Thursday, December 14, 2017

Japan's health insurance will pay for overseas transplants

In Japan, the national insurance will now pay for some transplants done overseas, when they cannot be done at home. The discussion reflects concern that they may be accused of organ trafficking. (Thanks to Fuhito Kojima for the link...)

海外臓器移植、一部保険給付へ 1千万円程度 現在は全額自己負担

(Google translate: Overseas organ transplantation, partial insurance benefit To ten million yen now All costs self-burden)  http://www.sankei.com/politics/news/171212/plt1712120018-n1.html

"Katsuobu Kato Kunihiro Kato revealed a policy to pay part of expenses from public health insurance to patients who are going abroad and get organ transplants because they are not provided domestically at the Cabinet meeting after the Cabinet meeting on December 12 . Consider using "overseas medical care expense system" to reimburse overseas treatment expenses from medical insurance of subscribers. The relevant patient seems to be around ten people a year, mainly children.

 "Currently, all overseas organ transplant patients are borne entirely by themselves, and in the case of the heart, since it costs several hundred million yen, there are many cases where fund raising activities are carried out. There is also an international declaration that "Organs necessary for transplant surgery should be secured in the home country", and this policy can lead to promotion of transplantation and international criticism is also anticipated. Kato Atsushi said, "It is fundamental to implement organ transplants under the domestic regime and it will not change anything."

 "The subjects to be covered by insurance are limited to patients who satisfy certain criteria such as being registered in the Japan Organ Transplant Network and being in danger of maintaining life in the standby state. When applying for overseas medical expenses, it is also necessary to prove that it is an operation not applicable to organ trafficking."
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 I'm reminded of current controversies concerning global kidney exchange, which involves cross-border kidney exchange.

Wednesday, December 13, 2017

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...

Tuesday, December 12, 2017

Ed Glaeser reviews Who Gets What and Why in the Journal of Economic Literature

Ed has written a generous review in the Journal of Economic Literature, of my book and of the field of market design. His review gave me an inkling of what it was like to read the book rather than to have written it*.

Glaeser, Edward L.. 2017. "A Review Essay on Alvin Roth's Who Gets What—And Why." Journal of Economic Literature, 55(4):1602-14.

Abstract: Alvin Roth’s Who Gets What—And Why provides a richly accessible introduction to his pioneering work on market design. Much of economics ignores the institutions that allocate goods, blithely assuming that the mythical Walrasian auctioneer will handle everything perfectly. But markets do fail and Roth details those failures, like the market for law clerks that unravels because clerks and judges commit to each other too quickly. Roth combines theory and pragmatic experience to show how the economist can engineer successful markets. He has even enabled welfare-improving trades in kidney exchanges, where law and social repugnance forbids cash payments.


*To put it another way, I'm reminded of Ralph Waldo Emerson's line "“Tis the good reader that makes the good book...," or maybe Samuel Johnson “A writer only begins a book. A reader finishes it.”

Monday, December 11, 2017

Wales' organ donation opt-out law has not increased donors--BBC

Here's the story from the BBC:
Wales' organ donation opt-out law has not increased donors

"Wales' opt-out system for organ donation has not increased the number of donors in the two years since it was introduced, a study has confirmed.
"Adults in Wales are presumed to have consented to organ donation unless they have opted out.
"The data was published in a Welsh Government report about the impact of the Human Transplantation (Wales) Act.
"In the 21 months before the law changed in December 2015 there were 101 deceased donors in Welsh hospitals. The data showed there were 104 in the same time period since the law change.
Every quarter NHS Blood and Transplant releases figures for organ donation for each county in the UK.
Mr Gething acknowledged the figures and added: "The report suggests this may be because there have been fewer eligible donors over the short period since the change in law.
"It's important to remember that it's too early to know what the true impact of the change will be, but I'm confident we have started to create a culture where organ donation is openly discussed."


HT: Frank McCormick

Sunday, December 10, 2017

Different ways of being a bad apple

Readers of this blog may be familiar with the article by Judge Alex Kozinski about how he hires and interacts with law clerks, earlier than his competitors:
Confessions of a Bad Apple, The Yale Law Journal, Vol. 100, No. 6 (Apr., 1991), pp. 1707-1730

It began as follows:



I was sad to notice this Dec 8 Washington Post story which reports that Judge Kozinski is the latest public figure to face credible allegations, from six of his former clerks, of being a different sort of bad apple.

Prominent appeals court Judge Alex Kozinski accused of sexual misconduct

Saturday, December 9, 2017

The gray market for marijuana in Holland

The combination of a legal market and an illegal one makes for a gray market, which seems to be the situation of marijuana sellers in the Netherlands. (Not so different from legal marijuana sellers in some American states, who still run afoul of federal laws...)

The Guardian has the story:
Netherlands coffee shop case highlights 'paradox' of cannabis laws

"With 3,000 customers a day, a restaurant, ample parking and turnover of €26m (£23m) a year, Checkpoint cafe, the largest cannabis-selling coffee shop in the Netherlands, was a fabulous commercial success.

"That was until it was closed down in 2009 for testing to the limits what the Dutch describe as their gedogenbeleid (tolerance policy) under which prosecutors turn a blind eye to the breaking of certain laws, including in the business of selling cannabis.

"The latest and most likely final appeal hearing of criminal charges against the cafe’s owner, Meddie Willemsen, has highlighted what the president of a court in Den Bosch described as “paradoxes” in the Dutch approach to so-called soft drugs.

"Licensed coffee shops are allowed to sell cannabis from their premises, but can keep only 500g on site at any time. Production of the drug is illegal.

"When Checkpoint was at its peak, Willemsen, 66, was regularly keeping about 200kg of cannabis on his large premises in Terneuzen, near the Belgian border. The size of the enterprise could have led to fairly reasonable assumptions that those providing the drugs would be large criminal gangs.

"Prosecutors were informed by the court that while Checkpoint cafe was certainly criminal, local authorities had effectively aided it at times and turned a blind eye for long enough that punishment of the owner would be inappropriate.

"The court heard the illegal activity was necessary for a cafe of Checkpoint’s size. The president ruled: “That is punishable. But at the same time not to be avoided when you run a well-functioning coffee shop.”
...
"The president of the court in Den Bosch said the story of Checkpoint cafe highlighted the absurdity of the law in the Netherlands, where selling cannabis at the front of the shop is legal, under strict criteria, but production and sourcing of it at the back is illegal. “Here lies a task for the legislator,” the president said.

"In 2012, the Dutch government changed the law to criminalise sales by coffee shops to customers who cannot prove they live in the Netherlands. There is a dispensation for people in Amsterdam, on the grounds that the practice is part of the attraction for tourists visiting the city.

Friday, December 8, 2017

Hiring America's soldiers

The veterans' publication Task and Purpose has the story:
The Recruiters: Searching For The Next Generation Of Warfighters In A Divided America  By ADAM LINEHAN 

"Since the draft was ended in 1973, recruiting has become one of the most important jobs in the military. For the Army, it’s imperative. While the Marine Corps prides itself on being lean, mean, and agile, and the Navy and Air Force increasingly rely on unmanned vehicles and long-range munitions, the Army’s greatest contribution to the battlefield is, and always has been, people. Roughly 70% of the nearly 7,000 U.S. troops killed so far in Iraq and Afghanistan were Army soldiers. Most were recruited through centers like the one in East Orange.

"Headquartered in Fort Knox, Kentucky, U.S. Army Recruiting Command, or USAREC, manages the recruiting mission for the service’s active-duty and reserve components. It is a massive, ever-evolving operation involving approximately 12,500 military and civilian personnel spread across 1,400 recruiting centers in the United States and abroad, including in Europe and Guam. Roughly $4.6 billion of the Army’s $33.8 billion budget for fiscal year 2017 was allotted for recruiting and training new soldiers; $424 million of that was spent on bonuses alone. The Army also poured more than $289 million into television, radio, digital media, direct mail, and sports-related advertising campaigns. A lot of blood, sweat, and tears goes into keeping the ranks filled with qualified volunteers. The recruiting machine never stops.

"The biggest factor in recruiting success is the health of the economy. Typically, when the unemployment rate goes up, so does the number of Americans wanting to join the military. Nonetheless, the more economically stressed, socioeconomic classes tend to be underrepresented in the armed forces. Although people in low-income neighborhoods are generally more inclined than their wealthier compatriots to enlist, fewer and fewer have the qualifications to serve. Rising standards are part of the reason. But so are a host of societal problems that tend to hit disenfranchised populations especially hard, such as increasing obesity rates and a public education system that disadvantages low-income zip codes.

"Currently, only about 29% of Americans between the ages of 17–24 are eligible to serve. Disqualifiers include lack of a high-school diploma or GED; tattoos on the hand, face, or neck; a wide range of physical and mental-health problems; a history of illegal drug use, and a criminal record.
...
"Bryant believes the Army could keep its ranks filled by focusing on a handful of states, most of them south of the Mason-Dixon line, while paying extra attention to communities within those states that have formed around military installations. Current trends support this view: Of the newest crop of Army recruits, half came from just seven states; 79% had relatives who served. The military has become increasingly — some would even add dangerously — insular since the advent of the all-volunteer force. As the journalist Thomas E. Ricks noted in a 1997 article for The Atlantic titled The Widening Gap Between Military and Society, this trend toward homogeneity was likely accelerated by the closing of dozens of bases and installations following the end of the Cold War, which significantly reduced the military’s footprint in the West and Northeast. 

“You can kind of draw a smiley face from North Carolina around the southern United States halfway up California, and that’s where the majority of [military] post, camps, and stations are,” Snow said. “Youth who have more interaction with those in uniform tend to [be more likely to enlist].” Could the Army shutter its recruiting centers in the Northeast and still meet its quotas? Snow suspects it could. “But then we’re getting away from the very principles that we pride ourselves on, and that’s that we are a microcosm of society,” he added.