Today on Economics Detective Radio, I discuss health economics with Hannes Schwandt of Northwestern University. Hannes is the co-author, along with Diane Alexander, of "The Impact of Car Pollution on Infant and Child Health: Evidence from Emissions Cheating."

Car exhaust is a major source of air pollution, but little is known about its impacts on population health. We exploit the dispersion of emissions-cheating diesel cars which secretly polluted up to 150 times as much as gasoline cars across the United States from 2008-2015 as a natural experiment to measure the health impact of car pollution. Using the universe of vehicle registrations, we demonstrate that a 10 percent cheating-induced increase in car exhaust increases rates of low birth weight and acute asthma attacks among children by 1.9 and 8.0 percent, respectively. These health impacts occur at all pollution levels and across the entire socioeconomic spectrum.

We also discuss his work on the health impacts of the 9/11 dust cloud.

My guest today, Mario Macis of Johns Hopkins University, has done a number of interesting studies related to blood and organ donation, particularly the compensation of blood and organ donors. For instance, Mario and his coauthor, Nicola Lacetera, observed the effect of an incentive system that offered symbolic rewards to blood donors in a particular Italian town. They found that when prizes for frequent donation were publicly announced, people donated more blood, indicating that social image concerns are a factor in blood donation.

Through a large-scale natural field experiment with the American Red Cross, Mario and his coauthors showed that offering donors economic incentives to donate blood increases donation without increasing the fraction of ineligible donors.

Mario's more recent research deals with people's attitudes towards compensated kidney donation. Using a choice experiment, Mario and his coauthors study the determinants of Americans' views on these repugnant transactions:

Regulation and public policies are often the result of competition and compromise between different views and interests. In several cases, strongly held moral beliefs voiced by societal groups lead lawmakers to prohibit certain transactions or to prevent them from occurring through markets. However, there is limited evidence about the specific nature of the general population’s opposition to using prices in such contentious transactions. We conducted a choice experiment on a representative sample of Americans to examine preferences for legalizing payments to kidney donors. We found strong polarization, with many participants in favor or against payments regardless of potential supply gains. However, about 20% of respondents would switch to supporting payments for large enough supply gains. Preferences for compensation have strong moral foundations. Respondents especially reject direct payments by patients, which they find would violate principles of fairness. We corroborate the interpretation of our findings with the analysis of a costly decision to donate money to a foundation that supports donor compensation.

Finally, we discuss some proposed legislation that would allow limited experiments in compensating kidney donors.

My guest is Peter Jaworski of Georgetown University's McDonough School of Business. He is the author, along with Jason Brennan, of Markets Without Limits.

We recorded this on August 24th, 2017, the same day Peter published an op-ed in the National Post titled "Canada needs blood plasma. We should pay donors to get it." The op-ed argues in favour of allowing people who donate blood plasma in Canada to be compensated in return:

Canada buys the overwhelming majority of its plasma-protein products from American, for-profit companies that attract plasma donors by paying them. In 2016, Canadian Blood Services collected only 17 per cent of the total plasma it needs for essential plasma-products. To cover the shortfall, Canadian taxpayers spent $623 million buying just one of these products, immune globulin.

That’s why Canadian Blood Services (CBS) recently asked the government for $855 million in additional funding over the next seven years. They want to use the funds to open plasma collection centres that could collect more plasma that would be used to manufacture more of these products. And small wonder. Plasma-product pharmaceuticals treat a growing list of ailments, including life-threatening bleeding disorders, immune deficiencies, and infectious diseases like tetanus and hepatitis.

Despite this, when the Canadian company Canadian Plasma Services (CPS) stepped in to fill more of this need domestically—by using a paid donor model—groups like the Canadian Union of Public Employees, Canadian Health Coalition and others launched an aggressive campaign to stop them.

Peter and I discuss the best and most popular arguments against compensating blood plasma donors, and organ donors in general, then Peter gives counterarguments to each of these objections.

Furthermore, we discuss the United States' recent legalization of compensation for bone marrow donors. In 2012, The Institute for Justice successfully argued in front of the 9th Circuit Court of the United States that bone marrow should be exempted from the 1984 National Organ Transplant Act (NOTA), since bone marrow can be extracted from blood and does not thus count as an organ. Blood was specifically exempted from NOTA.

This episode’s guest is Vincent Geloso, here to talk about his work on Cuban healthcare statistics. He recently released a working paper with coauthor Gilbert Berdine titled "The Paradox of Good Health and Poverty: Assessing Cuban Health Outcomes under Castro." The abstract reads as follows:

In spite of being poor and lacking in economic opportunities, the population of Cuba enjoyed significant improvements in health outcomes under the Castro regime. Many have praised the ability of the regime to overcome the barriers of poverty and economic stagnation in order to improve health outcomes. Many have also argued that efficient features of Cuba’s health policy should be imported regardless of political considerations. In this paper, we argue that these improvements are probably overestimated, but that they are real nonetheless. We also argue that some of these improvements were an integral part of health policy and could only have been realized by the use of extremely coercive institutions. While efficient at fighting certain types of diseases, coercive institutions are generally unable to generate economic growth. On the other hand, the poverty such coercive institutions engender may have actually helped improve health outcomes, providing us with a false impression of the efficacy of the health care system in Cuba.

We have a wide-ranging discussion about Cuban health statistics, what they mean and don't mean, how good health could be achieved by forcing people into healthy behaviours, and how well other Latin American countries have done in comparison to communist Cuba.

Photo credit: Eric Marshall