You can do a lot of good if you don't worry about who gets the credit

Shane Greenstein's' piece on false claims of credit for inventing email got me thinking about the larger question of attributing and claiming credit (especially after I initially mis-identified Shane as his co-blogger JG who shared the post to G+...).  Often, accomplishments have many parents. (And sometimes someone who helps disseminate the news is mistakenly credited as its source.)

Market design in particular is an outward facing part of economics, and much of what needs to be accomplished requires economists to play a helping role. So I've always liked the sentiment in the title of this post, whose origins turn out to be (fittingly) hard to attribute. Quote Investigator looks into it and finds many early origins and variations.

[1] A man may do an immense deal of good, if he does not care who gets the credit for it.

[2] This was the opportunity for a man who likes to do a good thing in accordance with the noble maxim … “Never mind who gets the credit.”

[3] The way to get things done is not to mind who gets the credit of doing them.

[4] There is no limit to what a man can do who does not care who gains the credit for it.

"These sayings are certainly not identical, but they are closely interlinked thematically. Quotation number [1] appeared in a diary entry from the year 1863 in which the words were recorded as spoken by a Jesuit Priest named Father Strickland. This is the earliest citation located by QI.

In 1896 the text of [2] was published, and the phrase “Never mind who gets the credit” was dubbed the noble maxim of Edward Everett Hale.

In 1905 quotation [3] was published, and the words were attributed to Benjamin Jowett who was a theologian and classical scholar at Oxford University. But one of the author’s who made this attribution decided it was flawed, and in a later book he reassigned credit for the saying from Jowett to a “Jesuit Father”. This is probably a reference to Father Strickland. This maxim is the same as quote [A] given by the questioner above.

Expression [4] was used by Charles Edward Montague in 1906, but he did not claim coinage of the phrase. He said it was the favorite saying of his friend and colleague the journalist William T. Arnold. But Montague did not credit Arnold as originator either. He left the attribution anonymous by using the locution “someone has said”.

In 1922 Montague published a close variant of saying [4], “There is no limit to what a man can do so long as he does not care a straw who gets the credit”, in his book “Disenchantment”. For this reason he is sometimes cited in modern texts and databases.

Finally, quotation [B] which is similar to [4] appeared in the 1980s on a small plaque atop the desk in the Oval Office of the White House during the Presidency of Ronald Reagan."

[B] There is no limit to what a man can do or where he can go if he doesn’t mind who gets the credit.

Credit cards, data mining, incentives

Two recent stories point to the fact that banks, seeking to control their lending, are selectively suspending credit cards or cutting credit limits, based on data about individuals' credit card use. This introduces some interesting incentive problems, quite different from usual credit card decisions.

The NY Times story, American Express Kept a (Very) Watchful Eye on Charges , reports
"In some instances, if it didn’t like what it was seeing, the company has cut customer credit lines. It laid out this logic in letters that infuriated many of the cardholders who received them. “Other customers who have used their card at establishments where you recently shopped,” one of those letters said, “have a poor repayment history with American Express.”
"It sure sounded as if American Express had developed a blacklist of merchants patronized by troubled cardholders. But late this week, American Express told me that wasn’t the case. The company said it had also decided to stop using what it has called “spending patterns” as a criteria in its credit line reductions. "...

"American Express wouldn’t have been the first company to try cordoning off certain industries. Last year, CompuCredit, a subprime lender, got in trouble with the Federal Trade Commission for failing to disclose that it could reduce customers’ credit lines for using their cards at various establishments.
What was on CompuCredit’s no-go list? Marriage counselors, tire retreading and repair shops, bars and nightclubs, pool halls, pawnshops and massage parlors, among others. "

The Globe story, Lenders abruptly cut lines of credit, focuses on customers who have had their cards suspended.

"Many of the credit lines being taken away or reduced have not been used recently, according to people who track the business. Dennis Moroney of TowerGroup, a Needham research firm, called it the "kitchen drawer" syndrome because some consumers keep cards they don't need or don't use often. Card issuers are trying to rein in such accounts before they get tapped for emergencies in the slumping economy, Moroney said."...

"...if you have a card you haven't used in a while that you want to keep, ... "Buy something inexpensive and pay it off that month." "

Marriage markets and credit markets

 With attitudes about money being an important ingredient of marital compatibility, is it any wonder that a readily available index for one is (apparently) increasingly being used to judge the other? The NY Times is on the story: Even Cupid wants to know your credit score


"The credit score, once a little-known metric derived from a complex formula that incorporates outstanding debt and payment histories, has become an increasingly important number used to bestow credit, determine housing and even distinguish between job candidates.

"It’s so widely used that it has also become a bigger factor in dating decisions, sometimes eclipsing more traditional priorities like a good job, shared interests and physical chemistry. That’s according to interviews with more than 50 daters across the country, all under the age of 40.

“Credit scores are like the dating equivalent of a sexually transmitted disease test,” said Manisha Thakor, the founder and chief executive of MoneyZen Wealth Management, a financial advisory firm. “It’s a shorthand way to get a sense of someone’s financial past the same way an S.T.D. test gives some information about a person’s sexual past.”
...
"A handful of small, online dating Web sites have sprung up to cater specifically to singles looking for a partner with a tiptop credit score. “Good Credit Is Sexy,” says one site,Creditscoredating.com, which allows members to view the credit scores of potential dates who agree to provide the numbers.

"On another site, Datemycreditscore.com, a member posted on the Web site’s home page that others should to “stop kidding” themselves and realize that credit scores do matter."

Tax credit for adopting a child

Philip Held draws my attention to this oped from the WSJ, by By Jedd Medefind (who is president of the Christian Alliance for Orphans, and formerly led the White House Office of Faith Based and Community Initiatives (2008-09)).

The Adoption Tax Credit Saves Money
The foster system costs over $25,000 a year for each child.

"The adoption tax credit, which provides up to $13,570 to aid families in adopting a child, has teetered on a razor’s edge in tax-reform negotiations. But the bills passed by the House and Senate both ultimately preserved it, and now the conference committee should follow suit. Eliminating the credit would harm children who need families, while hitting America in the pocketbook.

"There are more than 115,000 children in foster care today. About half of them will be adopted, but without the tax credit that number would drop significantly. The rest “age out” of foster care, likely without family for life.
...
"Families don’t adopt to get a tax credit. But the costs of going through the process—and then meeting the needs of a child coming from a hard place—can be a major barrier. After the adoption tax credit first became widely available in 1997, adoptions from foster care nearly doubled in three years.

"A drop in adoptions would mean fewer [children] finding families. It would also push government spending higher in many areas. Government’s replacement for parents—the foster system—costs taxpayers well over $25,000 a year for each child, according to a 2011 report by the National Council for Adoption. That doesn’t count spending on a huge number of other programs that chip in, including food stamps, Medicaid and Temporary Assistance for Needy Families."
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Here's the 2011 report.
"Comparing the per-child cost ofsubsidized adoption from fostercare with the cost of maintaininga child in foster care, one concludes that the child adoptedfrom foster care costs the publiconly 40 percent as much as thechild who remains in fostercare. The difference in cost perchild per year amounts to$15,480."
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I can't help seeing a strong analogy between

• adoption saving kids from foster care;
• kidney transplants saving patients from dialysis; and
• adoptive parents being analogous to kidney donors...

Coalition to Modify NOTA (the National Organ Transplant Act of 1984)

 Elaine Perlman forwards the following discussion points:

Coalition to Modify NOTA Talking Points

modifyNOTA.org

What is the Coalition to Modify NOTA proposing? The Coalition to Modify NOTA proposes providing a $50,000 refundable tax credit to remove all disincentives for American non-directed kidney donors who donate their kidney to a stranger at the top of the kidney waitlist in order to greatly increase the supply of living kidney transplants, the gold standard for patients with kidney failure.

What is the value of a new kidney? The value of a new kidney, in terms of quality of life and future earnings potential, is between $1.1 million and $1.5 million.

What is the American kidney crisis? Fourteen Americans on the waiting list for a kidney transplant die each day. That number does not include the many kidney failure patients who are not placed on the waiting list but would have benefited from a kidney transplant if we had no shortage. The total number of Americans with kidney failure will likely exceed one million by 2030. 

Why not rely on deceased donor kidneys to end the shortage? A living kidney transplant lasts on average twice as long as a deceased donor kidney. Fewer than 1 in 100 Americans die in a way that their kidneys can be procured. Currently, the 60% of Americans who are registered as deceased donors provide kidneys for 18,000 Americans annually. Even if 100% of Americans agreed to become organ donors, this would raise donations by only about 12,000 per year. In the USA, 93,000 Americans are on the kidney waitlist. A total of 25,000 people are transplanted annually, two-thirds from deceased donors and one-third from living donors. The size of the waitlist has nearly doubled in the past 20 years, while the number of living donors has not increased.

What is the extra value that non-directed kidney donors provide? Non-directed kidney donors often launch kidney chains that can result in a multitude of Americans receiving kidneys. Fewer than 5% of all living kidney donations are from non-directed kidney donors who are an excellent source of organs for transplantation because they are healthier than the general population. 

 

How much does the taxpayer currently spend on dialysis? Kidney transplantation not only saves lives; it also saves money for the taxpayer. The United States government spends nearly $50 billion dollars per year (1% of all $5 trillion collected in annual taxes) to pay for 550,000 Americans to have dialysis, a cost of approximately $100,000 per year per patient, a treatment that is far more expensive than transplantation.

 

How many more lives will be saved with the refundable tax credit for non-directed donors? The number of non-directed donors increased from 18 in 2000 to around 300 each year. After our Act becomes law, we estimate that we will add approximately 7,000 non-directed donor kidneys annually. That is around 70,000 new transplanted Americans by year ten. 

 

How much tax money will be saved once the Act is passed? The refundable tax credit will greatly increase the number of living donors who generously donate their kidneys to strangers. We estimate that in year ten after the Act is passed, the taxpayers will have saved $12 billion. 

 

What is a refundable tax credit? A refundable tax credit can be accessed by both those who do and those who do not pay federal taxes. 

 

What do Americans think about compensating living kidney donors? Most Americans favor compensation for living kidney donors  to increase donation rates. 

 

Who is able to donate their kidneys?  Donation requires potential organ donors to undergo a comprehensive physical and psychological evaluation, and each transplant center has its own rigorous criteria. Only around 5% of those who pursue evaluation actually end up donating, and only about one-third of Americans are healthy enough to be donors. Providing financial incentives will encourage more Americans to donate their kidneys to help those with kidney failure.

 Do kidney donors currently have expenses that result from their donation? The medical costs of donation are covered by the recipients' insurance, but donors are responsible for providing for the costs of their own travel, out-of-pocket expenses, and lost wages. Programs like the federal NLDAC and NKR's Donor Shield can help offset these costs, making donation less expensive.

Is it moral to compensate kidney donors? Compensation for kidney donors can be viewed as a way to address the current kidney shortage and save lives. Americans are compensated for various forms of donation such as sperm, eggs, plasma, and surrogacy, all of which involve giving life. 

How long do we need to compensate living kidney donors? Compensation should continue until a xenotransplant or advanced kidney replacement technology becomes available. In the meantime, it's crucial to prevent further loss of lives due to the shortage.

 Will incentivizing donors undermine altruism?  Financial compensation for donors can coexist with altruism. Donors can opt out of the funds from the tax credit or choose to donate those funds to charity. The majority of donors support financial compensation, and relying solely on altruism has led to preventable deaths.

 In addition to ending the kidney shortage, what are other benefits of the Act? The Act can help combat the black market for kidneys and reduce human trafficking because we will have an increased number of transplantable kidneys. It can also motivate individuals to become healthier to pass donor screening, potentially further reducing overall healthcare costs.

 Why provide non-directed donors with a refundable tax credit of $50,000? The compensation is designed to attract those who are both healthy and willing to donate. Given the commitment, time, and effort involved in the donation process, this compensation recognizes the value of those who save lives and taxpayer funds.

 When more donors step forward, can transplant centers increase the number of surgeries?  There is considerable unused capacity at most U.S. transplant centers, and increasing the number of donors is likely to lead to more surgeries. The goal is to perform more kidney transplants and reduce the waitlist, benefiting patients in need.

 In what way does the Act uphold The Declaration of Istanbul?  While the Act deviates from one principle of the Declaration of Istanbul by offering compensation, it aligns with the other principles and is expected to standardize compensation and reduce worldwide organ trafficking.

 What about dialysis as an alternative to transplant?  Dialysis, while a treatment option, can be a challenging and uncomfortable process for patients. For those who could have been transplanted if there were no kidney shortage, dialysis can result in needless suffering and an untimely death.

 Why not compensate living liver donors? Liver donation is riskier and not as cost-effective as kidney donation. While the Act currently focuses on kidney donors, it's possible that compensation for liver donors could be considered in the future.

 What about the argument that providing an incentive to donate will exploit the donors, especially low income donors? 

Primarily middle and low income kidney failure patients are dying due to the kidney shortage. People with lower incomes tend to have social networks with fewer healthy people because health is related to income level. In addition, being placed on a waitlist often costs money. Kidney donation also costs money, an estimated 10% of annual income. The refundable tax credit will help low income donors and recipients the most by making donation affordable and increasing the number of kidneys for those waiting the longest on the waitlist, frequently middle and low income Americans. The tax credit aims to help those most affected by the kidney shortage, as poorer and middle-income individuals often bear the brunt of the kidney crisis’s consequences. The Act will level the playing field, making it easier for those at all income levels to receive a life-saving kidney. 

Please examine this chart:

 

Shane Greenstein on a false history of email

Sometimes people believe that they deserve more credit than they're getting, and Shane Greenstein writes about a man who believes he should be credited with inventing email.  (Earlier this morning I mistakenly identified the author of the post as Shane's co-blogger Joshua Gans; apologies to both.) Apparently the fellow who thinks he invented email and should get the credit for it is pretty clearly mistaken, but the Huffington Post took the bait, and so Shane organizes his post about how that makes HuffPo a much less trustworthy news source than he had hoped. (Apparently some things on the internet just aren't true...)  HuffPo and the Loss of Trust

"Now for the detail: HuffPo published a multipart history of email that is historically inaccurate. Yes, you read correctly. More specifically, a few of the details are correct, but those are placed next to some misleading facts, and these are embedded in a certifiably very misleading historical narrative. The whole account cannot be trusted.

The account comes from one guy, Shiva Ayyadurai, who did some great programming as a teenager. He claims to have invented electronic mail in 1978 when he was fourteen. He might have done some clever programming, but electronic mail already existed by the time he did his thing. Independent invention happens all the time in technological history, and Shiva is but another example, except for one thing. He had his ideas a little later than others, and the other ideas ended up being more influential on subsequent developments. Shiva can proudly join the long list of geeky teenagers who had some great technical skills at a young age, did some cool stuff, and basically had little impact on anybody else.

Except that Shiva won’t let it go. This looks like nothing more than Shiva’s ego getting in the way of an unbiased view.

Look, it is extremely well established that the email systems in use today descended from a set of inventors who built on each other’s inventions. They did their work prior to 1978. For example, it is well documented that the “@” in every email first showed up in 1971. Ray Tomlinson invented that. Others thought it was a good idea, and built on top of the @. We all have been doing it ever since. Moreover, this is not ancient history. Tomlinson has even written about his experiences, and lots of people know him. This is easy to confirm.

Though Ayyadurai’s shenanigans were exposed a few years ago, he persists. In the HuffPo piece yet again he pushes the story in which his inventions played a central place in the history of electronic mail. This time he has a slick infographic telling his version of things, and he managed to get others to act as shills for his story. He also now accuses others of fostering a conspiracy against his views in order to protect their place in history and deny him his.As if. “A teenager invented electronic mail” might be a great headline, and it might sound like a great romantic tale, but this guy is delusional."

Shane focuses on trust in news sources, but I can't help sympathize a bit with the delusional guy.  I know of many cases in which someone feels, often with considerable justice, that they don't get the credit they deserve. That's part of the problem with apportioning credit, and it may be a near universal feeling. You can certainly witness it among academics, and probably also among top athletes who don't make it to the Olympic podium or the Hall of Fame, and maybe even among some of those who do. Maybe a good sanity check on whether you are delusional is if you think there's a conspiracy...

Why might machine learning be unfair?

Hear Aaron Roth speak on this at Penn Law School, starting around minute 7:30 (you can control the video from under where the slides appear, and you can also speed it up--1.5x is still quite intelligible):

What is Machine Learning? And Why Might it be Unfair? at the Optimizing Government Workshop

Here's a slide I liked from minute 35, about why a simple classifier rule might be a better judge of a majority population than of a minority population, simply because there are a lot more data points for the majority. (+'s are people who paid back their loans, -'s did not, the trick is to predict who will pay based on observables, in this case number of credit cards and SAT scores. The orange population is in fact more credit worthy, but has overall lower SAT scores. If you can only use one classifier, the best one is the blue line: and it denies credit to all the orange folks. If you could take group membership into account and use two lines, you could also distinguish the credit worthy oranges...)

Misc. repugnant transactions: marijuana, camel meat, and concealed carry on campus

The Maastricht ban on selling marijuana to foreign tourists is spreading to the rest of Holland:
Dutch govt to ban tourists from cannabis shops (HT Bettina Klaus)
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A little-noticed move by American Express to ban the purchase of medical marijuana with its credit cards has reignited a longstanding debate: How much can a credit card company control what you buy?
        To the surprise of consumers, major credit card companies are making decisions about what they can and can't buy with their credit cards. What's off-limits? Legal purchases like gambling chips and donations to at least one controversial non-profit organization; in some cases, buying pornography is also restricted, and so, increasingly, is medical marijuana. Last month, shortly before Delaware became the 16th state to legalize medical marijuana, American Express told merchants that its cards could not be used to buy it.
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Good news for camel meat lovers: The Knesset's Defense and Foreign Affairs Committee annulled various outdated regulations Monday, including a longtime ban on the sale of camel meat. (HT Assaf Romm)
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And those of you looking forward to concealed carry on campus will have to wait a bit longer, even in the Lone Star State:
State legislators in Texas could not meet Monday's end-of-session deadline to pass a bill that would have allowed people to carry concealed weapons on campus -- meaning a win for higher education leaders, who almost uniformly opposed the legislation.

Kidney sales and incentives for donors: current controversy

The American Journal of Transplantation has over the past year been full of surveys about the attitudes of various groups towards compensation of organ donors, including particularly live kidney donors. The groups surveyed have included transplant surgeons, the general public, kidney patients, and kidney donors. The surveys reveal a great deal of variance within groups, but a surprising willingness across groups to consider various kinds of compensation for donors, especially when subject to government regulation. So there's at least a suggestion that some kinds of payment to donors may one day become a "formerly repugnant transaction," i.e. it seems that its status as a repugnant transaction may be shifting.

The discussion was punctuated by a signed editorial, with a surprisingly contemptuous tone, called “Kidneys for Sale: Whose Attitudes Matter?”  It took the point of view that kidney transplantation is a business run by kidney surgeons, and that no one else's opinions should be consulted on matters of health policy related to kidney patients.

This is an especially surprising view given that kidney disease is treated very specially by Medicare, to the great benefit of kidney patients (as well as kidney surgeons). (Medicare is financed primarily by payroll taxes and general tax revenues, as well as premia paid by beneficiaries, and it presently spends about $8 billion a year on dialysis, for example; see Medpac for good Medicare background).

But the view of the editorialists that kidney transplantation is only about surgeons seems to be a fringe view (certainly not shared by the surgeons I've had an opportunity to work with on kidney exchange, although they have varied opinions on donor compensation). Subsequent letters to the AJT rebuked the editorialists, not only for their contemptuousness, but also for misrepresenting the data from the survey of transplant surgeons.

Below are the citations, with abstracts of the articles, and excerpts from the editorial and letters, since those don't have abstracts.

Stimulus for Organ Donation: A Survey of the American Society of Transplant Surgeons Membership by J. R. Rodrigue, K. Crist, J. P. Roberts, R. B. Freeman Jr., R. M. Merion and A. I. Reed, Am J Transplant 2009; 9 (September): 2172–176.
     "Federal legislation has been proposed to modify the National Organ Transplant Act in a way that would permit government-regulated strategies, including financial incentives, to be implemented and evaluated. The Council and Ethics Committee of the American Society of Transplant Surgeons conducted a brief webbased survey of itsmembers’ (n = 449, 41.6% response rate) views on acceptable or unacceptable strategies to increase organ donation. The majority of the membership supports reimbursement for funeral expenses, an income tax credit on the final return of a deceased donor and an income tax credit for registering as an organ donor as strategies for increasing deceased donation. Payment for lost wages, guaranteed health insurance and an income tax credit are strategies most strongly supported by the membership to increase living donation. For both deceased and living donation, the membership is mostly opposed to cash payments to donors, their estates or to next-of-kin. There is strong support for a government-regulated trial to evaluate the potential benefits and harms of financial incentives for both deceased and living donation. Overall, there is strong support within the ASTS membership for changes to NOTA that would permit the implementation and careful evaluation of indirect, government-regulated strategies to increase organ donation."

"How Different Conceptions of Risk Are Used in the Organ Market Debate," by A. Aronsohn, J. R. Thistlethwaite, Jr., D. L. Segev, and L. F. Ross, American Journal of Transplantation, 10, 4, 931-937, APR 2010
"The success of kidney and liver transplantation is hindered by a shortage of organs available for transplantation. Although currently illegal in nearly all parts of the world, a living 'donor' or 'vendor' kidney market has been proposed as a means to reduce or even end this shortage. Physician members of the American Society of Transplantation, the American Society of Transplant Surgeons and the American Association for the Study of Liver Disease were surveyed regarding organ markets for both living kidney and living liver transplantation. The survey queried respondents about their attitudes toward directed living donation, nondirected living donation, the potential legalization of living donor organ markets and the reasons for their support or opposition to organ markets. Partial or completed surveys were returned by 346 of 697 eligible respondents (50%). While virtually all supported or strongly supported directed living donation (98% and 95% for kidney and liver lobes, respectively), the vast majority disagreed or strongly disagreed with the legalization of living donor organ markets (80% for kidneys and 90% for liver lobes). Both those who support and those who oppose a legalized living donor organ market rate risk to the donor among the most important factors to justify their position."


Leider, Stephen and Alvin E. Roth, “Kidneys for sale: Who disapproves, and why?” American Journal of Transplantation, 10 (May), 2010, 1221-1227.
     "The shortage of transplant kidneys has spurred debate about legalizing monetary payments to donors to increase the number of available kidneys. However, buying and selling organs faces widespread disapproval.
We survey a representative sample of Americans to assess disapproval for several forms of kidney market, and to understand why individuals disapprove by identifying factors that predict disapproval, including disapproval of markets for other body parts, dislike of increased scope for markets and distrust of markets generally. Our results suggest that while the public is potentially receptive to compensating kidney donors, among those who oppose it, general disapproval toward certain kinds of transactions is at least as important as concern about specific policy details. Between 51% and 63% of respondents approve of the various potential kidney markets we investigate, and between 42% and 58% want such markets to be legal. A total of 38% of respondents disapprove of at least one market.
Respondents who distrust markets generally are not more disapproving of kidneymarkets; however we find significant correlations between kidney market disapproval and attitudes reflecting disapproval toward certain transactions—including both other body markets andmarket encroachment into traditionally nonmarket exchanges, such as food preparation."


Patient Willingness to Pay for a Kidney for Transplantation, by D. K. Herold,
American Journal of Transplantation, Volume 10, Issue 6, pages 1394–1400, June 2010
     "While kidney transplantation is the most cost-effective treatment available for end-stage renal disease (ESRD) and affords patients with the best quality of life, the current supply of kidneys does not meet the demand. A potential solution to increasing the supply is to compensate living donors for a kidney. The purpose of this study was to describe ESRD patient willingness to pay for a kidney. Using a self-administered survey, 107 patients in 31 U.S. states completed the survey. The quantitative method and descriptive survey design employed descriptive, correlational, nonparametric and multivariate statistical tests to evaluate the data. Of participants, 78.5% were willing to pay for a kidney; there were significant correlations between gender, health status, household income, preferred source of a kidney and willingness to pay. Men, patients with poor and fair health status and those with household incomes ≥$50 000 were more willing to pay. Step-wise regression analysis found price and doctor’s influence accounting for 52% of variance in willingness to pay. As price increased and doctor’s opinion mattered, willingness to pay increased. This study supports development of additional studies with
larger sample sizes and patients on kidney transplant waiting lists."

 
"For Love or Money? Attitudes Toward Financial Incentives Among Actual Living Kidney Donors", by M. C. Van Buren, E. K. Massey, L. Maasdam, W. C. Zuidema, M. T. Hilhorst, J. N. IJzermans and W. Weimar, American Journal of Transplantation, Volume 10, Issue 11, pages 2488–2492, November 2010
     "Due to lengthening waiting lists for kidney transplantation, a debate has emerged as to whether financial incentives should be used to stimulate living kidney donation. In recent surveys among the general public approximately 25% was in favor of financial incentives
while the majority was opposed or undecided. In the present study, we investigated the opinion of living kidney donors regarding financial incentives for living kidney donation. We asked 250 living kidney donors whether they, in retrospect, would have wanted a financial reward for their donation.We also investigated whether theywere in favor of using financial incentives in a government-controlled system to stimulate living anonymous donation. Additionally, the type of incentive deemed most appropriate was also investigated.
In general almost half (46%) of the study population were positive toward introducing financial incentives for living donors. The majority (78%) was not in favor of any kind of reward for themselves as they had donated out of love for the recipient or out of altruistic principles. Remarkably, 60% of the donorswere in favor of a financial incentive for individuals donating anonymously. A reduced premium or free health insurance was the preferred incentive."

And here is the editorial against finding out what non-surgeons think:

D. L. Segev and S. E. Gentry “Kidneys for Sale: Whose Attitudes Matter?” American Journal of Transplantation 2010; 10: 1113–1114
"...Should we devote resources to investigating the nuances of public attitudes toward these markets? Probably not, for two major reasons."
"First, nothing else is relevant until physicians support organ sales....
"Second, and more importantly from a logistical standpoint, is that it will take an act of Congress—that is the reversal of the National Organ Transplant Act (NOTA) of 1984—to make organ markets a reality. And this act will be nearly impossible to come by."

And the following two entries are letters to the editor objecting to the Segev-Gentry editorial, the first by Arthur Matas (a kidney transplant surgeon and former president of the American Society of Transplant Surgeons), the second by Sally Satel, a doctor, kidney recipient, and commentator working at the American Enterprise Institute.

A. J. Matas, Department of Surgery, University of Minnesota
"Markets or Incentives: Terminology Is Critical," American Journal of Transplantation 2010; 10: 2374
     "I am disappointed in Segev and Gentry’s Editorial (1) regarding Leider and Roth’s survey, which was recently published in The American Journal of Transplantation (2). Leider and Roth conducted a survey of public attitudes regarding markets for living and deceased donation. They found that a majority of respondents approved of either individual or government payment for either living or deceased donation (although there was considerably stronger support for government payment).
     "Segev and Gentry respond by noting that a survey of the membership of the American Society of Transplant Surgeons (ASTS) showed that only 20% were in favor of ‘cash
payments’ for donation (3). Segev and Gentry are correct. But what they did not note in their editorial,was that for deceased donation, the majority of ASTS respondents were
in favor of funeral expenses (73%), an income tax credit (65%) and about halfwere in favor of a donation to a charity selected by the donor’s family (51%) and reimbursement
of next-of-kin expenses (56%). For living donation, the majority supported payment of lost wages (76%), payment of health insurance premiums (72%) or an income tax credit
(64%) and 56% supported payment of life insurance premiums."...
     "It is a disservice to the debate and discussion to present only part of the ASTS survey results. There are other issues with Segev and Gentry’s Editorial. They suggest that doing these kinds of public opinion surveys are a waste of resources because: (a) physicians are against ‘sales’ and (b) to establish trials of ‘organ markets’ would require changing the law (1). However, using the same survey data that they quote (see above), (a) physicians are in favor of incentives (and before trials of incentives could be developed the law would need to be changed) and (b) legislators are certainly going to be more inclined to change the law if the public supports such a change. Finally, they conclude that the many recent advances in donation may solve the tremendous organ shortage problem,
making need for incentives moot. But the data says otherwise;  in spite of laparoscopic nephrectomy, use of ECDs, DCD, desensitization and paired exchange, there has been little or no increase in donation over the last few years and the wait list for a kidney transplant has continued to grow (4)."

Sally Satel, "The Physicians’ Voice Is Only One of Many," American Journal of Transplantation 2010; 10: 2558
    "...medical policy is a social activity, not a guild enterprise. The traditions and preferences of learned practitioners have a large role, to be sure, but they are not, nor
should they be, the sole determinants of clinical policies."
...
"As for physician opinion, Segev and Gentry relate only half of the story. True, a mere one-fifth of physician respondents to an ASTS poll endorsed cash payments to donors (1). Unmentioned, however, is the highly significant fact that 64% of respondents favored income tax credits to living donors (12% were neutral or undecided). This finding has critical policy relevance because it is regulated in-kind benefits, such as tax credits, not free market cash exchange, that have long been the basis for serious reform efforts in Congress and in state legislatures. Notably, the American Medical Association has endorsed proposals for pilot trials on three occasions between 1995 and 2008 (1995, 2003 and 2008) (3)."

Decline and decay of nudges

 Here's the latest paper to suggest that small "nudges" can have much less of a lasting effect than was initially thought.

The Semblance of Success in Nudging Consumers to Pay Down Credit Card Debt  by Benedict Guttman-Kenney, Paul D. Adams, Stefan Hunt, David Laibson, Neil Stewart & Jesse Leary, NBER WORKING PAPER 31926 DOI 10.3386/w31926  December 2023

Abstract: We run a field experiment and a survey experiment to study an active choice nudge. Our nudge is designed to reduce the anchoring of credit card payments to the minimum payment. In our field experiment, the nudge reduces enrollment in Autopaying the minimum from 36.9% to 9.6%. However, the nudge does not reduce credit card debt after seven payment cycles. Nudged cardholders tend to choose Autopay amounts that are only slightly higher than the minimum payment. The nudge lowers Autopay enrollment resulting in increasing missed payments. Finally, the nudge reduces manual payments by cardholders enrolled in Autopay.

The credit crisis and market design

The WSJ, in its Real Time Economics Blog and in a related story in their January 2 issue, raises some questions about how discussion of financial market regulation has turned into a discussion of market design (although that's not exactly the way they put it). They recount the poor reception given to Raghuram G. Rajan's 2005 presentation at the Fed's Jackson Hole conference in honor of Alan Greenspan. Prof. Rajan noted that banks' increased exposure to the securities markets would make them less able to serve as a source of credit in a crisis, and his concerns were, the story reports, met with disdain by those assembled. The blog summarizes the attitude at the time:

"The episode suggests one reason that the crisis went unchecked: A dangerous all-or-nothing orthodoxy had come to dominate the policy debate, where one was either for free markets or against them. "

The point of the market design movement, of course, is that markets aren't either "free" or non-existent. A better description is that markets have rules, and some rules work better than others, and the goal of regulators and others who shape the rules should be to find rules that enable markets to work better.

However the WSJ blog also quotes Professor Rajan on the difficulties facing academics who wish to offer opinions on compex issues of public policy:
"“Most academics are really reluctant to take part in the public dialog, because the public dialog requires you to have an opinion about things you can’t really be sure about,” says Mr. Rajan. “They fear talking about things where everything is not neatly nailed in a model. They stay away and let the charlatans occupy the high ground.” "


(The story notes that calls for sensible regulation and market design were met with condescension before the credit crisis, a condescension that is being reevaluated now. So perhaps now is the chance I've been waiting for to note that an anagram for MARKET DESIGN is NEGATED SMIRK :-)

Legislative proposals to help living kidney donors

 Martha Gershun brings us up to date on various proposed pieces of legislation to help organ donors and increase access to transplants.

Legislative Efforts to Support Living Kidney Donors,  by Martha Gershun, Guest Blogger

"As a member of the Expert Advisory Panel to the Kidney Transplant Collaborative, I have been honored to provide input during the development of the organization’s priority legislation, the Living Organ Volunteer Engagement (LOVE) Act.  This legislation would help build a comprehensive national living organ donor infrastructure that would support a national donor education program, create a donor navigator system, ensure appropriate donor cost reimbursement, collect essential data, and improve all aspects of living organ donation across the country, substantially reducing barriers that limit participation today.

Key provisions of the LOVE Act would:

• Provide reimbursement for all direct and indirect costs for living donation, including lost wages up to $2,500 per week.
• Provide life and disability insurance for any necessary care directly caused by donation.
• Modify NLDAC rules so neither the recipient’s income nor the donor’s income would be considered for eligibility.
• Provide for new public education program on the importance and safety of living organ donation.
• Provide for new mechanisms to collect and analyze data about living organ donation to enable evidence-based continuous process improvement.

Numerous other federal proposals are also currently vying for support to address barriers to living donation on a national level.  They include:

Living Donor Protection Act (H.R. 2923, S. 1384)

• Prohibits insurance carriers from denying, canceling, or imposing conditions on policies for life insurance, disability insurance, or long-term care insurance based on an individual’s status as a living organ donor.
• Specifies that recovery from organ donation surgery constitutes a serious health condition that entitles eligible employees to job-protected medical leave under the Family and Medical Leave Act.

Organ Donor Clarification Act (H.R. 4343)

• Clarifies that reimbursement to living organ donation is not “valuable consideration” (I.e., payment), which is prohibited under the National Organ Transplant Act (NOTA)
• Allows pilot programs to test non-cash compensation to living organ donors.
• Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.

Living Organ Donor Tax Credit Act (H.R. 6171)

• Provides a $5,000 federal refundable tax credit to offset living donor expenses.

Honor Our Living Donor (HOLD) Act (H.R. 6020)

• Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.
• Requires public release of annual NLDAC report.

Helping End the Renal Organ Shortage (HEROS) Act

• Provides a $50,000 refundable federal tax credit over a period of five years for non-directed living kidney donors.

############

And here's one more, from the Coalition to Modify NOTA

Surgery Grand Rounds at UCSF. "Kidneys and Controversies: Kidney Exchange Within and Across Borders" Oct 21 (7am PST)

 Tomorrow at dawn I'll give a seminar to the surgeons at UCSF, about kidney exchange, and the controversies it has overcome, and is overcoming.

Surgery Grand Rounds | Kidneys and Controversies: Kidney Exchange Within and Across Borders

Date: October 21, 2020 Time: 7:00am-8:00am Place: Webinar

Rishwain Visiting Speaker: Alvin E. Roth, PhD

Al Roth is the Craig and Susan McCaw Professor of Economics at Stanford University and the George Gund Professor Emeritus of Economics and Business Administration at Harvard University. He shared the 2012 Nobel memorial prize in Economics. His research interests are in game theory, experimental economics, and market design. In the 1990’s he directed the redesign of the National Resident Matching Program (NRMP) and currently is a member of the Board of Directors. He has been involved in the design and organization of kidney exchange, which helps incompatible patient-donor pairs find life-saving compatible kidneys for transplantation. He is on the Advisory Board of the National Living Donor Assistance Center (NLDAC). His work on kidney transplantation led him to become interested in repugnant transactions, and more generally how markets, and bans on markets, gain or fail to gain social support.

The University of California, San Francisco School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  CME Course MGR21045

UCSF designates this live activity for a maximum of 43 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

*The above credit is inclusive of credit for all Fiscal Year 2020-2021 Department of Surgery Grand Rounds.

Disclosure declaration – No one in a position to control the content of this activity has a relationship with an ACCME-defined commercial interest. Planners  Wen Shen, MD, Julie Ann Sosa, MD, MA, Lygia Stewart, MD, and Ryutaro Hirose, MD, have stated that they have no relationships to disclose. Speaker Roth has stated that he has no relevant relationships to disclose.

This activity is supported by the Department of Surgery’s Howard Naffziger Endowment Fund.

Join Webinar: https://ucsf.zoom.us/j/252447171?pwd=MWt0bG9vTjBSZEo1UnpidXRVWWU2UT09 

Blood Money, by John Dooley and Emily Gallagher

 Are paid plasma donors being exploited? Here's a paper that suggests not, but rather that the payments that plasma donors receive can improve their financial well being not merely by providing additional income, but also by helping them avoid going into expensive debt.

 Dooley, John and  Emily Gallagher, Blood Money (October 11, 2021). Available at SSRN: https://ssrn.com/abstract=3940369 or http://dx.doi.org/10.2139/ssrn.3940369

Abstract: "Little is known about the motivations and outcomes of sellers in remunerated markets for human materials. We exploit dramatic growth in the number of commercial blood plasma centers in the U.S. to study the individuals who sell plasma. We find sellers tend to be young and liquidity constrained with low incomes and credit scores; they also report less access to traditional bank credit. Plasma centers absorb demand for non-traditional credit. The opening of a nearby plasma center reduces payday loan inquires and transactions by 13–18% among young borrowers. Meanwhile, foot traffic increases by over 9% at both essential and non-essential goods establishments when a new plasma center opens nearby. Our findings suggest that, at least in the short-term, constrained households use the discretionary income from plasma centers to smooth consumption without appealing to high-cost debt."

HT: Mario Macis

Payday loans

The NY Times has a discussion of payday loans, and whether and how they might be regulated. (See also my previous posts on payday loans.)

The Allure of Easy Money

INTRODUCTION

Kevin J. Miyazaki/Redux for the New York Times

In his State of the Union address, President Obama presented a series of initiatives aimed at the middle class and the growing income inequality in the United States.

One thing on the minds of many working-class Americans is greater federal regulation of payday loans, the small, short-term high-interest loans that are currently under state jurisdiction. Critics of payday loans say they lead to a cycle of ballooning debt for consumers, who can rarely afford to pay them back and must take out more loans to stay afloat. But payday lenders say that strict rules would eliminate the industry and with it, the only viable lending option for people with bad credit.

Should payday loans be federally regulated?

READ THE DISCUSSION »

DEBATERS

• 

  Help Level the Playing Field for Desperate Borrowers

  VALERIE WILSON, ECONOMIC POLICY INSTITUTE
  Ban predatory interest rates. Make borrowers account for the ability to repay. Limit duration of debt and restrict lenders’ access to bank accounts.
• 

  Don’t Restrict Access to Credit

  DENNIS SHAUL, COMMUNITY FINANCIAL SERVICES ASSOC.
  Regulation already exists for legitimate payday lenders. In more than 30 states, there are already strict limits on loan amounts, fees and rollovers.
• 

  One Size Won’t Fit All

  LISA SERVON, PROFESSOR OF URBAN POLICY
  Research about whether these loans are helpful or harmful is inconclusive, and most of it lumps all borrowers together.
• 

  Regulations Can Help Improve the Market for Borrowers

  RAJ DATE, INVESTOR
  Technological innovations will draw customers who use payday loans to cheaper products, like credit cards and installment loans, that better meet their needs.
• 

  End Predatory Practices

  GARY KALMAN, CENTER FOR RESPONSIBLE LENDING
  New rules must keep predatory lenders from pushing consumers into increased risk of losing bank accounts, their foothold into the mainstream financial system.
• 

  Let Banks and Nonbanks Play by the Same Rules

  JAMIE FULMER, ADVANCE AMERICA
  The Consumer Financial Protection Bureau must establish consistent guidelines for the entire marketplace, creating healthy competition.