If it weren’t for America’s free-market ways, there’d be fewer of us and we’d be in trouble.
“I want tariffs,” President Trump was recently quoted as having said. He also said, off the cuff, he would “end up probably terminating NAFTA.” Either one would be a catastrophe for my home country, Canada, and not just economically. If it weren’t for NAFTA’s reduction of trade barriers between our two countries, and your willingness to donate bodily fluids, my people would be in a lot of trouble. Overwhelmingly, it is American sperm and American blood plasma that makes and saves so many Canadian lives.
Apart from NAFTA, the other reason for this state of affairs is that you appear to find the idea of compensating people for sperm and blood plasma less objectionable than we do. It would be good if we stopped finding it so objectionable but, until we do, we will continue to be increasingly reliant on the importation of your bodily fluids.
Canada used to have a sufficient supply of domestic sperm donors. But in 2004, we passed the Assisted Human Reproduction Act, which made it illegal to compensate donors for their sperm. Shortly thereafter, the number of willing donors plummeted, and sperm donor clinics were shuttered. Now, there is basically just one sperm donor clinic in Canada, and 30-70 Canadian men who donate sperm. Since demand far outstrips supply, we turn to you. We import sperm from for-profit companies in the U.S., where compensating sperm donors is both legal and normal.
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Canada has never had enough domestic blood plasma for plasma-protein products, such as immune globulin. Our demand for those products, however, is increasing. Last year, we collected only enough blood plasma from unremunerated donors to manufacture 17% of the immune globulin demanded. The rest we imported from you, in exchange for $623 million, or $512 million U.S.
Reliance on your blood plasma looked like it might change a little bit when, in 2012, a company called Canadian Plasma Resources announced plans to open clinics in Ontario dedicated to collecting blood plasma. The trouble is that its business model included compensating donors. Almost immediately, groups such as the Canadian Union of Public Employees and the Canadian Health Coalition began to lobby the Ontario government to pass a law to stop CPR from opening clinics. Ontario obliged in 2014, passing the Safeguarding Health Care Integrity Act, which among other things made compensation illegal.
When CPR shifted attention to Alberta, so did the groups opposing them. Just this year, the Alberta government introduced the Voluntary Blood Donation Act, which would prohibit compensation.
British Columbia’s government is just now looking at options to ban it as well.
What persuaded these governments? The anti-compensation groups argued that blood plasma from compensated donors was less safe, that people should donate blood plasma for free rather than for money, and that there is something wrong with having a for-profit business model in health care.
The latter two concerns are strangely specific. They don’t seem to apply to you Americans. If they did, the groups would have lobbied to make importation of anything other than products made from unremunerated donors also illegal. But they didn’t.
Instead, they object to a Canadian for-profit company compensating Canadian blood plasma donors in Canada, but American for-profit companies compensating American donors in America does not appear to register on their moral radar. Like the importation of sperm from for-profit U.S. companies that compensate donors, it has all the appearance of moral NIMBYism. It’s fine if it happens in your backyard, and we’ll happily buy the products, but we object to it happening in our backyard.
As for safety, the fact that we import products made with remunerated donors should tell you that it is emphatically not an issue. Health Canada has said that there is no health concern. The CEO of Canadian Blood Services, Graham Sher, took to YouTube to explain that “it is categorically untrue to say, in 2015 or 2016, that plasma-protein products from paid donors are less safe or unsafe. They are not. They are as safe as the products that are manufactured from our non-remunerated or unpaid donors.”
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So committed are we to importing your fluids, that Canadian Blood Services rejected an offer from Canadian Plasma Services to purchase blood plasma at 20% less than what they pay you.
Maybe it’s true that people should donate these fluids out of the kindness of their hearts. But the fact is not enough people will. For years, we’ve been imploring people to do so, and it doesn’t work.
This anti-incentive ideology is not just a Canadian problem: About 100,000 Americans are suffering on a waiting list for a kidney. In 2014, 4,761 patients died waiting. A carefully regulated market in kidneys would save thousands of lives.
In the absence of charity and goodwill, perhaps it’s better to buy good results. We can’t let people die as we sit and wait for spontaneous explosions in virtue.
What Canada should do is legalize compensation for renewable bodily fluids in our own country. It would be the morally right thing to do. It would help make and save more lives, without harming anybody.
Until we realize our mistake, we need you Americans to keep rolling up your sleeves and unzipping your pants not just for the sake of lucre, but also for the sake of the thousands of current and future Canadians whose lives depend on you.
Peter Jaworski is faculty in the McDonough School of Business at Georgetown University, and co-author of Markets without Limits: Moral Virtues and Commercial Interests.
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