate suggests that we are just not ready for.
New York has, or has had, 16 of these. Massachusetts and Virginia has or has had 7 each. Pennsylvania has or has had 5. California, Delaware, D.C., and Maine: 3 each. Connecticut, Illinois, Maryland, Ohio and South Carolina: 2 each. Florida, Georgia, Indiana, Kentucky, Louisiana, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, and Texas: 1 each.
This is a comprehensive list, and unique to the United States of America. (The total count is 68. Thanks to Mike Schilling for flushing out my oversight on the initial post.)
So here’s the deal: I have one Linky Friday post ready and I need two. So you are invited to provide the second!
1) Send an email to my gmail account (trumwill at). Include the link and between one and three sentences of commentary. If you have more than that to say on the article, put it in a comment.
2) Since it may not be appearing until next week, I would not recommend an article that is particularly time-sensitive (say, commentary on the Zimmerman verdict may well be stale.)
3) You will be identified as the submitter unless you ask not to be identified. I will not take credit for your work.
4) If I get enough of them to be posted this Friday, it will go up this Friday. Otherwise, I’ll ask for more and it will go up next Friday.
5) The average Linky Friday has between 20-30 links. That’s what I’ll be aiming for. Submit as many as you wish.
6) When it goes up, the open source Linky Friday will be identified as such in the title.
7) I am moving across the country and will not be in a great position to acknowledge your submission right away.
Since people are talking about self-driving cars in the previous Linky Friday thread, I thought I would share a post I wrote from a couple years ago that explores a potential future and the tradeoffs:
I have a hypothetical scenario and would be interested in your thoughts.
Imagine that a company creates something that they call the Antcar. The Antcar is a self-driving car where you basically put a destination into a GPS device and it will drive you there. By and large, it is not meant to be driven. There may be controls (like a steering wheel and breaks) for an emergency, but it’s all pretty limited. The entire point is that it will take you where you want to go.
The first question is… would you want such a car? Would you trade the ability to drive for the ability to do other things while the car drives itself? Would you pay $12,000 more for the privilege? $8,000?
The second question, though, is the real question. Let’s say the Antcar (and its competitors) work very well. They’ve been on the market for a while and now the premium is down to $8,000 per car. The initial hopes that it would cut down on automobile accidents was premature. They don’t always play well with human drivers. The Antcar manufacturers, meanwhile, start a pilot program in an eastern European city and then a few cities where Drivercars are banned and only Antcars are allowed on their roads. The results are astonishing in terms of safety improvements. Traffic engineers in the United States start proposing that the US consider doing the same.
Below are some factors to consider. Feel free to point off if I am way off-base about something, but for the sake of this hypothetical accept what I say as true. I’m less interested in how you think Antcars would really work and more interested in how you would evaluate the tradeoffs.
Pro: Safety! Car-against-car accidents reduce by 90%. Cars running off the road reduce by 98%. Pedestrian accidents reduce by only about 10%, but the victims of remaining accidents are caused by pedestrian error. Accidents where pedestrians follow the correct traffic signals are reduced by 98% (the remaining 2% are Antcar malfunctions). No drive drivers, no exhausted drivers, no reckless drivers results in considerable safety improvements.
Neither: Operation costs are roughly the same. The taxes to account for increased costs of road maintenance are offset by much lower insurance premiums.
Con: The cars are more expensive. In today’s dollars, you can add about $8,000 to the cost of any given car. However, the increased safety means that driving smaller cars becomes more possible. So while a 4-door economy car might cost $20,000, you can get a 2-seat Smart-size car for $15,000 and a one-seat bucket car for about $12,000. Nobody would have to buy the Antcar right away because there would be a ten-year transition period, but you would have to factor these higher prices into future cars purchased.
Pro: A more productive populace. People can (sorta) work in their cars. I say “sorta” because they can’t lay papers out everywhere or anything cause the car would be turning and breaking and even if there were some signals to alert the driver, it could be kind of tough in a lot of circumstances. They can unwind during the drive rather than when they get home. Cell phone calls are now guilt-free.
Pro: The makers of the (capital-A) Antcar enjoy a market advantage but not an absolute one. They’re willing to submit to standards so that their cars can cooperate with cars made by other companies. They already do somewhat, but they understand that the standards are going to become much more rigid. In other words, they would not have a monopolistic advantage.
Con: The government would have to administer these standards. A cynical person would point out that they may not always necessarily do so with the public interest in mind.
Con: Everywhere an individual driver goes becomes a matter of record. Law enforcement and courts can subpoena it the same way that they can subpoena phone records. A drug dealer is arrested and theoretically they can look through the records and see everybody that’s visited that house or street in the last thirty days or longer or whatever the records say. Divorce proceedings could unmask precisely where the husband or wife has been. And so on. Definite loss of privacy.
Pro: The ability to investigate where people have been would help the police solve crimes. It could also help innocent people establish alibis.
Con: No more driving. No more getting a turbo-engine car that you can rev up. These cars would still be available, but you really couldn’t drive them anywhere. The engines in the Antcar (and its competitors) would be pretty standard in terms of capabilities. Having a muscle car would not be nearly as advantageous since the cars would be navigating in a more cooperative manner.
Pro: Significantly reduced traffic times. No more accidents means no more accidents causing delays. No red lights at intersections where nobody is coming. Lane merges because much less painful. Eventually it will get to the point that traffic lanes themselves are no longer necessary, though the antcars are not yet ready for that.
Con: Riding in inclement weather can become difficult or impossible in some circumstances. These things are directed by satellite so things that disrupt a satellite signal would make the car not work. When signals are lost and are cutting in and out, the car can let you direct it (you tell it to turn right ahead and then you tell it when to turn left and so on), but it’s a real hassle.
So… what do you think? Here are some options, though I’d like you to elaborate if you have any further thoughts.
a) I would absolutely support banning drivercars. Safety is a premium consideration. Not just the lives saved, but the freedom from fear on being on the road after 2am would absolutely make it worth it.
b) I would probably support banning drivercars. I’m concerned about some aspect of it or another, though.
c) I couldn’t support banning drivercars on libertarian grounds. People should never lose the freedom to drive (and conceal where they’ve been) even if it results in the loss of life and a significant reduction of accidents.
d) I can’t support it because I don’t trust our government to play fair with standards and not play favorites.
e) It’s hard to answer your question because you didn’t explore what I would consider to be a significant factor and/or your prediction on some aspect or another is so far off-base I can’t suspend my disbelief that far.
f) What’s an Antcar? I’ve never heard of that. I don’t think this technology exists. I also don’t understand the meaning of the word “hypothetical.”
g) I refuse to recognize your hypothetical because that’s not how it would happen and I would much prefer to litigate that issue rather than put any thought into the post you wrote.
Fun fact: 32 is one of the most popular jersey numbers in sports…
[S1] Here’s a cool interactive map where you can watch housing prices rise and fall.
[S2] Floating buildings! I dig it.
[T1] According to some, a cracked cellphone screen is a new status symbol, of sorts. Like pre-frayed hats, I guess.But only if you can actually afford a new one, or something. We’ve turned smartphone functionality into something irony-based.
[T2] I like my oversized smartphone. Next time, I may go all-in and get a Note. That being said, for a lot of people, the drawbacks can be pretty significant. It can, for instance, make you lose your friend. Of course, there is a solution to this: Everyone wears pants, a belt, and a phone holster. Problem solved!
[OD1] Online dating has been good for gays, too, in accepting their sexuality.
[OD1] An intriguing idea for online dating: Telling you what you’re doing wrong.
[B1] Your brain knows a phony smile when it sees one.
[B2] Are the results of the Milgram Experiment overstated?
[B3] Research Digest has a cool piece on the intuition of homicide detectives.
[B4] It’s a tl;dr world.
[B5] An unexpected benefit of nuclear bombs: Brain regeneration in humans. (Addendum: Brandon points out that it’s actually the measurement of regeneration and not actually regeneration itself)
[T1] We could be flying faster than we do, but we’re too thrifty. Well, there are definite environmental upsides, I suppose.
[T2] MIT Tech Review looks at how self-driving vehicles are outstripping regulators’ ability to regulate them.
[E1] The top foreign-language shows you can see legally in the US. I got my fill of subtitles during my anime days, which is a bit of a shame because I do like foreign entertainment.
[E2] David Lloyd, the artist behind V for Vendetta, talks about the Guy Fawkes mask‘s embrace by radicals and protestors worldwide.
[E3] In the aftermath of Newtown, a lot of people who wanted to talk about the gun culture wanted to keep video game culture off-limits. That’s not so easy.
[J2] Food trucks: Feeding employees, and possibly keeping them around.
[A1] Ron Unz has a great piece on the collective failures of our media.
[A2] One of the interesting things during my 1946-60 US History class was how tough the smart set was on Dwight Eisenhower. Often, compared unfavorably to Lincoln. As it ever was…
[A3] Smithsonian.com and PBS have a great story about how a a bunch of artists used smoke and mirrors to fool the Nazis.
[W1] One of these days, I’m going to sit down and read as much about seasteading as I can.
I had to write a check for $166.34 for Lain’s latest visit to the hospital for her hip dysplasia treatment. The $166.34 itself doesn’t bother me as much as the fact that our insurance provider apparently does not believe that hip dysplasia should be covered and has rejected almost every claim that has been filed.
I told my wife that we have paid $2,164 for her hip treatments this year and insurance has paid “thirty-seven fifty-seven.”
She said the latter was small comfort, until I specified that what I meant was not $3,757, but rather $37.57.
Whatever, though. Lain shouldn’t need hip surgery when she’s 35. That’s what’s important. To us, anyway, if not to the insurance company.