Communitarianism and Commodification
I recently received an email from an organization that calls itself "Communitarian Network," and, being somewhat curious, began to read it. Followers of this organization claim to be seeking "economic justice" and lay out the plans to do so.
Now, to their credit, I guess, the "communitarians" say they are against state coercion, although much of what I read in their email and in subsequent attached texts belies such statements. Indeed, coercion is at the heart of their belief system, although I am sure they would hotly deny that. However, I am moving ahead of myself.
One of the issues with which they dealt in their latest communiqué was that of organ donation, which this page and other free-market organizations have noted might function better and more justly (if I can use that word) than the present system. Even the communitarians acknowledge a serious problem exists here. Amitai Etzioni, the founder and director of the Communitarian Network, writes that more than 5,500 Americans died waiting for organ transplants in 2000, and that more than 80,000 at the present time are awaiting new organs.[i]
At the same time, he adds, of the 10,000–12,000 eligible donors who die annually, only about half actually permit their organs to be donated. In other words, he accurately points out that the current system, in which donors voluntarily give their organs for no compensation, is a failure, if one considers high death rates to be a sign that the system is malfunctioning.
However, as one might expect of a socialist, Etzioni immediately dismisses any talk of compensation to donors or families because such an action, in his words, would result in "commodification" of "another social relation, change an act of altruism into an act of commerce, and offend religious and personal beliefs in the sanctity of the body, as well as give rise to issues of injustice and cost."
To put it another way, such action would take something that supposedly is out of the noncommercial realm and "commercialize" it, which he automatically assumes is an evil thing. However, in that one short sentence, Etzioni has managed to engage in one fallacy after another, and however convincing he may sound to many, he really is advocating the slow, painful death of thousands of people rather than acknowledge that a market in organs not only would be more "efficient" than the present approaches (including his own "communitarian" one), but also would make organ transplants less costly and promote (I believe) social justice.
When Lenin's Bolsheviks proved victorious in the Russian Revolution, Lenin declared that he would rather see Russians starve to death than have to depend upon a free market for grain. His attempts to communize the growing and distribution of grain, as history grimly tells us, resulted in the starvation of millions of people. Yet, at least temporarily, Lenin had his wish: the Russian people did not have a free market in grain.[ii]
Etzioni's first fallacy is his use of the word "commodification," which in economic parlance truly is meaningless. The word is supposed to denote the seizure by unscrupulous business people of what should be a "free" good; thus having the good in their possession, the new owners then slap a price on it, thus creating artificial scarcity.
Those who speak of "commodification," which apparently has become a buzzword in socialist circles, actually have things backwards. The presence of a price upon a good does not make it scarce; rather, it is the scarcity that creates the price. To put it another way, the very nature of scarcity means that a good must be rationed, as it cannot be given freely to everyone who wants it. Etzioni himself seems to acknowledge that transplantable organs are scarce by the presence of shortages that lead to death.
By definition, scarce goods must be rationed, as is currently the case with organs. Declaring them to be a good created out of "altruism" or a free good does not change the fact that not everyone who is eligible for them can obtain them. A free market price is not an arbitrary designation that transfers a good from a category of non-scarce to scarce; rather it reflects the relative scarcity of that good to the demand for it.
The giving of a good out of altruistic motives or selling the good does not reflect upon the morality of the exchange per se, despite what Etzioni and others of his persuasion might declare. Because a grocery store does not give away all of the food in its aisles for free does not mean the management there is immoral. Given that food is scarce, if there were not some way to ration it, and to provide individuals with the incentives to produce and transport that food in the first place, all of us would quickly starve to death or have to produce solely for our own consumption, hardly an ideal state of affairs. The very presence of a market in food is what enables us to be able to have an abundant supply of food in our homes—yet not have to work directly in agriculture on our own.
If Etzioni believes that a market in organs is immoral, why should he stop there? Food is a necessity, and on a daily basis, more necessary than transplantable organs. If he wishes to be consistent, then he can join with Lenin, who at least was willing to admit he was prepared to force starvation on millions of people just to prove his point.
The issue of cost is also a red herring, and the argument goes as follows: At the present time, organs are free, and while they are horribly scarce, at least those who are lucky enough to receive them do not have to pay for them. If we permit a direct price to be placed on organs, then only wealthy people will be able to afford them.
This argument ignores a number of relevant facts and totally distorts economic processes. First, there already is a hefty price to be paid for organs, or more specifically, for the entire process. Procurement organizations that take possession of the organ then sell it to the hospital where the transplant takes place. Furthermore, everyone in the process is paid for his or her services. (Please remember that one does not simply obtain an organ, but rather an organ is an input into a larger medical procedure. It is the value of the transplant operation that makes the organ valuable, not the other way around.)
Furthermore, those who make this argument are assuming that nothing will change except that "free" organs will now come with a price tag, but that the number of available organs will stay the same. This is a denial of reality. Those who advocate a market in organs do so precisely because they believe that permitting individuals and their families who supply the organs to receive compensation will increase the number of organs that are available.
By making more organs available for transplant, more doctors will be able to do transplants, which will increase the supply of available transplants, which will, in the end, result in lower prices than people currently pay for the procedures. Indeed, instead of increasing the overall costs to patients for transplants, as the critics claim would happen, permitting a free market in transplantable organs would ultimately mean more transplants, lower costs, and, most importantly, fewer premature deaths.
However, the communitarians counter, the process of permitting a free market to operate in an area that formerly was left to altruism might result in a backlash of people who are turned off by the whole process. In other words, if individuals are allowed to sell organs, then large numbers of people will find this process so morally objectionable that the actual number of available organs will decrease.
Again, this is a red herring. People who do not wish to receive compensation would not be forbidden to donate organs. Indeed, I suspect that in many cases, people might be willing to donate for free, anyway. For example, I had a friend whose mother gave him one of her kidneys (unfortunately, he died soon afterwards). Had a free market in organs been in existence when the donation occurred, I doubt seriously that the mother would have demanded her son cough up a few thousand dollars before she would have been willing to give away her kidney.
Of course, Etzioni has his own "solution," that being the use of "moral suasion." He writes, "'Friends don't let their friends waste the gift of life' needs not to become a clever slogan of an ad campaign, but rather a way of life." The communitarian approach, he argues, is one in which people are constantly reminded that they must be willing to donate organs because it is part of the common good and would make for a better way of life for the community.
This seems to be fine on the surface, except it really is part of the "iron fist in a velvet glove" approach. That is because while it allegedly preserves the veneer of volunteerism, it actually attempts to shame people into making choices they otherwise might not make.
Furthermore, it would not take long for such a "communitarian" campaign to become thoroughly politicized and coercive. Yes, while Etzioni claims to be appealing to a voluntary spirit of community, it is clear that those who would disagree would be ostracized and condemned for not being willing to participate in the community.
Those who favor commodification draw on those social sciences, especially neoclassical economics, that tend to assume that people's preferences (or tastes) are fixed. Hence, if individuals do not do something on their own, such as donating organs, they must be "incentivized" to do so with money to buy the things they do want. Financial incentives, the argument goes, make people willing to do things they are asked to do, but which they would rather not (say work harder). The social sciences we draw on here presume that preferences can be altered so that people become willing to do things they were reluctant to engage in before, not because they are compensated, but because they have come to truly believe these things are right.
The $64 question, of course, is this: How do people come to the point where their minds are changed to where they will be willing to part with their organs for free? As I have noted before, it would be through the "gentle" persuasion of the state or those in authority, mostly through propaganda and other means that are even more unpleasant.
Thus, we have the Etzioni approach: Continue the current system, but increase the propaganda in order to increase the supply of organs. Should that not work, then either step up the social pressure or revert to things as usual. However, we should never even consider using a method we know would ultimately reduce the current death rate. To Etzioni and his followers, the market approach would be morally repugnant, and apparently they are willing to subject thousands of people to slow, painful deaths each year just to prove their points. Humanitarians, indeed.
[ii] In 1921, facing near disaster and the possible ouster of his own government, Lenin declared a “tactical retreat” against capitalism and instituted his “New Economic Policy,” which returned much of farming to a quasi free market, although the government held ownership of other industries.