Tuesday 16 June 2020

Plasma compensation

Kerre McIvor over on Newstalk had a bit of a go at me on the issue of compensating plasma donors. She worried about that facilities paying for plasma would locate in and prey on poorer communities.

I think that gets things entirely backward, and is beside the point even if it didn't get things entirely backward.

It's beside the point because gaps in NZ's supply are currently made up from donations by compensated plasma donors in the United States. Prohibitions here just shift the location of the paid person, and if you have any reason to expect that whatever ethical checks there might be on practice around donors would be stricter here than there, then you should want it to happen here rather than there. Note that I have zero concerns about practices in the US either though. 

But more fundamentally, if your view of the world is that there are some people in such desperate circumstances that they'd turn to plasma donation as a last resort, and that they need to be protected against that somehow because the horrors of giving plasma are just too risky to be encouraged by anything as dirty as cash, I just have trouble understanding that whole line of argument. If someone's conditions are that bad, how can banning that person from accessing what they view to be their best option be in that person's interest? Surely the better answer is to find other things that might improve that person's circumstances. There aren't really that many cases where banning people from their best alternative really makes them better off. 

And plasma regenerates in two days. The ban doesn't prevent someone from going and doing some giant irreversible thing out of some desperate circumstance. It prevents them from making maybe $30 or $50 for spending an hour on a machine that takes some of their plasma. It's not like "Hey, I hear you're desperate. Can I have one of your eyes?" Plasma sorts itself out. And if you're the sort of person for whom plasma doesn't sort itself out, pretty unlikely you'd make it through the medical checks to be a donor (and you might even then find out about something that you need to find out about). 

If it's of any interest, here's one of the Canadian centres that pays for plasma. The payment structure is rather neat. Plasma regenerates after 2 days; they require at least 2 days between visits (no more than 2 visits per week) and pay more for the second donation. The whole structure is geared around encouraging repeat visits. Why would that make sense? There are going to be big onboarding costs with any new donor. They have to screen donors and go through a pile of health checks. After those are through, ongoing monitoring is easier. So the centre's costs will be sharply declining in the number of donations per donor. The worst thing would be dealing with a giant surge of one-off donors motivated by some publicity campaign. You want repeat donors. 

So here's the compensation structure:

First donation of the week: $30.
Second donation of the week: $50.
After your 25th donation: $25 lump sum bonus, and an extra $4 per donation.
After your 50th donation: $150 lump sum bonus, and an extra $5 per donation.

If you made 100 donations in a year - take two weeks off for holidays - you'd be on $4529 for the year for 150 hours' commitment. Better than $30/hour, for hanging out on a table catching up on your reading. 

I just don't get folks who'd consider that to be exploitative. It's an utterly alien mentality. If that's exploitative, what about someone desperate for money who takes any job that's riskier than donating plasma and pays way less? Is there anything that shouldn't be banned, if that's your view of exploitation? 

There are variants of this stuff that seem worth taking seriously. Mike Munger's discussions of voluntary versus euvoluntary exchange are fruitful. But banning compensating plasma donors because of invented concerns about coercion isn't that. 

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