Revisiting Incentives, and Some Comments

My wife likes to say, “If you want to find out where something is wrong most quickly, just put it on the Internet.” I think she is correct, and it came to mind as I was mulling over my piece from earlier this week.

Earlier this week, I put together a post in reaction to the news surrounding Planned Parenthood and the video “sting” that attempted to prove that Planned Parenthood was making money via selling harvested, developed fetal tissue for the purposes of research. After reflection, and reading over the comments on the piece, I got it wrong, and it warrants a bit of self-examination.

Bottom line up front: I think that I was wrong on some of the conclusions of the piece, substantially so, to the point that I wish I hadn’t written and posted it when I did. I will try to explain where and why I think I got those things wrong, in the interests of getting it right in the future.

Writing at Ordinary Times, my goal is to do analysis, first and foremost, even if I have my own biases (as we all do). I see two main errors in the piece.

First was the baseline assumption. I wrote,

It seems quite clear that Planned Parenthood is making some money by selling the body parts of aborted fetuses.

But in reality, this was far too strong. The full video shows that the “target” of the sting goes to great pains in all but one quote to signify that they do not try to “profit” from the sales.

I do not–repeat, not–think that this is crystal clear in either direction. (As I wrote in the comments, I think expecting a “silver bullet” remark is unrealistic.) I expect that other information will emerge from other videos (apparently) and the ensuing politically-motivated investigations that will push the reality in either direction. I have my suspicions about the underlying dynamics, but that’s really all they are: suspicions. We know that the person in the video claims something most of the time, and something slightly different one other time. But that’s all it is so far; there is not enough to assume that money is being made, and then use that as a baseline assumption for the rest of the piece. My initial correction on the piece was, frankly, weak tea.

What is darkly amusing to me is that I literally just wrote something to this effect in a paper from my other life as a student, something to the effect of “if you don’t want to accept a prevailing understanding of facts and assumptions that is tangential to something you are writing about, that’s OK, but you have to challenge it explicitly, rather than just hand-waving it.” I did not take my own advice here.

Second is the incentives piece itself. commenter zic’s remarks and questions here were particularly instructive and clarifying: specifically, zic was insisting on me producing a mechanic for my suggestion that the misaligned incentives would lead to delayed abortions.

The truth is that on the ground, after much reflection and some discussion with someone with more knowledge on this front, the only instance I can think of where Planned Parenthood could delay an abortion substantially would be through something like skewed prenatal counseling. If a mother was hesitant, Planned Parenthood might suggest that she wait a little while. From the coldly economic perspective though, Planned Parenthood might not want wavering mothers to reconsider. If they’re ready to go, they’re ready to go. This is also true if we dispense with the economics and try to explore the ideology from Planned Parenthood’s perspective: they are interested in taking care of the mother rather than their pocketbooks.

This reminds me of an historical issue that I’ve read about in some detail. If you analyze the relationship between tariffs and international trade in the 19th century, you might argue that the increased tariffs of the late 19th century skewed incentives against trade. This would be true, but the rapidly-decreasing shipping costs cut in the exact opposite direction. In doing the analysis, we must look at the totality of the incentives, rather than a single incentive. The incentives cut both ways, and I think the totality of them actually push against delaying abortion, in the case of Planned Parenthood. I missed on that one, badly.

You could argue that working to preserve organs in abortions presents its own misaligned incentives: the procedure becomes more challenging for the doctor, then, and then presents additional possible risks to the mother. Certainly, if mothers are informed of the risks of tissue donation and provide consent, that would be acceptable; if not, it wouldn’t be. I think this remains a troubling piece of the story, but it is not what I argued.**

Thus in the end, I now reject the certainty by which I presented the underlying assumptions of the piece, as well as the implication and conclusion that I developed off of those assumptions. Put together, that’s virtually the whole architecture of the piece. Normally, if I write something, I might change my mind on a couple of minor word choices or concepts in a piece after engaging with comments. It is rare for me to reject a whole underlying assumption and conclusion after a mere two days. That is why I felt compelled to examine it in detail.

Thinking about it, I suspect that most of this essentially can be explained by two things: my own visceral horror at the video I watched, and my desire to get something original written quickly. But this cuts against a more prudent writing process: have an idea, let it marinate, do some additional research, see if it’s been written up anywhere else, write something, let it sit for a day, and then revisit. This is particularly important when trying to analyze consequential, controversial topics. In this instance, I skipped the important review steps. I wanted to be first to market, I think, with this “incentives” angle. But that’s a fool’s errand, and an error on my part. I hope I would have caught some of these errors if I hadn’t rushed, but there are no guarantees. The prudent thing to do in writing a piece like this would have been to wait: wait for additional videos, wait for additional information from reporters, etc. I did not.

I remain deeply disturbed by the idea that developed fetal organs are sold in a market of any sort, and I think that it warrants discussion. But again, that is not what I wrote, and it’s not a particularly interesting analytical conclusion; it’s a moral judgment.

Lastly, to clarify two things that kept coming up in comments:

1. Non-profit organizations can and do seek profit; the distinction is over where the “profit” winds up, rather than the overall aims. Universities are non-profits, but they seek money to reinvest in faculty, facilities, and administrators so they they can attract future “customers.” It’s not all that different from any other business. (The NFL, of all things, was a non-profit for a very long time.)

2. I’m not in favor of mandatory waiting periods because of the dynamic I discussed in the piece. To me, the later the abortion, the higher the risk that we are destroying a living human. Waiting periods push that risk marginally higher, day by day. Again, in my estimation, if abortion is legal, it should be earlier, ceteris paribus. (This is a minority position on the Right, but considering how important it was for my original argument, I feel like I should state it more explicitly.)

I genuinely do appreciate the feedback on the piece, and I will write more intelligently (I hope!) in the future. I will leave it up to my fellow OTers as to how to handle the original post.

**An interesting thought experiment: in a world where abortion rights were uncontroversial, what would the ideological divide be surrounding procedures being modified to extract organs for research, if those procedures were to result in increased health risks for the mother?

Cover photo from Jfruh at the English language Wikipedia [GFDL or CC-BY-SA-3.0], via Wikimedia Commons.

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27 thoughts on “Revisiting Incentives, and Some Comments

  1. Obviously, a lot of this goes back to when a person becomes a person. Since both sperm and egg are living material, I don’t think it’s really a question of when life begins, it comes from living material already, but to me, a fetus is a potential person, but not yet a person.

    I must ask, though, knowing that opinions on personhood differ widely: would it be better the tissue being discussed in the video be wasted, when they could be used for living, breathing definite persons who could benefit?

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  2. These posts suck to write, especially when the original was well-written and had a great point, if based on an ultimately false assumption. I know the difficulty of writing these types of things from all too much experience – well done.

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  3. I would be equally disturbed by the notion of selling organs, on the basis of the sanctity of the human person.

    And I’m not sure that abortion can ever be uncontroversial. As I mentioned before, even if everyone were to agree that a fertilized ovum is not a person, while an 8 month fetus is, there is no way to draw a line between that will make sense to everyone.

    This is where conventional politics and religion break down, when they search for definitive solutions which preclude question or debate.

    I would use the abortion issue as a way of calling for a greater willingness to tolerate ambiguity and uncertainty, where we can be conflicted even as we act.

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    • +1

      What does it say that, while I hold a pro-choice position, the first baby pictures I tacked up on my wall were in-vitro sonograms? (Yes, Burt, I’m one of “those” people.)

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    • The way to make sense is to remember that the fetus is living inside an autonomous human being who should have the right to make decisions about what happens inside their own body, whether we agree with them or not.

      I certainly wouldn’t really embrace a woman who wanted to terminate a pregnancy in its 8th month. I just don’t believe there can be more than a fraction of a fraction of a percentage of women who would do so unless they were facing a worse option.

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  4. Thank-you, Dan. Now I can go back to making the “mistake” of reading you charitably. FWIW, I respect your moral position even though I disagree with some of the premises involved.

    Also, retractions suck to write. Good on you.

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  5. Thinking about it, I suspect that most of this essentially can be explained by two things: my own visceral horror at the video I watched, and my desire to get something original written quickly.

    A suggestion: Never hold a discussion with a doctor — especially a medical examiner or surgeon — about their work. “Blood, visceral horror” is a good description of their jobs. Every day. Cutting someone open ain’t pretty.

    What you see as visceral horror? That’s necessity in the medical industry. Tissue — whether tumors cut from cancer patients, limbs amputated from accident victims, or fetal tissue after surgical abortions — has to be properly disposed of. It’s complex because it’s biohazardous waste.

    It’s often valuable waste because it’s critical to certain types of research (or at least far superior to alternatives). You like your cornucopia of pharmaceuticals and the burgeoning fields of tissue engineering? This visceral horror is the base upon which is stands.

    Doctors, surgeons, people working in the field — they distance themselves from it so they can do the job.

    What you saw there is how a modern society handles it. You generally can’t sell this stuff, you can’t take it from donors without permission — what you can do (and should do) is price them at your costs. Biomedical waste is expensive to handle, more expensive to ship. (For good reasons).

    So where’s the horror? That people are talking about body parts, left-over tissue? Would it be less horrific if it was quietly burned? (Much of it is). Out of sight, out of mind? The cost is only a great deal of medical progress.

    This isn’t to jump on you — this is actually a pretty important thing. Medicine, surgery, and medical research? It’s often disgusting, bloody, and triggers visceral responses. Human beings react pretty understandably when someone’s intestines are exposed — but surgeons have to deal with it. They react poorly to bits of dead bodies — but everyone from the clean-up staff to the doctor’s have to deal with it.

    That instinctive, brain stem reaction to go “Eww” can’t be your guide — if it is, you foreclose not just progress, but giant swathes of medicine. Because what doctors DO is often disgusting. (And I thank them for it. I can only imagine what it takes to be able to deal with some of the things they do).

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  6. Thank you, Dan.

    Women’s reproductive health care is still such a tabu topic that we have a difficult time with even the language of discussing it. Through all of this, I’ve struggled with those tabus, I typically want to smash them. I want to tell how periods are gross and disgusting even as they are natural and normal; how little girls in many third-world countries stop going to school once they start their menses because there’s no facilities for them to maintain cleanliness. I want to scream the hard choices I’ve faced, and how in reflecting on these issues, I found that statistically, women actually have acted responsibly when given access the right to control their own bodies. I want to tell you of friends, one who had an abortion because her much wanted child was, in reality, an ectopic pregnancy that threatened her own life, and how she mourned. Another going through fertility treatments, pregnant with twins at three months who died, and who had to have labor a DNC to remove them.

    Equally important, I want to tell you about the pain of being pregnant; it is not always a breeze. Or of labor. The two or three months of bleeding after, the breasts that leak milk and are painful and swollen as any injury you’ve ever received when they’re engorged. The changes to ones body are substantial; and recovery from birth takes two years. Two full years, much of which the woman may well be nursing and having her resources sorely tapped.

    But most of all, I want to point out that this whole discussion still presumes her body, somehow, is not her own, and her judgment is not her own. As I said on your fist post, it’s like she’s a child; even when it comes to the penalties people who want to limit abortion try to impose. Punish the doctor. Shut down the clinic. If it’s murder, why not punish the person who’s decided to commit this murder? I question our how, if she’s not adult enough to determine the course of her own body, she’s adult enough to be responsible for that child? This seems like seriously warped thinking to me; she’s a child and can’t decide what’s right for her when it comes to reproduction, yet she’s responsible enough to raise that child, to decide what’s right for its body until he or she comes of age?

    Women are not children, once they’ve reached the age of consent. So if you’re not comfortable with thinking a woman who might choose to have an abortion as fully adult, and responsible both to the law and to her own gods, to decide for herself, how can you think her capable of deciding for her child? Either let the alone, or hold them responsible as adults. Stop treating women like children.

    We see this even in the way we repeatedly have to tell our stories; it’s a kind of porn; discussing our rapes and our pregnancies and our abusive relationships to point out why it’s important to maintain the rights to our own bodies. Men don’t have to justify the need for viagra, there’s no tell-all stories about limp dicks and an unhappy wife to maintain that legal right. Dirty mags still flourish. Scantily-clad teenagers in strut in car ads and beer commercials; and we sort of recognize it veers on immoral; but men are men, driven by their urges, and beautiful young women are enormously successful ways to sell stuff to men, who are adult, even though they often cling to boyhood and have to be excused for their more crass behavior like spiking a young girl’s drink for sex or staring down her shirt.

    So I appreciate you’re engaging the mechanism; because that matters. I wish you’d engage the morality of feminism; of treating people as adult, once they are adult and bear adult responsibility. Sexually, that begins when you’re old enough to get pregnant.

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    • Cultural leftovers. We’re a century out, at most, from women being seen as property of men — their fathers, their husbands, their brothers if need me. The ‘weaker’ sex, not as capable in thought or word or deed as a man.

      And it’ll linger, as each generation teaches the next. Sometimes weaker, sometimes stronger.

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    • It’s not a question considering women to be children rather than adults, or treating them as not being moral agents, at all. It’s a question as to whether the life of an unborn child has value and worth; and, if so, whether it has as much value and worth as the life of an adult.

      I believe that, in general, a human life is of more worth than nine month’s of another human being’s time.

      It would be highly preferable if pro-choice people didn’t just make up views out of the whole cloth and attribute them to pro-life people rather than addressing the views we actually hold. Namely, I hold the view that human life – all human life, including the unborn – is of value. And Every. Single. Time I state that in an abortion debate, even among people who are familiar with me and know my economic opinions well, pro-choicers accuse me of being inconsistent, and only caring about the lives of the unborn, and not caring about the poor, or about those killed in war, or about those killed as a result of the death penalty. Even though I oppose the death penalty; support a strong social safety net and believe that it both possible and morally incumbent upon us to end poverty globally; and am strongly anti-war.

      There is little point in participating in a discussion where the opposite side refuses to debate your actual views, and prefers to create straw men (such as “you stop caring about people after they’re born” or “you just hate/despise women”) instead.

      But, as we’ve just covered, politics is increasingly the art of lying about your opponents to make them look bad.

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      • I disagree,

        It’s because culturally it’s acceptable for other people to make decisions for women, and to discount the sheer physicality of pregnancy and mothering; as I said, it’s all part of that taboo lady stuff that’s not polite to discuss.

        Well, it is physical. It is a woman’s body, and it’s her child; she will be responsible for it if she gives birth to it, and has to legally hand the rights over should she not want that responsibility; the responsibilities are innate. Yet the pro-life stance is to stop abortion (because it’s murder of an innocent) by stopping abortion providers, not by holding mothers accountable for their actions. It’s exactly treating women like children, incapable of making their own decisions and not fully responsible for their own actions, and so it’s okay to decide these things as if the particular woman in question has no say about it. It’s between you and your god, not her and her gods; the limits are on the physician, not the mother.

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        • If pro-life people fought for stronger legal penalties for mothers rather than for abortion doctors, their positions would be overwhelmingly more unpopular and would get nowhere. Which, obviously, fits your political goals.

          Telling your political opponents to do something which 1) you would fervently oppose if they did it and 2) would be far more unpopular than their current actions, and accusing them of malign principles or lack of principles when they fail to do so, is really rather transparent.

          And it’s rather rich of you to accuse other people of treating women like children at the exact same time you’re telling me that you know more about my personal opinions that I do.

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          • If pro-life people fought for stronger legal penalties for mothers rather than for abortion doctors, their positions would be overwhelmingly more unpopular and would get nowhere. Which, obviously, fits your political goals.

            Which sort of proves my point, no? Their positions would be overwhelmingly more unpopular because they would be admitting that women aren’t really capable of making these decisions and being responsible for them; they are childlike in this particular way.

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  7. Good on you Dan, as others have pointed out, it is very hard to write something such as this. Most would just walk away, but you have shown you are better than that.

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  8. Pingback: Planned Parenthood and Incentives | Ordinary Times

  9. Pingback: talk to me like an adult: planned parenthood edition | Ordinary Times

  10. This post still says “maybe I was right, maybe I was wrong… Who can tell in this pstmodern world?” Dan is a lying piece of shit, and he should admit it. The fact that others are praising him for his halfway mea culpa is disgusting. I know I’ll get a “tsk tsk” for my strong language, which prove that LOOG cares more about a veneer if civility than any genuine sense of decency or intellectual honesty.

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