I should mention that I’m not at all sure that in the particular case of kidneys, permitting sale would be bad. What I am fairly confident of is that most people who are sure it’s obviously good haven’t actually considered some important factors. (I suspect that this is also true of most of those who are sure it’s obviously bad, but I don’t think that’s news here.)
Some relevant considerations on the examples being considered:
The Hospital budget example
The hospital’s budget is a socially determined fact, not a pure material constraint, and it’s an iterated game with a chicken component. By taking the budget as a given, the administrator is allying with the budget-setters who want the hospital to do constrained optimization within the given budget, and not pushing against the constraint by expanding the hospital’s mission. (Cf the Obama administration’s decision not to modify the government’s burn rate after Congress refused to raise the debt ceiling, even as this brought a default steadily closer, because accepting the optimization constraint would ipso facto grant the other side a victory. This is a pretty normal thing in budget & other legislative fights. More generally, refusing to understand tradeoffs is an effective way not to have to make them.)
I expect people will feel less outrage at the decision that acknowledges “tradeoffs” in the following modified scenarios:
A desert island scenario where a fixed budget corresponds directly to a fixed pool of resources, and resource allocation doesn’t affect budget size.
An “uneconomic” expense that seems very good but doesn’t fit people’s sense of what a hospital ought to be doing.
The kidney example
There’s also a reasonable heuristic that people who profit from an inequity are disproportionately likely to be complicit in perpetuating it. Complicity level can take intermediate values between 0 and 1. Even if right now the people excited about buying kidneys aren’t excited about causing poverty, and there’s no one with a current financial interest in lowballing the costs of donating, we can reasonably expect this to change if kidney sales become legal.
The likely bad outcomes would be things like someone getting scammed into giving a kidney when it’s not as good a deal as they’d been led to believe, and the money doesn’t adequately compensate them for the ensuing health problems. I don’t see why I’d expect to find out about whether that sort of thing’s happening in Iran.
I should mention that I’m not at all sure that in the particular case of kidneys, permitting sale would be bad. What I am fairly confident of is that most people who are sure it’s obviously good haven’t actually considered some important factors. (I suspect that this is also true of most of those who are sure it’s obviously bad, but I don’t think that’s news here.)
Some relevant considerations on the examples being considered:
The Hospital budget example
The hospital’s budget is a socially determined fact, not a pure material constraint, and it’s an iterated game with a chicken component. By taking the budget as a given, the administrator is allying with the budget-setters who want the hospital to do constrained optimization within the given budget, and not pushing against the constraint by expanding the hospital’s mission. (Cf the Obama administration’s decision not to modify the government’s burn rate after Congress refused to raise the debt ceiling, even as this brought a default steadily closer, because accepting the optimization constraint would ipso facto grant the other side a victory. This is a pretty normal thing in budget & other legislative fights. More generally, refusing to understand tradeoffs is an effective way not to have to make them.)
I expect people will feel less outrage at the decision that acknowledges “tradeoffs” in the following modified scenarios:
A desert island scenario where a fixed budget corresponds directly to a fixed pool of resources, and resource allocation doesn’t affect budget size.
An “uneconomic” expense that seems very good but doesn’t fit people’s sense of what a hospital ought to be doing.
The kidney example
There’s also a reasonable heuristic that people who profit from an inequity are disproportionately likely to be complicit in perpetuating it. Complicity level can take intermediate values between 0 and 1. Even if right now the people excited about buying kidneys aren’t excited about causing poverty, and there’s no one with a current financial interest in lowballing the costs of donating, we can reasonably expect this to change if kidney sales become legal.
Selling kidneys is legal in Iran. I haven’t heard of any disaster that happened as a result...
The likely bad outcomes would be things like someone getting scammed into giving a kidney when it’s not as good a deal as they’d been led to believe, and the money doesn’t adequately compensate them for the ensuing health problems. I don’t see why I’d expect to find out about whether that sort of thing’s happening in Iran.