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this post was submitted on 25 Sep 2023
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This is a terrible plan. "Breaking up monopolies" = privatizing the organ coordimation and distribution systems. It will politicize the procurement process, and award the contracts to distribute kidneys to the highest ~~bribe~~ donor.
The current aystem is flawed, but the solution is not de-regulated capitalism. This will be a long term disaster.
I don't see how this change represents de-regulated capitalism any more or less than the status quo. Currently there is a single nonprofit corporation that has been the sole recipient of the primary government contact for over 40 years. Just because they are a nonprofit corporation doesn't mean they can't have many of the conflict of interest issues that for profit corporations have. Indeed, it sounds like there is evidence of that as there is overlap between the UNOS board of directors and their oversight board.
The change doesn't impact the fact that the government is contacting out for services. What it does is allow the government to contact out more ala carte since it seems the current organization has allowed aspects of the service to languish.
I would be worried if the government was moving responsibilities from a government agency to an outside bidder, but that doesn't seem to be the case.
What it does is increase the spending limits and allows for wider discretion in doling out the contracts. But that's it. That's the bill. It does not modernize the database, it does not address racial disparities in organ distribution, it does not improve transparency or provide access to collected data or save lives or increase awareness outreach. Those are all the victories that the authors and supporters of the bill are claiming. Their dancing around the ring with their arms raised, like they fixed the OPTN and defeated the evil UNOS Monopoly.
UNOS supports the bill, and will probably get more contracts out of it.
This bill does not solve problems. It creates opportunities.
I don't see how you addressed my point that the change doesn't in and of itself represent deregulation. Surely opening the process up to more bidders and allowing the government to more directly prioritize initiatives isn't deregulation.
Setting that aside, I only have a cursory knowledge of the background from some NYT articles I read in the spring. Those articles mentioned the concerns you give around inequality and outdated technology and systems. My understanding is that one of the first planned contracts to go to bid is to modernize the technology systems, which seems to at least be a start at addressing known deficiencies. Additionally, more targeted contracts allow the government to review for more specific goals and outcomes rather than a monolithic overarching agreement.
It's easy to list all the negative things that could happen with the process. But like you say, this bill itself doesn't solve the problems, it creates opportunities. I see opportunities to fix the problems. Your are welcome to focus on the negative and assume this is just a financial play. Both of us are predicting the future and time will tell.
From how the bill reads, the system is already privatized and has been run by one single non-profit for the past 40 or so years. Now it can be operated by more than one organization, but I can't immediately find information on if the the non-profit organization requirement has been changed or not.
UNOS has issues, but the organization is not the cause of most of them. The lack of competition is not the source of their problems. They need a modernized infrastructure, and there should be more transparency in the policy decisions. We should expand access to transplants and improve healthcare across the board.
This bill claims to fix all of those things, but doesn't. It merely removes the guardrails in contract allocation and amounts. It won't be immediate, but give it ten years, and the system will be ridiculously corrupt, incompetent, and entirely partisan.
Like everything else the government does,
As usual, all criticism without references or an alternative solution. Oh, and a casual slur without proof.
Go back beneath your bridge
Where's the slur?
You could just read the text of the bill. What does this bill accomplish? It removes the $7 million limit on contract awards, and give the HRSA authority to give contracts out to whomever for whatever.
It also requires that the HRSA submit a GAO report, which you would think means oversight, but in reality it just means politicizing the decisions made by the HRSA, ensuring that fatter contracts go to the oligarchs that want more taxpayer money. Do you really think the MAGAs in Congress don't expect to get their beaks wet? There's a reason it has so much bipartisan support in Congress.
It also corrects the misspelling of "histocompatibility," just in case you were concerned that the people making decisions were incompetent.
UNOS has actual problems, and there are systemic inequalities inherent in our OPTN. This bill addresses none of them. If they wanted to fix them, they could nationalize UNOS or regulated OPOs, or fund a national modern database with proper EDI formats. They could fund research for ethical reviews of bias in organ distribution. None of that is in this bill. All of the speeches and summaries include these targets as possibilities and goals for the new process, but none of it is actually included.
The bill isn't named in the article, which makes tracking down the text to read it a bit challenging. Will edit this comment later as I garner info.
Bill name: Securing the U.S. Organ Procurement and Transplantation Network Act
Very brief summary.
Slightly longer aummary.
Allegedly the full text. I am not certain this is the final version, as opposed to the Senate version pre-reconciliation.
Based on the summaries, it for sure sounds like the contracts will simply go out for bid now, which should mean we can expect performance to degrade as companies compete for who can provide the worst service at the lowest pay grade.
Here's the two page summary from the Senate Finance committee. It's a pdf warning.
https://www.finance.senate.gov/imo/media/doc/051723_securing_the_us_optn_act_summary.pdf
edited to unmask the link
Page not found. The above poster's links work
Sorry, fixed it. Should work now.