OP-ED: If we want things, we have to pay for them

It is entirely true that money isn’t everything, that there are values to gifts, charity, and simple human good heartedness. However, something we have found out over the centuries is that if we desire a consistent and large scale supply of something then we’ve got to be willing to pay for it. 

There are many who refuse to believe this. For example, parts of the human body are said to be unsaleable. Kidneys for transplant for example. If someone should wish to gift one that’s fine, to use them from corpses is just fine, but the purchase of one from a live human being is an anathema. 

Well, OK, it’s a moral view but it’s one that leaves us with a problem. There are not enough corpses with usable kidneys to provide for those who need kidney transplants. Nor do voluntary gifts from the living make up the gap. However, the one place in the world that allows -- controlled and managed -- purchases, Iran, also has no people dying while requiring a kidney transplant. 

That is, we can indeed place these moral limits on what may be bought and sold but our end result is that not enough are provided. 

The number of examples possible is large. It is not possible to pay for either sperm or egg donations for IVF treatment in the UK. In fact, for any fertility treatment it is not possible to pay the providers of the gametes. Thus the country imports sperm from Denmark and those requiring eggs must actually, often enough, leave the country. That insistence upon the voluntary nature of the supply imposes costs in people who don’t get any that is.

As my colleagues at the Adam Smith Institute have just pointed out (Bloody Well Pay Them) this applies to certain blood products. For blood itself it has long been seen as simply the market of being a good citizen to donate and that’s fine, in many countries this produces a more than adequate supply. 

There has been a lot of looking down noses at the older American practice of often paying for it. Sellers of a pint that is, rather than donors. It’s also true that that American system isn’t entirely great. When the distribution system started to label blood as to source, paid or donated, it became very clear that the recipients much preferred the donated version. Thinking on who might, and their circumstances, be persuaded to donate a pint of blood by a $20 or $30 payment one can see their point too.

However, when we consider blood plasma we find ourselves on the other side of this effectiveness divide. No country that relies upon donation produces enough plasma for its own use. The few countries that do pay collect much more than is necessary to use locally. Thus the countries that pay for collection (Austria, Hungary, Czechia, Germany and the United States) all export substantial amounts of blood plasma. Actually, those five account for 90% of the global supply, the US for fully 70% of it alone.

That is, the insistence on not sullying the transaction with the grubbery of money means that either there is no supply locally, or there is just no money locally. The plasma is still bought, it’s just bought from foreigners. And while there is a point about having that grubbiness done in another country, out of sight and out of mind, it’s really not quite insisting upon the original moral point, is it? 

We should pay people for the things that we desire from them. Not for any moral reason at all, but simply because that’s how we get an adequate supply of those things that we desire.

It’s also possible to invert the entire discussion and point out that we all already agree with this thought anyway. Exactly those who tell us that, say, blood must be donated voluntarily, are likely to be those who also insist that we don’t solely rely upon charity to solve poverty and inequality. 

We must instead tax and then use government to hand out that forcibly acquired revenue to solve that problem. No, this doesn’t mean I think we should use force to gain kidneys for transplant. But by insisting that voluntary action, charity, won’t solve the problem we have just agreed that voluntary action, charity, won’t solve the problem. We thus have to use some other method to do so.

Pure charity does not solve the supply of kidneys for transplant problem, nor the supply of blood plasma problem. Thus, we have to use some other method -- paying people for them. Or, of course, we can just insist that the problem cannot be solved but then we’ve those examples of the US and Iran that it can be by the right method.

Tim Worstall is a Senior Fellow at the Adam Smith Institute in London.