What do Texas driver's licenses, health care in 18th century Vienna and the ambulance business in mid-20th century America have in common? Misaligned economic incentives, perhaps?
Recently, I renewed by Texas driver's license and was offered the opportunity to become a registered organ donor. Why I never signed up before, I can't say. OK, I can say but I don't want to (it was laziness). There's really no good reason not to. In case you imagine you have a good reason, set yourself straight by reading the "Myths and Facts" section of the website for the Glenda Jackson Donate Life - Texas Registry. It's the official state organ, tissue and eye donor registry. Then sign up right there, online. Simple. Painless. Gratifying.
While reading about the current health insurance reform effort in Congress, I came across some historical background written by Colin Dickey. It's a column in Lapham's Quarterly titled "The Cadaver Method" about universal health care in 18th century Vienna.
"One of the earliest experiments of universal health care for the poor could be found in eighteenth-century Vienna. Founded in 1784 by Joseph II, the massive General Hospital provided free health care to thousands of the sick poor well into the nineteenth century. ... The poor who came to its halls could be assured that they were receiving the finest medical treatment Europe had to offer. The price for this service was simple: if things didn't turn out well and you didn't make it, the hospital kept your body. Joseph II felt that the use of one's body after death was a fair price for the free medical attention given in life."
Modern society has removed the stigma of donating one's body to science. The need for grave-robbing is history. So, too, is the option of donating your body in exchange for health care. Dickey laments that one consequence is that "once again the poor have nothing to offer to entice others to save their lives."
Steven D. Levitt and Stephen J. Dubner, co-authors of SuperFreakonomics, look at the economics of everyday behavior in an effort to understand that behavior. They provide related historical background about the ambulance business in mid-20th century America.
"Ambulances were often run by the local mortuary. It is hard to think of a better example of misaligned incentives: a funeral director who is put in charge of helping a patient not die!"
If you didn't question it already, the ambulance example should raise the question whether Vienna used to have misaligned incentives, too. The hospitals wanted bodies for scientific study and doctor training. The poor agreed to donate their bodies if they didn't survive the medical treatment the hospital provided. What safeguards were in place to balance the misaligned incentives?
It's this same concern that leads some Texans today to resist becoming an organ donor. They imagine doctors halting life-saving efforts too soon out of greediness to begin harvesting organs. It's a thought-out issue with thought-out solutions, explained in the aforementioned "Myths and Facts" section of the Glenda Jackson Donate Life - Texas Registry. Read it. Control your fears. Then sign up. Get your donor card. Carry it.
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