The organ procurement system has long been a miasma of inefficient monopoly providers. In 2024 I quoted some shocking facts from a great Statecraft interview with Jennifer Erickson and Greg Segal:

“Organs are literally lost and damaged in transit every single week. The OPTN contractor is 15 times more likely to lose or damage an organ in transit than an airline is a suitcase.”

Organs are not GPS-tracked!

“In an era when consumers can precisely monitor a FedEx package or a DoorDash dinner delivery, there are no requirements to track shipments of organs in real time — or to assess how many may be damaged or lost in transit.

“If Amazon can figure out when your paper towels and your dog food is going to arrive within 20 to 30 minutes, it certainly should be reasonable that we ought to track lifesaving organs, which are in chronic shortage,” Axelrod said.

Here’s one more astounding statistics:

“Seventeen percent of kidneys are offered to at least one deceased person before they are transplanted….”

Did you get that? The tracking system for patients is so dysfunctional that 17% of kidneys are offered to patients who are already dead–thus creating delays and missed opportunities.

Fortunately, even then there were changes in the works. In 2019 President Trump issued Executive Order 13879 to improve the performance of OPOs with better incentives and to allow living donors to recover more of their costs. The government being what it is, it has taken years to implement some of the new rules and enforcement of the  OPO performance measures was deferred to 2026-2027. Nevertheless, there have been improvements. For example, many OPOs now GPS-track kidney transfers. And a new report estimates there have been significant gains from the changes.

• The Advancing American Kidney Health initiative was launched by President Donald Trump via Executive Order 13879 on July 10, 2019. In this Data Point, we estimate the range of increased growth in transplants that might be attributed to the policies launched through the Executive order and the economic value of that increased growth.
• The estimated impacts of the Executive Order (EO) range from a conservative 1,055 additional transplants annually to an upper estimate of 2,110 additional transplants. The range reflects variation in the counterfactuals used to compare with post-2019 transplant growth.
• Under the conservative-case scenario, the policy is estimated to be associated with approximately 23,214 additional kidney transplants between 2019 and 2040, generating about 147,410 life-years gained and 21,821 quality-adjusted life-years (QALYs) gained. Under the optimistic-case scenario, the policy is estimated to be associated with approximately 46,428 additional kidney transplants between 2019 and 2040, generating about 294,819 life-years gained and 43,643 quality-adjusted life-years (QALYs) gained.

The biggest and most consequential change would be to allow payment to living organ donors. The End Kidney Deaths Act, H.R. 2687, proposes a $50,000 refundable tax credit over five years for qualifying nondirected living kidney donors. The act has bipartisan support. Because dialysis is so expensive—and the federal government pays for much of it through Medicare’s special kidney-failure entitlement—the Act could save taxpayers money as well as saving lives.

Hat tip: The indefatigable Elaine Perlman.

The post Better Incentives, More Kidneys, More Lives appeared first on Marginal REVOLUTION.

The average price of health insurance in the Obamacare marketplaces will rise by 13 percent next year, according to an analysis on Friday by KFF, the health research group.

The Trump administration on Friday published new prices for 2027 in 30 states with markets managed by the federal government. Using that data and state figures, KFF calculated the increase nationwide.

…The average cost for the cheapest bronze plan with a high deductible will be about $700 a month for a 50-year-old single person, according to Ms. Cox.

Here is more from the NYT.  Of course that makes the people who can expect to be healthy all the less likely to sign up, given that the enforcement of the mandate, for political reasons, was forced to evolve into something quite weak.  For purposes of context, when the original mandate was more tightly enforced, with actual penalties, the ACA was very unpopular and led to significant political protests.  In essence the benefits to a broad, scattered majority were imposed on a well-identified minority, namely those who signed up because of the mandate.  Trump in his first term relaxed mandate enforcement, thereby politically saving Obamacare at least for a while, but also creating this longer-term problem.

It is striking to me how infrequently I hear Democrats boasting about Obamacare.  They instead prefer to talk as if little or nothing has been done for America’s uninsured.

The post As predicted, the ACA exchanges seem not to be stable appeared first on Marginal REVOLUTION.

The post The death of Brazilian democracy? appeared first on spiked.

Before 7 October 2023, the English-language Wikipedia article on Zionism opened by describing a movement that emerged to “espouse support for the establishment of a homeland for the Jewish people in Palestine.” Since then, the opening has been reworded to say that this homeland was to be established “through colonization,” immediately followed by a new sweeping claim: “Zionists wanted to create a Jewish state in Palestine with as much land, as many Jews, and as few Palestinian Arabs as possible.” The sentence is backed by an unusually large bundle of 17 citations, drawn from historians including Benny Morris, Rashid Khalidi, Avi Shlaim and Ilan Pappé, and to the casual reader it looks like the settled verdict of scholarship. It is not. The editor who introduced it in August 2024 has since been banned from the entire Palestine-Israel topic area for non-neutral editing. Yet the sentence survives, and for a year Wikipedia formally barred its editors from even discussing whether to remove it.

That matters because Wikipedia is widely regarded as a generally reliable source of information, and its influence extends far beyond the millions of people who consult it directly: it has also been incorporated into many of the datasets used to train artificial intelligence systems, thereby shaping the information those systems subsequently reproduce. That reputation and reach rest in large part on one of Wikipedia’s foundational principles—presenting a “neutral point of view.” Wikipedia articles are supposed to summarise what reliable sources say without taking a position of their own. This principle is particularly important on controversial subjects, and few subjects are more contentious than Zionism and the Israeli-Palestinian conflict more broadly.

The rewrite

The sentence is only the most visible symptom of a much larger change. Over the past three years, Wikipedia’s coverage of this topic has undergone an extraordinary transformation, best exemplified by the Zionism article itself. I recently conducted a quantitative analysis of the article’s revision history and found that since 7 October 2023, about 80 percent of the article has been completely rewritten, and only about 20 percent of the pre-October 2023 text has survived.

More importantly, this dramatic, measurable change reflected a fundamental shift in the topics emphasised by the article. For example, the volume of material associated with colonialism rose roughly two-and-a-half-fold, and coverage of ethnic cleansing roughly doubled. At the same time, discussion of antisemitism and persecution—the primary historical drivers of the Zionist movement—was cut approximately in half, while the return to the historic Jewish homeland went from the most prominent of the four topics to the least.

What makes this particularly unusual is the maturity of the article. By October 2023, it was already more than twenty years old, contained more than 27,000 words and represented the cumulative product of over 9,000 edits by nearly 3,000 different editors. While it is not unusual to see major rewrites of new articles or specialised pages in need of serious scholarly attention, this was an extensively sourced article that had been revised and expanded for two decades and already prominently featured critical perspectives, including interpretations of Zionism as a colonial project, discussion of Palestinian displacement, and competing accounts of the causes and conduct of the 1948 war.

Similarly, the scale of this rewriting cannot be explained by any recent fundamental shift in the underlying scholarship. For example, the most cited author in the article is Benny Morris, who published Righteous Victims in 1999, the substantially revised The Birth of the Palestinian Refugee Problem Revisited in 2004, and 1948: A History of the First Arab-Israeli War in 2008, drawing extensively on Israeli and Western archival material that had become available over the preceding decades. The same holds for the broader academic literature on the subject: the key works on which the article relies had all been published long before the page underwent its wholesale rewrite. In other words, there has been neither substantial new evidence nor a major historiographical shift since 7 October 2023 that could plausibly explain why four-fifths of a mature encyclopedic article suddenly needed to be replaced.

The explanation lies instead within Wikipedia itself—specifically, in the editorial choices determining which sources were foregrounded and how they were represented. An encyclopedic article is not supposed to reflect the political preferences of its editors, but to fairly represent serious scholarship on the subject. The post-October 2023 rewrite did exactly the opposite. Rather than neutrally presenting the actual range of views found among historians, the article moved towards a simplistic, partisan account, dominated by the perspective of Zionism’s political adversaries. Nor was the partisan editing limited to deciding which parts of the scholarship to foreground and which to push aside. It also repeatedly distorted what the scholarship actually said.

The most cited historian

Wikipedia’s use of Morris’s work shows the pattern particularly clearly. His archival research played a central role in reshaping the historiography of the Israeli-Palestinian conflict by foregrounding many previously neglected aspects of Jewish and Israeli conduct before and during the 1948 war that contributed to the creation of the Palestinian refugee problem, including expulsions, massacres, attacks on civilian communities and the destruction of villages. At the same time, he rejected the simplistic claim that the Palestinian exodus was the result of a pre-existing Zionist master plan to expel the country’s Arabs. As Cambridge University Press noted in its description of The Birth of the Palestinian Refugee Problem Revisited, Morris’s findings “undermined the conflicting Zionist and Arab interpretations”—the former that the Palestinians had left voluntarily, and the latter that their flight was the result of a pre-planned expulsion. His account instead presented a much more complex history that did not conform neatly to either political narrative. That complexity is precisely what the rewritten article strips away. To make sure I was reading Morris’s work correctly, I asked him to review my analysis at an early stage. He confirmed that I had accurately caught and explained the distortions of his scholarship described below, and later graciously agreed to review the full draft.

Tim Stanley is a historian by trade, and the author of Whatever Happened to Tradition? — a book subtitled History, Belonging and the Future of the West.

He was, of course, talking about the seismic demographic changes which have taken place in this country over the past few decades, against the express wishes of the British people. Indeed, the changes which have taken place over the past few decades represent the biggest demographic change in these islands since the migration of the Anglo-Saxons a millennium and a half ago.

– George Baker

Which in turn causes me to recall a remark made by Chesterton:

The whole modern world has divided itself into Conservatives and Progressives. The business of Progressives is to go on making mistakes. The business of Conservatives is to prevent mistakes from being corrected. Even when the revolutionist might himself repent of his revolution, the traditionalist is already defending it as part of his tradition. Thus we have two great types — the advanced person who rushes us into ruin, and the retrospective person who admires the ruins. He admires them especially by moonlight, not to say moonshine. Each new blunder of the progressive or prig becomes instantly a legend of immemorial antiquity for the snob. This is called the balance, or mutual check, in our Constitution.

– G.K. Chesterton

Nixon incurred a generation’s outrage and mockery for insisting to interviewer David Frost that, “When the president does it, that means that it is not illegal.” Trump, within the first month of his second term, asserted on social media that, “He who saves his Country does not violate any Law,” a formulation frequently attributed to Napoleon. When asked the previous month by The New York Times whether there were any constraints on his power, he said: “Yeah, there is one thing. My own morality. My own mind. It’s the only thing that can stop me.” These statements are much closer to reality than they were during his first term, thanks to a 2024 Supreme Court decision, Trump v. United States, granting presidents absolute immunity from criminal prosecutions for the exercise of “core constitutional powers,” plus lesser forms of immunity for “official acts.”

– Matt Welch gives the POTUS a kicking.