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Edited on Tue May-16-06 09:06 AM by Plaid Adder
My parents get the New York Times delivered, and reading it has reminded me why I get my news from the internet now. I don't have a link to the piece I'm about to talk about because I'm not signed in to their website, but surely one of you guys will come up with it shortly. It's an op-ed from Monday, May 15, 2005, page A25, by one Sally Satel, described in her byline as "a psychiatrist and resident scholar at the American Enterprise Institute," which as a quick Google search will tell you is a major neo-con think tank. It is entitled "Death's Waiting List," and its argument can be summed up thusly: The federal government should buy and sell human organs.
No, seriously. Because this woman was on a waiting list for a new kidney for a long time and was afraid she might not get one before she had to go on dialysis, and because instead of being one of the thousands of ordinary folks who are in that situation and have to put up with it she is "a resident scholar at the American Enterprise Institute," she is calling for a federally-funded program which would provide "incentives" for people to donate their organs. I'll let her tell you all about it:
"One model resembles a 'futures' market in cadaver organs. A potential donor could receive compensation--outright payment, a sizable contribution to a charity of his choice or lifetime health insurance--in installments before death or to his estate afterwards in exchange for permission to recover his organs at death."
But that's only one model. She's got a plan for increasing kidney donations from living donors as well:
"Some critics worry that compensation for kidney donation by the living would be most attractive to the poor and hence exploit them. But if it were government-regulated we could ensure that donors would receive education about their choices, undergo careful medical and psychological screening and receive quality follow-up care. We could even make a donation option that favors the well-off by rewarding donors with a tax credit. Besides, how is it unfair to poor people if compensation enhances their quality of life?"
Well, since you ask...
First of all, the logic Satel is using in that last bit--that harvesting organs from the poor is fair because the compensation will "enhance their quality of life"--can also be used to justify child labor (it's so hard on those poor families having to give up their children's earning power just because other people think six year olds shouldn't be mining coal), or, what the hell, selling human flesh as food. If you're poor, and your child's just died, and the federal government can ensure that he didn't have mad cow disease, and someone wants to buy the meat, isn't it unfair that you can't sell it and thereby improve your quality of life? And yet nobody's arguing for that--yet--because people can tell that it's the kind of thing you'd only do if starvation and poverty had reduced you to the point where you no longer had anything left in you but the fear of death. But here's the really crazy thing about this piece: Satel isn't really arguing that paying people for organs wouldn't be coercive, just that it wouldn't be unfair. Check it out:
"Paradoxically, our nation's organ policy is governed by a tenet that closes off a large supply of potential organ donors--the notion that organs from any donor, deceased or living, must be given freely."
Now, from the context it's not clear whether she's using "freely" to mean "without compensation" or "voluntarily," but I think the ambiguity is instructive. To give an organ freely, in both senses, means to give it because you want to do that and for no other reason. Donating your organs after death is a generous but not necessarily heroic act; after all, you won't be using them any more. I myself have checked off the little organ donor box on my driver's license, though I can't help wondering what would happen to Sally Satel if she ever wound up getting one of my organs. If somehow someone put a Plaidder heart in her chest, would she wind up looking at this piece one morning and wanting to barf? Maybe that would have to be the stomach. Anyway, my point is, in order to be willing to donate one of your kidneys while you're still alive, most people need a strong motivation. The one person I know who's done it did it to save her son. In a sense, she didn't do that "freely" in that she would have vastly preferred for her son to be able to go on living with his original kidneys; but at least it was a choice she made out of love and not because she was strapped for cash or because it was the only way for her to get health care. Destitution and desperation are strong motivators too, and it's not impossible that if there were a federal program in place that paid people for their kidneys, the donor pool would increase. And if that's the sole and only thing that you care about, then I guess that would make sense; but if you are worried about things like, I dunno, human rights, human dignity, what happens to a society that views the bodies of the poor as an exploitable resource, and so on, then it really doesn't.
But of course all of Satel's sources and all the logic she mobilizes are basically window-dressing. The core of this piece is the snipped that they pulled out for the box quote: "I needed a new kidney. Why couldn't I buy one?" That's what this piece is really about. The basic principle of neocon econonmic policy is that if you're rich, you should be able to buy anything. If you're poor, you should be able to sell anything. That's freedom, for the American Enterprise Institute. The idea that people should be free, whether rich or poor, to own their own bodies and not be forced by poverty to start selling them for parts comes from the other side of the spectrum, the side that takes the position that life and health are not commodities and that one's right to them is not linked to one's bank balance.
Satel does not talk about how money would work on the recipient end, but that box quote tells you the story anyway. So does the anecdote describing her wait for a kidney:
"I had been on the list only for a year and was about to start dialysis. I had joined a Web site, MatchingDonors.com, and found a man willing to give me one of his kidneys, but he fell through. I wished for a Sears organ catalog so I could find a well-matched kidney and send in my check. I wondered about going overseas to become a 'transplant tourist,' but getting a black market organ seemed too risky."
I should say that Satel leads off the piece by informing us that she did get her kidney, so the system worked for her after all. But she feels she shouldn't have had to go through all of that anxiety and anguish when, after all, she could afford to buy her way out of it. Being a "transplant tourist" seems risky to her because, of course, nations poor enough to have populations willing to sell their organs for cash often don't have the world's best medical care. Ideally, what people in Satel's situation would need would be desperately poor donors side by side with expensive and cutting-edge medical technology--a first world country enclosing a sizable third world population. And that's really where America is going, under the Bush administration, as corporations are given freer and freer rein to exploit us just as viciously as they exploit their overseas workers.
So what Satel describes as her fantasy solution here is to be able to "send in a check" and get a kidney and not have to wait in line behind all the other people who got there first and wonder whether she'll be able to get the procedure she needs to save her life. And that's a horrible position to be in; but there are hundreds of thousands of people all over this country who face that situation every day, not because they need kidneys but because they don't have health insurance. When Satel's colleagues and fans at the American Enterprise Institute talk about "rationing health care," they don't mention that health care in this country is already effectively being rationed--it's just that instead of sharing it out equally to everyone we distribute it based on what kind of benefits you have, which is determined by where you work, which means it's linked to your economic status. Is that fair? I guess to the American Enterprise Institute, it is, because from their point of view, fairness means being able to buy your way out of anything, even death itself. If you need a kidney just as bad as Satel did and you don't have the money to buy one from the imaginary Sears catalog, and you die because people with more money than you have bought up all the inventory, is that fair? I guess it is, because according to the American Enterprise Institute...uh...all people who are poor deserve to be poor and all people who are rich deserve to be rich, and so it's only fair that the rich people should be able to buy all the poor people. So basically, in the world as the AEI fantasizes about it, if you're poor and you need a kidney, you don't get one; but you are free to sell the one you have that still functions, and use the money to improve your quality of life while you're on dialysis.
We haven't even talked yet about the fact that Satel wants the buying of organs to be done through a federal program. Does government get any bigger or more intrusive than that? How is that "conservative"? Or is that supposed to make this idea more attractive to liberals somehow? Or her specious comparison with the fertility industry: "The Institute of Medicine cautioned against treating the body as if it were 'for sale.' But that's outdated thinking: we've accepted markets for human eggs, sperm, and surrogate mothers." Yes, because wanking off into a cup is exactly as traumatic and life-threatening as having a kidney hacked out of your body, and because each body contains one or at most two eggs, and because once you've given birth you can never do it again. I'm not saying that some of the ethical problems with Satel's money-for-organs scheme don't apply to all this--especially to surrogate motherhood--but that's not an argument that we should start selling off more of our body parts.
But basically what strikes me about this piece is not what Satel says but what she seems to think goes without saying. And really, I'm not even talking about her; I'm talking about the think tank that has provided her with all the studies she cites and the polls she quotes and the ideas she promulgates. And what goes without saying for everyone who's floating in the warm comforting womb of that tank is: 1) Money is freedom. 2) Everything is for sale. 3) The only right the poor have is the right to sell themselves to the rich. 4) Tax cuts can be used for EVERYTHING!
I'm glad Satel got her kidney. I'm glad my cousin got his kidney. I will be glad if one day everyone who needs a kidney can have one. But I sure hope I do not live to see the day when the federal government gets into the business of harvesting the bodies of its poorest citizens. And I hope that I don't live to see the day when instead of maintaining a transplant waiting list, organs are bought and sold on the stock exchange so that the rich may live and the less rich may die. And it would be nice if I could live to see the day when the American Enterprise Institute no longer has the credibility and clout to get something that's really only three steps away from A Modest Proposal into The New York Times instead of contenting itself with The Onion.
The Plaid Adder
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