Question A:
There is draft legislation in Congress to increase the supply of human kidneys by encouraging donations to strangers: https://www.congress.gov/bill/119th-congress/house-bill/2687
It is summarized here: https://www.hawaiibusiness.com/bipartisan-bill-aims-to-prevent-kidney-deaths-by-compensating-donors/
Existing matching markets for kidney exchange have extended the lives of thousands of Americans with kidney disease.
Responses
Responses weighted by each expert's confidence
Question B:
A one-time $50,000 tax credit for kidney donation to strangers (with the transplants allocated at zero cost to recipients on the basis of waiting times) would save thousands of lives and pay for itself through a reduction in the cost of providing medical care to people suffering from renal failure.
Responses
Responses weighted by each expert's confidence
Question C:
Allowing hospitals to pay people for kidney donation to strangers would be at least as effective at saving lives and more cost effective than a tax credit.
Responses
Responses weighted by each expert's confidence
Question A Participant Responses
Question B Participant Responses
| Participant | University | Vote | Confidence | Bio/Vote History |
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 Daron Acemoglu |
MIT | Did Not Answer | Bio/Vote History | |
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 Mark Aguiar |
Princeton | Bio/Vote History | ||
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 Joseph Altonji |
Yale | Bio/Vote History | ||
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 Alan Auerbach |
Berkeley | Bio/Vote History | ||
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 David Autor |
MIT | Bio/Vote History | ||
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 Abhijit Banerjee |
MIT | Bio/Vote History | ||
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We were not asked whether we are morally comfortable with this idea-simply whether it will pay for itself...
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 Dirk Bergemann |
Yale | Bio/Vote History | ||
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 Marianne Bertrand |
Chicago | Bio/Vote History | ||
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Even if it were to "pay for itself," one should tread very carefully given ethical questions. What's next: a market for lungs, bone marrow, corneas? What if (poor) people are willing to "supply" their organs at an even lower price? Should we totally free up "market forces"? Grim.
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 Markus Brunnermeier |
Princeton | Bio/Vote History | ||
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 Judith Chevalier |
Yale | Bio/Vote History | ||
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 David Cutler |
Harvard | Bio/Vote History | ||
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 Darrell Duffie |
Stanford | Bio/Vote History | ||
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 Aaron Edlin |
Berkeley | Bio/Vote History | ||
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 Barry Eichengreen |
Berkeley | Bio/Vote History | ||
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 Liran Einav |
Stanford | Bio/Vote History | ||
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 Ray Fair |
Yale | Bio/Vote History | ||
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 Edward Glaeser |
Harvard | Bio/Vote History | ||
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 Pinelopi Goldberg |
Yale | Bio/Vote History | ||
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Harvesting organs of convicted felons might also reduce waiting times. Still, it is morally unacceptable!
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 Michael Greenstone |
University of Chicago | Bio/Vote History | ||
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 Oliver Hart |
Harvard | Bio/Vote History | ||
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 Caroline Hoxby |
Stanford | Bio/Vote History | ||
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 Hilary Hoynes |
Berkeley | Bio/Vote History | ||
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Unsure of magnitudes
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 Erik Hurst |
Chicago Booth | Bio/Vote History | ||
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 Kenneth Judd |
Stanford | Bio/Vote History | ||
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This is a natural extension and improvement of the End-Stage Renal Disease (ESRD) program, signed into law by President Richard Nixon in 1972. We need to carefully manage the program to avoid exploding costs.
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 Steven Kaplan |
Chicago Booth | Bio/Vote History | ||
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 Anil Kashyap |
Chicago Booth | Bio/Vote History | ||
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Not clear if the "price" is the right one, or if this is the main policy lever to use, but anything that increases supply would be valuable.
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 Pete Klenow |
Stanford | Bio/Vote History | ||
 Jonathan Levin |
Stanford | Bio/Vote History | ||
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Would likely save lives but some might find the payments "repugnant"
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 Eric Maskin |
Harvard | Did Not Answer | Bio/Vote History | |
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 William Nordhaus |
Yale | Did Not Answer | Bio/Vote History | |
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 Maurice Obstfeld |
Peterson Institute for International Economics | Bio/Vote History | ||
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But likely low thousands because of limited number of folks with tax bills high enough to promptly benefit.
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 Parag Pathak |
MIT | Bio/Vote History | ||
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 Larry Samuelson |
Yale | Bio/Vote History | ||
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Transplants easily pay for themselves in terms of reduced dialyses and related costs.
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 José Scheinkman |
Columbia University | Bio/Vote History | ||
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Since the proposal states that the tax credit will become a net payment to donors with insufficient tax liability it is equivalent to a 50K payment. So why not just send a government check?
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 Richard Schmalensee |
MIT | Bio/Vote History | ||
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 Fiona Scott Morton |
Yale | Did Not Answer | Bio/Vote History | |
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 Carl Shapiro |
Berkeley | Bio/Vote History | ||
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 Robert Shimer |
University of Chicago | Bio/Vote History | ||
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 Stefanie Stantcheva |
Harvard | Bio/Vote History | ||
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 James Stock |
Harvard | Bio/Vote History | ||
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 Chad Syverson |
Chicago Booth | Bio/Vote History | ||
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 Richard Thaler |
Chicago Booth | Bio/Vote History | ||
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No idea about the specific numbers. This is what Al Roth calls a "repugnant transaction". Non-economists resist market solutions.
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 Christopher Udry |
Northwestern | Bio/Vote History | ||
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This is difficult, becase there is a need for balance. The purchase of an organ is a "repugnant transaction". The efficiency gains are obvious, but the market should be excluded from some realms. The tax credit + queuing mechanism help.
-see background information here |
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 Ivan Werning |
MIT | Bio/Vote History | ||
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I am confident providing incentives for donations is part of the solution and can help save lives. I have not seen the calculations showing it "pays for itself", but that seems possible (even if it is not the right metric or threshold for evaluation).
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Question C Participant Responses
| Participant | University | Vote | Confidence | Bio/Vote History |
|---|---|---|---|---|
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Daron Acemoglu |
MIT | Did Not Answer | Bio/Vote History | |
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Mark Aguiar |
Princeton | Bio/Vote History | ||
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Joseph Altonji |
Yale | Bio/Vote History | ||
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Alan Auerbach |
Berkeley | Bio/Vote History | ||
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David Autor |
MIT | Bio/Vote History | ||
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Abhijit Banerjee |
MIT | Bio/Vote History | ||
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The issue is whether the most needy will get the kidneys in an unregulated (or poorly regulated) private market
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Dirk Bergemann |
Yale | Bio/Vote History | ||
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Marianne Bertrand |
Chicago | Bio/Vote History | ||
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Markus Brunnermeier |
Princeton | Bio/Vote History | ||
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Judith Chevalier |
Yale | Bio/Vote History | ||
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Some tricky questions here such as what drives hospital wtp which will be different from the societal value.
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David Cutler |
Harvard | Bio/Vote History | ||
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Darrell Duffie |
Stanford | Bio/Vote History | ||
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Aaron Edlin |
Berkeley | Bio/Vote History | ||
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Barry Eichengreen |
Berkeley | Bio/Vote History | ||
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Liran Einav |
Stanford | Bio/Vote History | ||
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Ray Fair |
Yale | Bio/Vote History | ||
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Edward Glaeser |
Harvard | Bio/Vote History | ||
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Pinelopi Goldberg |
Yale | Bio/Vote History | ||
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Same as previous answer. Cost effectiveness is the wrong metric, it is a matter of moral values.
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Michael Greenstone |
University of Chicago | Bio/Vote History | ||
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Oliver Hart |
Harvard | Bio/Vote History | ||
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Given morality and equity issues, we need a centralized market. Leaving it to hospitals would not achieve this. Prices could vary and this would make it harder for people to accept the idea of monetary payments. Also the 50K is structured to be equivalent to a direct payment.
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Caroline Hoxby |
Stanford | Bio/Vote History | ||
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Hilary Hoynes |
Berkeley | Bio/Vote History | ||
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Depends on the amount
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Erik Hurst |
Chicago Booth | Bio/Vote History | ||
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Kenneth Judd |
Stanford | Bio/Vote History | ||
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While I agree with this statement, it is vague about how this would work and what its advantages would be relative to the proposal being considered.
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Steven Kaplan |
Chicago Booth | Bio/Vote History | ||
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Anil Kashyap |
Chicago Booth | Bio/Vote History | ||
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The ethics here are tricky and if there are some scandals over the allocations things could backfire. I can imagine a better system that works like this, but I am not sure that is what would emerge.
-see background information here |
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Pete Klenow |
Stanford | Bio/Vote History | ||
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Agree subject to the caveat (see citation below).
-see background information here |
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Jonathan Levin |
Stanford | Bio/Vote History | ||
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Likely effective at generating transplants but raises similar and perhaps more acute repugnance objections as prior proposal
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Eric Maskin |
Harvard | Did Not Answer | Bio/Vote History | |
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William Nordhaus |
Yale | Did Not Answer | Bio/Vote History | |
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Maurice Obstfeld |
Peterson Institute for International Economics | Bio/Vote History | ||
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As as purely economic question, yes, this is more efficient. There are issues around governance, ethics, and the ultimate source of funding that the question does not specify. In general, the cost savings from more kidney transplants that obviate dialysis are huge.
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Parag Pathak |
MIT | Bio/Vote History | ||
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Larry Samuelson |
Yale | Bio/Vote History | ||
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José Scheinkman |
Columbia University | Bio/Vote History | ||
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Without the 50K subsidy from taxpayers, it is possible that fewer kidney transplants from strangers would occur. Allocations to receivers would also change, because hospitals would probably favor patients able to pay at least part of the added cost.
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Richard Schmalensee |
MIT | Bio/Vote History | ||
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Not clear what incentives a hospital would have to pay somebody to donate a kidney that would be used in another hospital.
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Fiona Scott Morton |
Yale | Did Not Answer | Bio/Vote History | |
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Carl Shapiro |
Berkeley | Bio/Vote History | ||
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Robert Shimer |
University of Chicago | Bio/Vote History | ||
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Stefanie Stantcheva |
Harvard | Bio/Vote History | ||
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James Stock |
Harvard | Bio/Vote History | ||
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Chad Syverson |
Chicago Booth | Bio/Vote History | ||
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Richard Thaler |
Chicago Booth | Bio/Vote History | ||
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I don't know what the tax refund aspect is doing but it will add complexity.
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Christopher Udry |
Northwestern | Bio/Vote History | ||
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Again hard. Despite the obvious efficiency losses this is a line that should not be crossed. Elizabeth Anderson is excellent on related topics in the book below.
-see background information here |
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Ivan Werning |
MIT | Bio/Vote History | ||
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It would also raise donations and save lives. But a cost comparison is difficult without more precision, e.g. price may not be the same. The tax credit also has a delayed benefit built in, which may be considered a feature.
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