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To Rhiannon, Rory, and Eirian
Contents

List of Figures xvi

List of Tables xviii
List of Boxes xix
Preface xx
Acknowledgments xxii

PART I
Introduction to Public Policy Analysis 1

1 Preview 3
2 What is Policy Analysis? 30
3 Toward Professional Ethics 42

PART II
Conceptual Foundations for Problem Analysis 57

4 Efficiency and the Idealized Competitive Model 59

5 Rationales for Public Policy: Market Failures 74
6 Rationales for Public Policy: Other Limitations of the Competitive
Framework114
7 Rationales for Public Policy: Distributional and Other Goals 130
8 Limits to Public Intervention: Government Failures 149
9 Policy Problems as Market and Government Failure:
The Madison Taxicab Policy Analysis Example 182
x Contents
PART III
Conceptual Foundations for Solution Analysis203

10 Correcting Market and Government Failures: Generic Policies 205

11 Adoption 259
12 Implementation 280
13 Government Provision: Drawing Organizational Boundaries 304

PART IV
Doing Policy Analysis 325

14 Gathering Information for Policy Analysis 327

15 Landing on Your Feet: Organizing Your Policy Analysis 340
16 Case Study: The Canadian Pacific Salmon Fishery 376
17 Cost–Benefit Analysis: Assessing Efficiency 398
18 Public Agency Strategic Analysis: Identifying Opportunities
for Increasing Social Value 435

PART V
Conclusion 451

19 Doing Well and Doing Good 453

Name Index 455

Subject Index 468
Detailed Table of Contents

List of Figures xvi

List of Tables xviii
List of Boxes xix
Preface xx
Acknowledgments xxii

PART I
Introduction to Public Policy Analysis 1

1 Preview 3
Reducing the U.S. Kidney Transplant Shortage 3
Debriefing 22
Write to Your Client 23
Understand the Policy Problem 24
Be Explicit About Values 25
Specify Concrete Policy Alternatives 26
Predict and Value Impacts 27
Consider the Trade-Offs 27
Make a Recommendation 28
For Discussion 29

2 What Is Policy Analysis? 30

Policy Analysis in Perspective 31
Policy Analysis as a Profession 34
A Closer Look at Analytical Functions 38
Basic Preparation for Policy Analysis 39
For Discussion 41

3 Toward Professional Ethics 42

Analytical Roles 43
Value Conflicts 46
Ethical Code or Ethos? 53
For Discussion 55
xii Detailed Contents
PART II
Conceptual Foundations for Problem Analysis 57

4 Efficiency and the Idealized Competitive Model 59

The Efficiency Benchmark: The Competitive Economy 60
Market Efficiency: The Meaning of Social Surplus 62
Caveats: Models and Reality 72
Conclusion 73
For Discussion 73

5 Rationales for Public Policy: Market Failures 74

Public Goods 74
Externalities 93
Natural Monopoly 98
Information Asymmetry 104
Conclusion 112
For Discussion 112

6 Rationales for Public Policy: Other Limitations of the Competitive

Framework 114
Thin Markets: Few Sellers or Few Buyers 114
The Source and Acceptability of Preferences 115
The Problem of Uncertainty 119
Intertemporal Allocation: Are Markets Myopic? 124
Adjustment Costs 127
Macroeconomic Dynamics 128
Conclusion 128
For Discussion 129

7 Rationales for Public Policy: Distributional and Other Goals 130

Social Welfare beyond Pareto Efficiency 130
Substantive Values Other Than Efficiency 137
Some Cautions in Interpreting Distributional Consequences 142
Choosing Distributional Values 146
Instrumental Values 147
Conclusion 148
For Discussion 148

8 Limits to Public Intervention: Government Failures 149

Problems Inherent in Direct Democracy 150
Problems Inherent in Representative Government 156
Problems Inherent in Bureaucratic Supply 168
Problems Inherent in Decentralization 177
 Detailed Contents xiii
Conclusion 181
For Discussion 181

9 Policy Problems as Market and Government Failure: The Madison

Taxicab Policy Analysis Example 182
Postscript: Technology Makes the 24/7 Rule Irrelevant 195
The Relationship between Market and Government Failures 197
Conclusion 200
For Discussion 201

PART III
Conceptual Foundations for Solution Analysis 203

10 Correcting Market and Government Failures: Generic Policies 205

Freeing, Facilitating, and Simulating Markets 205
Using Subsidies and Taxes to Alter Incentives 215
Establishing Rules 231
Supplying Goods through Nonmarket Mechanisms 244
Providing Insurance and Cushions 251
Conclusion 257
For Discussion 258

11 Adoption 259
The Big Picture: Policy Process Frameworks and Theories 260
Practical Approach to Assessing and Influencing Political Feasibility 269
Political Strategies with Arenas 273
Conclusion 279
For Discussion 279

12 Implementation 280
Prerequisite: Sound Logic 281
Identifying the Links in the Chain: The Assembly Metaphor 282
Roles in the Implementation Process 282
Implementation Analysis Techniques 289
Policy Outcomes: Uncertainty and Error Correction 294
Understanding the Implications of Repeated Interaction 299
Conclusion 303
For Discussion 303

13 Government Provision: Drawing Organizational Boundaries 304

Provision or Production? 304
Production Costs, Bargaining Costs, and Opportunism Costs in Contracting 307
xiv Detailed Contents
Predicting Bargaining and Opportunism Costs 311
More Autonomous Public Supply 315
Complex Public Provision 316
Public–Private Partnership Case 319
Assessing and Building Public Agency Capacity 322
Conclusion 323
For Discussion 323

PART IV
Doing Policy Analysis 325

14 Gathering Information for Policy Analysis 327

Document Research 328
Field Research 336
Conclusion 339
For Discussion 339

15 Landing on Your Feet: Organizing Your Policy Analysis 340

Analyzing Yourself 340
The Client Orientation 341
Steps in Rationalist Policy Analysis 342
Problem Analysis 343
Solution Analysis 355
Communicating Analysis 370
Self-Analysis Once Again: Combining Linear and Nonlinear Approaches 374
Conclusion 375
For Discussion 375

16 Case Study: The Canadian Pacific Salmon Fishery 376

For Discussion 397

17 Cost–Benefit Analysis: Assessing Efficiency 398

Preview: CBA of a Juvenile Justice Program 400
Net Benefits and Potential Pareto Improvement 403
Step 1: Specify Current and Alternative Policies 404
Step 2: Specify Whose Costs and Benefits Count 405
Step 3: Catalogue Relevant Impacts 407
Step 4: Predict Impacts over Time Horizon of Policies 408
Step 5: Monetize All Impacts 412
Step 6: Discount Benefits and Costs to Obtain Present Values 420
Step 7: Compute the Present Value of Net Benefits 424
Step 8: Perform Sensitivity Analysis 426
 Detailed Contents xv
Step 9: Recommend 431
Conclusion 433
For Discussion 434

18 Public Agency Strategic Analysis: Identifying Opportunities for Increasing

Social Value 435
Clarifying Social (Public) Value 436
The External Forces on an Agency 438
Internal Analysis: The Value Creation Process 446
Feasible, Rather than Ideal, Alternatives 449
Conclusion 449
For Discussion 450

PART V
Conclusion 451

19 Doing Well and Doing Good 453

Name Index 455

Subject Index 568
Figures

3.1 Alternative Responses to Value Conflicts 48

4.1 Pareto and Potential Pareto Efficiency 61
4.2 Consumer Values and Surpluses 63
4.3 Changes in Consumer Surplus 64
4.4 Money Metrics for Utility 66
4.5 Average and Marginal Cost Curves 67
4.6 Monopoly Pricing, Rents, and Deadweight Loss 69
4.7 A Supply Schedule and Producer Surplus  71
4.8 Inefficiencies Resulting from Deviations from the Competitive
Equilibrium72
5.1 Demand Summation for Rivalrous and Nonrivalrous Goods 77
5.2 A Classification of Goods: Private and Public 80
5.3 Toll Goods 82
5.4 Private Provision of a Public Good: Privileged Group 85
5.5 Overconsumption of Open-Access Resources 89
5.6 Choice of Herd Size as a Prisoner’s Dilemma 90
5.7 Overproduction with a Negative Externality 95
5.8 Underproduction with a Positive Externality 96
5.9 Social Surplus Loss from Natural Monopoly 100
5.10 Shifting Demand and Multiple Firm Survival 102
5.11 X-Inefficiency under Natural Monopoly 104
5.12 Consumer Surplus Loss from Uninformed Demand 106
6.1 Utility Function Showing Loss Aversion 123
7.1 Lorenz Curve and Gini Index of Income Inequality 144
8.1 Agenda Control in a Two-Dimensional Policy Space 153
8.2 Surplus Transfers and Deadweight Losses under Price Supports 160
8.3 Surplus Transfer and Deadweight Losses under Price Ceilings 162
9.1 A Procedure for Linking Market and Government Failure to Policy
Interventions198
10.1 The Effect of a Matching Grant on Provision of Targeted Good 221
10.2 The Effect of an In-Kind Subsidy on Consumption 226
12.1 Implementation Roles 284
12.2 Equilibria in a Repeated Game 301
15.1 A Summary of Steps in the Rationalist Mode 343
15.2 Choosing a Solution Method 351
17.1 Opportunity Cost in a Factor Market with a Price Floor 413
 Figures xvii
17.2 Consumer Surplus Gain of Increased Swimming Pool Access for
the Wheelchair Disabled 416
17.3 The Present Value of Production and Consumption 421
17.4 Net Social Benefits of HEALTH 430
18.1 PASA External Analysis: Five Forces that Shape the Strategic
Situation439
Tables

2.1 Creation and Application of Public Policy Knowledge 32

3.1 Three Views on the Appropriate Role of the Policy Analyst 44
5.1 Examples of Externalities 94
6.1 A Summary of Market Failures and Their Implications for Efficiency 129
7.1 Alternative Social Welfare Functions 132
7.2 Comparison of Alternative Deceased-Donor Kidney Allocation Systems 147
8.1 An Illustration of the Paradox of Voting 151
8.2 Sources of Inefficiency in Representative Government: Divergences
between Social and Political Accounting 169
8.3 Sources of Government Failure: A Summary 181
10.1 Freeing, Facilitating, and Simulating Markets 206
10.2 Using Subsidies and Taxes to Alter Incentives 217
10.3 Establishing Rules 232
10.4 Supplying Goods through Nonmarket Mechanisms 246
10.5 Providing Insurance and Cushions 251
10.6 Searching for Generic Policy Solutions 257
11.1 Policy Process Frameworks and Theories: Implications for
Policy Analysts 261
11.2 A Political Analysis Worksheet: Feasibility of a Ban on Random
Workplace Drug Testing 270
12.1 Thinking Systematically about Implementation: Forward Mapping 291
13.1 When Are Incremental Costs Likely to Favor Contracting Out? 307
13.2 Six Dimensions of Property Rights: Differences between Public,
Private, and Public–Private Hybrid Organizations 318
15.1 The Simple Structure of a Goals/Alternatives Matrix 355
15.2 License Assignment Methods Compared 357
15.3 Typical Impact Categories for Efficiency 358
15.4 Comparison of Selected Policies for Cutting CO2 Emissions 366
15.5 Communicating Policy Analyses 374
17.1 Present Value of Net Benefits of Investing in New Garbage Trucks 425
17.2 Mean Costs and Benefits of HEALTH from Monte Carlo Simulation 429
17.3 Choosing among Projects on the Basis of Economic Efficiency 432
Boxes

1.1 Reducing the U.S. Kidney Transplant Shortage by Increasing

the Number of Live-Donor Kidneys 3
9.1 Taxi Regulation in Madison 182
16.1 Increasing the Social Value of the BC Salmon Fishery 377
17.1 The King County Education and Employment Training
(EET) Program 401
Preface

When we began our study of policy analysis at the Graduate School of Public Policy (now
the Goldman School), University of California at Berkeley, the field was so new that we
seemed always to be explaining to people just what it was that we were studying. It is no
wonder, then, that there were no textbooks to provide us with the basics of policy analy-
sis. More than a dozen years later, we found ourselves teaching courses on policy analysis
but still without what we considered to be a fully adequate text for an introductory course
at the graduate level. Our experiences as students, practitioners, and teachers convinced us
that an introductory text should have at least three major features. First, it should provide
a strong conceptual foundation of the rationales for, and the limitations to, public policy.
Second, it should give practical advice about how to do policy analysis. Third, it should
demonstrate the application of advanced analytical techniques rather than discuss them
abstractly. We wrote this text to have these features.
We organize the text into five parts. In Part I we begin with an example of a policy
analysis and then emphasize that policy analysis, as a professional activity, is client
oriented, and we raise the ethical issues that flow from this orientation. In Part II we pro-
vide a comprehensive treatment of rationales for public policy (market failures, broadly
defined) and we set out the limitations to effective public policy (government failures). In
Part III we set out the conceptual foundations for solving public policy problems, includ-
ing a catalogue of generic policy solutions that can provide starting points for crafting
specific policy alternatives. We also offer advice on designing policies that will have good
prospects for adoption and successful implementation, and how to think about the choice
between government production and contracting out. In Part IV we give practical advice
about doing policy analysis: structuring problems and solutions, gathering information,
and measuring costs and benefits. Furthermore, there is an entirely new chapter on per-
forming analysis from the perspective of a public agency and a particular program within
the agency’s portfolio: public agency strategic analysis (PASA). Part V briefly concludes
with advice about “doing well and doing good.”
We aim our level of presentation at those who have had, or are concurrently taking,
an introductory course in economics. Nevertheless, students without a background in
economics should find all of our general arguments and most of our technical points
accessible. With a bit of assistance from an instructor, they should be able to understand
the remaining technical points.
We believe that this text has several potential uses. We envision its primary use as the
basis of a one-semester introduction to policy analysis for students in graduate programs
in public policy, public administration, and business. (Thorough treatment of all topics
covered, including cost–benefit analysis, would probably require two semesters.) We
believe that our emphasis on conceptual foundations also makes it attractive for courses
 Preface xxi
in graduate programs in political science and economics. At the undergraduate level, we
think our chapters on market failures, government failures, generic policies, and cost–­
benefit analysis are useful supplements to, and perhaps even replacements for, the com-
monly used public finance texts that do not treat these topics as comprehensively.

New to This Edition

Faculty and students will find that a great many substantive changes have been made
throughout the text since the fifth edition was published. Among the more notable changes
are:

• A new introductory case on the shortage of kidneys for transplantation (Chapter 1);
• A sketch of policy analysis steps that serves as an introductory overview of the craft
of policy analysis (Chapter 1);
• A postscript added to the Madison taxicab case describing the impact of Uber on the
market and its regulation (Chapter 9);
• More explicit treatment of important roles in the implementation process (Chapter 12);
• Introduction of a property rights framework for assessing hybrid organizations
(Chapter 13);
• An updated British Columbia salmon fishery case (Chapter 16);
• A substantially revised and more accessible cost–benefit analysis chapter (Chapter 17);
• A new chapter that sketches public agency strategic analysis (Chapter 18).
Acknowledgments

A reviewer of the first edition of this text told us that we had expounded what he takes
to be the “Graduate School of Public Policy approach to public policy.” His comment
surprised us: we had not consciously attributed our peculiar views of the world to any
particular source. But in retrospect, his comment made us realize how much our gradu-
ate teachers contributed to what we have written. Although they may wish to disavow
any responsibility for our product, we nevertheless acknowledge a debt to our teachers,
especially Eugene Bardach, Robert Biller, Lee Friedman, the late C. B. McGuire, Arnold
Meltsner, William Niskanen, Philip Selznick, and the late Aaron Wildavsky.
We offer sincere thanks to our many colleagues in Rochester, Vancouver, Madison, and
elsewhere, who gave us valuable comments on the drafts of the first edition of this text:
Gregg Ames, David Austen-Smith, Judith Baggs, Eugene Bardach, Larry Bartels, William
T. Bluhm, Gideon Doron, Richard Fenno, Eric Hanushek, Richard Himmelfarb, Bruce
Jacobs, Hank Jenkins-Smith, Mark Kleiman, David Long, Peter May, Charles Phelps, Paul
Quirk, Peter Regenstreif, William Riker, Russell Roberts, Joel Schwartz, Fred Thompson,
Scott Ward, Michael Wolkoff, Glenn Woroch, and Stephen Wright. A special thanks to
Stanley Engerman, George Horwich, and John Richards, who went well beyond the call of
duty in offering extensive and helpful comments on every chapter. We thank our research
assistants, Eric Irvine, Murry McLoughlin, Katherine Metcalfe, and Donna Zielinski.
We also thank Betty Chung, Mary Heinmiller, Jean Last, Dana Loud, Karen Mason, and
Helaine McMenomy for logistical assistance at various times during preparation of the
first edition.
We wish to also thank the following people who helped us make improvements in the
second, third, fourth, fifth, and sixth editions: Theodore Anagnoson, Eugene Bardach,
William T. Bluhm, Wayne Dunham, Stanley Engerman, David Greenberg, Catherine
Hansen, Eric Hanushek, Robert Haveman, Bruce Jacobs, Kristen Layman, Greg Nemet,
William H. Riker, Ulrike Radermacher, Richard Schwindt, Danny Shapiro, and Itai Sened.
We thank our research assistants, Shih-Hui Chen, Christen Gross, Ga-der Sun, and Dan
Walters, for their help. Finally, we thank our students at the University of Rochester,
Simon Fraser University, Lingnan (University) College, and the Robert M. La Follette
School of Public Affairs at the University of Wisconsin–Madison, for many useful sugges-
tions regarding presentation.

David L. Weimer
Madison, Wisconsin
Aidan R. Vining
Vancouver, British Columbia
Part I

Introduction to Public Policy Analysis

1 Preview

After earning your policy degree last May, you immediately went to work on Mary
Smith’s campaign for the U.S. Senate. She won!
Your enthusiastic efforts during the campaign earned you a position on her transition
team, which the senator-elect created to identify policies for addressing problems she
views as particularly important. Senator-elect Smith hopes to be appointed to the Senate
Committee on Health, Education, Labor & Pensions because of her interest in health
policy. One specific problem she hopes to address is the long and growing waiting list for
kidney transplants. She asks the transition team to consider policies that might reduce the
length of the transplant waiting list by facilitating, even encouraging, more people to make
living donations of kidneys.
Neither you nor your colleague tasked with preparing the policy analysis addressing
the kidney shortage have any background in health issues. Fortunately, you had a course
on policy analysis as a student that gave you experience in gathering relevant information
quickly from already-available research and organizing it effectively to provide useful
advice. You work very hard on the report during the one week you have available, not
only because you hope it will earn you a position on the senator-elect’s legislative staff in
Washington, but also because once you start learning about the topic you find it interest-
ing and you realize that your advice might actually contribute to better public policy. Your
report follows.

BOX 1.1 REDUCING THE U.S. KIDNEY TRANSPLANT SHORTAGE

BY INCREASING THE NUMBER OF LIVE-DONOR KIDNEYS

To: Senator-elect Mary Smith

From: Transition staff
Box 1.1 page 1

Date: November 30, 2016

Concerning: Reducing the U.S. Kidney Transplant Shortage by Increasing the
Number of Live-Donor Kidneys

Executive Summary
Kidney transplants generally improve both the quality of life and longevity of
patients with end-stage renal disease (ESRD). By substituting for the costly alterna-
tive treatment, dialysis, they also reduce Medicare expenditures over the lifetime of
 4 Introduction

patients. However, a shortage of kidneys has resulted in a large and growing wait-
ing list for kidney transplants. Potential increases in the number of deceased-donor
kidneys are relatively small because the pool of feasible donors is small. Potential
increases in the number of live-donor kidneys are large because the pool of feasible
donors is very large. Financial incentives, ranging from greater compensation for
non-medical expenses to removal of the current ban on sale and purchase, can
increase the availability of live-donor kidneys. The transition team recommends that
you introduce legislation to establish expanded reimbursement with relative list-
ing, a policy that would increase federal reimbursement for non-medical expenses
incurred in making a live donation to the transplant waiting list, allow nonprofit
organizations to reimburse non-medical expenses incurred by any living donor, and
create a priority on the transplant list for living donors and one relative of their
choice.
The National Organ Transplant Act of 1984 currently bans commercial transac-
tions in transplant organs. An unregulated market for live kidneys would eliminate
the shortage of transplant kidneys. However, it would have inherent inefficiencies as
well as raise ethical concerns about exploitation of the poor, undue advantage for
the wealthy, and commodification of the human body. In light of these disadvan-
tages, this analysis considers three other alternatives to current policy that would
make live donation either more financially attractive or less financially prohibitive:
(1) brokered auctions would impose an intermediary between sellers (vendors) and
Box 1.1 page 2

purchasers (patients); (2) expanded reimbursement with relative listing would offset
more of the non-medical costs for living donors and give priority to deceased-donor
kidneys to living donors and their designated relatives, if they become patients; and
(3) purchase with demand-side chain auctions would allow purchase of vendor
kidneys by a chartered entity at an administered price and allocation of kidneys to
the transplant centers that can use them to initiate the largest number of transplants.
The transition team assesses these alternatives in terms of five policy goals: (1)
protection of human dignity; (2) equity; (3) efficiency; (4) favorable fiscal impact;
and (5) political feasibility. Although current policy protects the human dignity of
U.S. residents, provides equity in access to transplantation, and is politically feasible,
it inefficiently forgoes potential increases in the supply of kidneys and favorable
fiscal impacts offered by the other alternatives.
Brokered auctions would substantially increase the availability of kidneys by
thousands or even tens of thousands annually and generate very large savings for the
federal government. However, these gains in efficiency and favorable fiscal impact
come with an increased threat to human dignity through exploitation of the poor,
greater inequity in access to transplant organs in terms of wealth, and very poor
prospects for adoption.
Expanded reimbursement with relative listing would increase the availability of
kidneys by hundreds or perhaps thousands annually and produce savings for the
federal government. It would have small impacts on human dignity and equity, and
would likely be politically feasible.
Purchase with demand-side auctions would likely increase the availability of kid-
neys by the tens of thousands, offering the potential for eventually effectively elimi-
nating the kidney transplant waiting list. It would also have favorable fiscal impacts
for the federal government and not increase inequity in allocation. However, it does
 Preview 5

risk exploitation of the disadvantaged; moreover, as a radical departure from cur-

rent policy, it would have poor prospects for adoption.
Considering these trade-offs, expanded reimbursement with relative listing offers
the best prospects for a desirable and feasible improvement relative to current
policy. The transition team recommends that you ask the Congressional Research
Service to draft legislation for this alternative.

Policy Problem: Too Few Kidneys for Transplant

End-stage renal disease (ESRD) can currently be treated with either dialysis or
transplantation of a replacement kidney. Most ESRD patients prefer a transplant
because it generally provides a higher quality of life and greater longevity than dialy-
sis. However, transplantation currently requires available human kidneys, which
come from either deceased or living donors. In the United States, the demand for
kidney transplants currently far exceeds the supply of donated kidneys. The waiting
list for kidney transplants has over 100,000 patients.1 In 2015, available kidneys
allowed only 17,821 transplants, with 69 percent coming from deceased donors and
31 percent from live donors. That year, 35,037 new patients entered the waiting list
and 4,295 left it because they died. Recent increases in rates of obesity suggest that
the demand for kidney transplants will increase faster than population growth in
the future, because obesity contributes to diabetes and hypertension which are risk

Box 1.1 page 3

factors for ESRD. Increased prevalence of obesity also reduces the pool of potential
donors of healthy kidneys.
The shortage of kidneys has implications for federal expenditures as well as the
lives of ESRD patients. Medicare covers much of the cost of dialysis and transplanta-
tion not covered by private insurers. Its expenditures pay over 80 percent of the costs
of treating ESRD––$30.9 billion in 2013, or about 7.1 percent of total Medicare
paid claims.2 Over the expected lives of patients, a transplant involves lower cost to
Medicare than does dialysis. A recent study estimates that each kidney transplant
saves taxpayers on average about $146,000.3
Increasing the supply of deceased-donor kidneys could reduce, although not elimi-
nate, the shortage. Organ procurement organizations (OPOs) receive authorizations
for donations, either post-death from family members or pre-death from donors,
for approximately 73 percent of eligible deaths (brain death in a hospital by some-
one 70 years old or younger and without exclusionary medical conditions).4 If
authorizations were received for all the eligible deaths, then approximately another
4,500 kidney transplants could be done each year. Currently, about 15 percent of
donations come from those suffering cardiac rather than brain death, although

1 Current waiting list and other transplant-related data are available from the Organ Procurement and
Transplantation Network (https://optn.transplant.hrsa.gov/).
2 U.S. Renal Data System, Annual Data Reports (Bethesda, MD: National Institutes of Health, 2015).
3 Present value estimate, using 3 percent real discount rate. P. J. Held, F. McCormick, A. Ojo,
and J. P. Roberts, “A Cost–Benefit Analysis of Government Compensation for Kidney Donors,”
American Journal of Transplantation 16(3) 2016, 877–85.
4 D. S. Goldberg, B. French, P. L. Abt, and R. K. Gilroy, “Increasing the Number of Organ Transplants
in the United States by Optimizing Donor Authorization Rates,” American Journal of Transplantation
15(8) 2015, 2117–25.
 6 Introduction

some transplant centers have increased their rate of use to approximately 30 per-
cent.5 If all centers reached this level of use, then the total availability of kidneys
could increase by almost 6,000. Although an increase of this magnitude would be
extremely valuable if it actually could be obtained, it would be too small to slow the
growth of the kidney transplant waiting list.
Changes in the allocation rules for deceased-donor kidneys implemented in
December 2014 by the Organ Procurement and Transplantation Network (OPTN)
include provisions that may affect future kidney availability.6 A new classification
system for the quality of donated kidneys is likely to reduce refusals by patients to
accept kidneys from older or sicker donors. Better matching of expected kidney graft
life with expected patient life is likely to reduce the need for second transplants that
would otherwise result when patients outlive their grafts. Nonetheless, the new rules
are likely to have only a modest impact on the length of the waiting list.
Kidneys donated by living people could substantially reduce or even eliminate the
kidney waiting list. Humans are born with two kidneys but only need one kidney to
live a healthy life under normal circumstances. Live donation involves a small surgi-
cal risk: a 0.03 percent chance of death and less than 1 percent chance of a major
complication.7 Although some questions about long-term impacts have been raised
by a recent Norwegian study,8 long-term follow-up of living donors in the United
States finds neither increased risk of renal disease nor reduced longevity.9 Although
living kidney donation poses very small medical risk, it often involves travel and sub-
Box 1.1 page 4

sistence costs as well as potentially the loss of wages by donors and their caregivers.
A recent study found that, although some donors received financial assistance from
government or private sources, 89 percent suffered a net financial loss: average costs
for donors included direct expenses of $1,157 and lost wages of $1,660, with their
caregivers incurring an additional $377 in lost wages.10
The number of living donors peaked at 6,647 in 2004.11 Less than one-third of
transplanted kidneys now come from living donors, a decline since the peak. Most

5 A. J. Matas, J. M. Smith, M. A. Skeans, K. E. Lamb, S. K. Gustafson, C. J. Samana, D. E. Stewart, J. J.

Snyder, A. K. Israni, and B. L. Kasiske, “OPTN/SRTR 2011 Annual Data Report: Kidney,” American
Journal of Transplantation 13(s1) 2013, 11–46.
6 Ajay K. Israni, Nicholas Salkowski, Sally Gustafson, Jon J. Snyder, John J. Friedewald, Richard
N. Formica, Xinyue Wang, et al. “New National Allocation Policy for Deceased Donor Kidneys
in the United States and Possible Effect on Patient Outcomes,” Journal of the American Society of
Nephrology 25(8) 2014, 1842–48.
7 Robert S. Gaston, Vineeta Kumar, and Arthur J. Matas, “Reassessing Medical Risk in Living Kidney
Donors,” Journal of the American Society of Nephrology 26(5) 2015, 1017–19.
8 Anders Hartmann, Per Fauchald, Lars Westlie, Inge B. Brekke, and Hallvard Holdaas, “The Risk of
Living Kidney Donation,” Nephrology Dialysis Transplantation 18(5) 2003, 871–73.
9 Hassan N. Ibrahim, Robert Foley, LiPing Tan, Tyson Rogers, Robert F. Bailey, Hongfei Guo,
Cynthia R. Gross, and Arthur J. Matas, “Long-term Consequences of Kidney Donation,” New
England Journal of Medicine 360(5) 2009, 459–69.
10 J. R. Rodrigue, J. D. Schold, P. Morrissey, J. Whiting, J. Vella, L. K. Kayler, D. Katz, J. Jones, B.
Kaplan, A. Fleishman, M. Pavlakis, and D. A. Mandelbrot, “Direct and Indirect Costs Following
Living Kidney Donation: Findings from the KDOC Study,” American Journal of Transplantation
16(3) 2016, 869–76.
11 James R. Rodrigue, Jesse D. Schold, and Didier A. Mandelbrot, “The Decline in Living Kidney
Donation in the United States: Random Variation or Cause for Concern?” Transplantation 96(9)
2013, 767–73.
 Preview 7

of these donors are relatives or close friends of the ESRD patient. Often people
who are willing to donate to a specific person cannot do so because of biological
incompatibilities that would result in the patient’s immune system rejecting the
donated kidney. Although evidence is accumulating that patients can often be desen-
sitized to increase the range of kidneys feasible for transplantation, outcomes appear
less favorable than for compatible kidneys.12 A more common approach to donor
incompatibility is the arrangement of paired donations, which may enable incom-
patible donors to facilitate transplants for their intended patients by an exchange of
donations across pairs: the donor in the first incompatible pair gives to the patient in
the second incompatible pair, and the donor in the second incompatible pair donates
to the patient in the first incompatible pair. Exchanges can also involve three or
more pairs, though they are more difficult to arrange.
A transplantation chain begins with an altruistically motivated nondirected kidney
donation––approximately 180 per year or about 3 percent of all kidney donations
in the last five years were nondirected.13 The kidney is transplanted to the patient in
an incompatible donor–patient pair. The donor in that pair donates a kidney to the
patient in another incompatible pair. The process continues until no patient in an
incompatible pair can be found to receive the donation. Instead, the donor in the last
pair receiving a kidney donates a kidney to the compatible person on the waiting list
with highest priority. By seeding a chain, a single nondirected donation can facilitate
multiple transplants that would not otherwise occur. For example, a chain in 2015

Box 1.1 page 5

involved 34 donors and patients.14
The National Organ Transplant Act of 1984 (PL 98–507) established the legal
framework for the regulation of solid organ transplantation in the United States.
Section 274c(a) strictly bans the sale of organs: “It shall be unlawful for any person
to knowingly acquire, receive, or otherwise transfer any human organ for valuable
consideration for use in human transplantation if the transfer affects interstate com-
merce.” The provision has been interpreted to allow insurers, transplant recipients,
states, or others to reimburse living kidney donors for their medical, travel, and
subsistence costs. Further, the Organ Donation and Recovery Improvement Act of
2004 (PL 108-216) authorized the Secretary of Health and Human Services to make
grants to public or private entities to reimburse live kidney donors and up to two
caregivers for their travel, subsistence, and incidental expenses. It also allows reim-
bursement to those who incur these expenses in good faith but are actually unable to
make donations. The grants may fund payments only for costs not covered by state
programs, insurers, or organ recipients. Federal employees may take up to 30 days
of paid leave to make organ donations. Many states have similar programs for their
employees, and some allow their residents to deduct donation-related expenses from
taxable income.
Senator Smith, at your request, this analysis proposes and analyzes changes in
federal policy that could substantially reduce the kidney transplant waiting list by

12 Rob M. Higgins, Sunil Daga, and Dan A. Mitchell. “Antibody-Incompatible Kidney Transplantation
in 2015 and Beyond,” Nephrology Dialysis Transplantation 30(12) 2015, 1972–78.
13 Organ Procurement and Transplantation Network, Living Non-Directed Organ Donation (https://
optn.transplant.hrsa.gov/resources/ethics/living-non-directed-organ-donation).
14 Mark Johnson, “Longest Kidney Transplant Chain Shares Gift of Life 34 Times,” Milwaukee Journal
Sentinel, April 14, 2015.
 8 Introduction

encouraging more live kidney donation. Where possible, it provides quantitative

estimates of the impacts of the effects of alternatives to current policy on the increase
in the number of kidneys available for transplantation. However, because of the
deadline for preparing this report and the scarcity of available information, these
estimates should be viewed only as indicating likely orders of magnitude.

Problem Framing: Unregulated Market Unacceptable,

Market Ban Questionable
When goods are supplied in competitive markets with many buyers and sellers,
shortages cannot occur: if demand exceeds supply, prices rise to clear the market by
either eliciting greater supply, reducing the quantity demanded, or both. In the case
of live-donor kidneys in the United States, law prohibits the operation of a market so
that a shortage of kidneys for transplant persists. Those seeking a kidney transplant
can wait for a deceased donation to become available, seek a live donation from a
friend or relative, or engage in “transplant tourism” by buying a kidney in an illicit
market in a country that does not enforce bans on kidney markets as vigorously as
does the United States.
Three questions require answers to frame the kidney shortage as a public policy
problem. First, in the absence of a ban on kidney markets, would a market for
kidneys operate? Second, if an unregulated market did operate, would it efficiently
Box 1.1 page 6

allocate scarce kidneys in ways consistent with other important social values? Third,
if not, could a regulated market provide greater efficiency, be more consistent with
important social values, or both?
First, it is very likely that a market for live-donor kidneys would exist if it were
not prohibited. The ban on commercial transactions was included in the 1984 law
in response to the announced intentions of a physician to create an international
kidney exchange.15 The existence of markets for human eggs, which imposes an
irreplaceable loss on the donor, and surrogate motherhood, which involves risks to
health, suggest that live-donor kidney markets would arise. So too does the existence
of illicit markets enabling transplant tourism.
Second, would an unregulated market be efficient and desirable? There are at least
two “market failure” reasons to believe it would not. One failure is seller–buyer
information asymmetry. Live-donor kidneys are very heterogeneous in medically
relevant qualities. Some of these qualities can be assessed through medical tests.
Other qualities can be imperfectly imputed from medical histories, age, and perhaps
reported or observed lifestyles. Nonetheless, it is likely that kidney sellers would
enjoy an informational advantage relative to buyers about the quality of the kidneys
they offer. This information asymmetry results in inefficiency if buyers purchase
kidneys that they would otherwise not buy if they were fully informed about quality.
Additionally, buyers may enjoy an informational advantage (or asymmetry) about
the quality of the medical services that will be provided to sellers before, during, and
after the kidney is extracted and transplanted. This information asymmetry on the
supply side of the market may also result in inefficiency if people sell kidneys that

15 Kieran Healy, Last Best Gifts: Altruism and the Market for Human Blood and Organs (Chicago:
University of Chicago Press, 2010).
 Preview 9

they would not have sold if they had been fully informed about the quality of the
services they would receive––the “regretted sales” outcome that is reported to often
occur in transplant tourism markets.16 Thus, an unregulated market would almost
certainly suffer from dual-sided information asymmetry (this can occur whenever
the good has more than one quality dimension that determines value).
The second market failure is closely related. Because of the heterogeneity of
organs and their values, any market for kidneys that sought to match buyers and
sellers would unfold using an intermediate or so-called platform organization. As
seen in many information markets, the outcome of this market development process
would almost certainly be a single intermediary platform with monopoly power or
a few platform providers with market power. Platform concentration tends to occur
because sellers naturally want access to the maximum number of buyers and buyers
naturally want access to the maximum number of sellers. Ironically, the search by
suppliers for many buyers and by buyers for many sellers (that is, competition) can
result in a platform provider with monopoly power over both. It is hard for the
market to solve this inefficient outcome via market forces because the platform has
declining average cost that makes successful entry by other providers difficult.
In addition to inefficiencies resulting from information asymmetry and platform
concentration, an unregulated market would pose a number of ethical concerns.
These concerns often serve as a rationale to support market prohibition. First, an
unregulated market poses a threat to human dignity because it would risk exploita-

Box 1.1 page 7

tion of the poor. Financial stress may economically coerce some people into selling
kidneys that they would otherwise not sell.17 Second, an unregulated market would
obviously favor those with the resources to purchase kidneys. Not only would they
be able to outbid other patients for offered kidneys, but they would be better able to
hire agents to search out potential sellers, further increasing the risk of exploitation
of the poor or less informed. Third, many ethicists argue that allowing the com-
modification of kidneys in markets intrinsically violates human dignity by treating
the human body as having instrumental value and undercutting the exercise of
altruism.18 The first two ethical concerns are related to the outcomes of a market;
the third to its very operation.
Third, the market failures, exploitation of the poor, and undue advantage for
the wealthy could potentially be addressed, at least to some extent, through either
a regulated market or market-like policy, but the objection to commodification
would remain. However, the once-almost-universal rejection of commodification by
ethicists has eroded somewhat in recent years.19 One counter argument recognizes

16 Trazeen H. Jafar, “Organ Trafficking: Global Solutions for a Global Problem,” American Journal of
Kidney Diseases 54(6) 2009, 1145–57.
17 Samuel J. Kerstein, “Autonomy, Moral Constraints, and Markets for Kidneys,” Journal of Medicine
and Philosophy 34(6), 573–85.
18 F. Daniel Davis and Samuel J. Crowe, “Organ Markets and the Ends of Medicine,” Journal of
Medical Philosophy 34(6) 2009, 586–605.
19 Gerald Dworkin, “Markets and Morals,” in Gerald Dworkin, ed., Morality, Harm, and the Law
(Boulder, CO: Westview Press, 1994), 155–61; Mark Cherry, Kidney for Sale by Owner: Human
Organs, Transplantation, and the Market (Washington, DC: Georgetown University Press, 2005);
James Taylor, Stakes and Kidneys: Why Markets in Human Body Parts Are Morally Imperative
(Burlington, VT: Ashgate); Benjamin E. Hippen, “The Case for Kidney Markets,” The New Atlantis:
A Journal of Technology and Society 14 (Fall) 2006, 47–61.
 10 Introduction

that the preservation of life is an important value that conflicts with a rejection of
commodification. Another sees bans on commodification as reducing the autonomy
of those who might want to sell kidneys for economic gain.
In summary: An unregulated live-donor kidney market could potentially eliminate
the shortage of transplant kidneys. However, it would be subject to several market
failures that would prevent it from efficiently allocating live-donor kidneys. Its
operation and likely outcomes would also raise serious ethical concerns. However,
in view of the large losses in quality of life and longevity of patients that result
from the prohibition of commercial transactions, alternative policies involving com-
modification that substantially mitigate the disadvantages of an unregulated market
deserve consideration.

Policy Goals
Policy alternatives that affect the availability of kidneys from live donors should
be assessed in terms of several goals: impact on the preservation of human dignity,
impact on equity, impact on efficiency, impact on the fiscal state of the federal gov-
ernment, and political feasibility.

Impact on preservation of human dignity

Box 1.1 page 8

The ideal policy should ensure the dignity of potential and actual living donors.
Potential living donors, including those who are financially or otherwise disad-
vantaged, should have autonomy over the decision to donate. The health of actual
donors should be guarded. Although the primary impact of policies on human
dignity will be on U.S. residents, the impacts of the policies on residents of countries
who are exploited by transplant tourism should also be considered.

Impact on equity
The ideal policy should promote more-equal access to transplantation. Access to this
valuable medical treatment should not depend primarily on wealth.

Impact on efficiency
The ideal policy should maximize the number of successful kidney transplants and
more generally promote a socially efficient transplant system. Transplantation gener-
ally improves the quality of life and longevity of ESRD patients. A cost–benefit anal-
ysis estimated that each additional transplant produces an average ­time-discounted
gain of about 4.7 quality-adjusted life years relative to dialysis.20 The greater the
availability of healthy kidneys for transplant, the greater is the efficiency gain as
measured by the number of patients who can realize these benefits.

20 Quality-adjusted life years weight each additional year of life by a scale in which perfect health is
given a weight of 1, death is given a weight of zero, and states of imperfect health a value between 0
and 1. The analysis assigns a weight of 0.52 for time on dialysis and 0.75 for time after transplant.
Held et al., “A Cost–Benefit Analysis of Government Compensation of Kidney Donors.”
 Preview 11

Favorable fiscal impact

The ideal policy should minimize the net fiscal cost to the federal government of the
ESRD Program. Funds expended on this program are not available for other uses.
Reducing the net costs of the ESRD Program allows for other uses of the freed-up
funds.

Political feasibility
The policy should be sufficiently acceptable to be adopted into law. For a policy to
produce its anticipated benefits, it must be adopted. Ideally, a recommended policy
would be adopted soon with certainty. More realistically, political feasibility can be
assessed in terms of the likelihood of adoption sometime in the future.

Policy Alternatives
This analysis considers four policy alternatives: (1) current policy; (2) brokered
auctions, which would established a regulated market; (3) expanded reimbursement
with relative listing, which would encourage donation by reducing out-of-pocket
costs borne by donors and allowing donors to place a relative at the top of the
transplant waiting list; and (4) purchase with demand-side chain auctions, which

Box 1.1 page 9

would create an entity to purchase kidneys and distribute them to promote chain
donations. A description of the key elements of each of the alternatives follows.

Current Policy
Under current policy, the sale or purchase of live-donor kidneys is strictly prohib-
ited. Protocols in place require substantial efforts by transplant centers to ensure
that those making live donations are fully informed and their donations freely made.
To avoid relational coercion, centers report medical incompatibility for potential
donors at their request, even if they are compatible.21
Those making altruistic directed or nondirected kidney donations may receive
reimbursement for travel and subsistence costs related to the donation from insur-
ers, state programs, transplant centers, or kidney recipients. Those not compensated
fully from these sources may receive compensation from the National Living Donor
Assistance Center if their annual income is less than 300 percent of the official
poverty line or they can document extreme financial hardship from the donation.
Payments from the center are limited to $6,000 and the center is constrained by an
annual operating budget of about $3.5 million. Currently, the center does not pro-
vide compensation for lost wages by either donors or their caregivers.

21 “If a potential donor chooses to not proceed with the evaluation or donation process, the center
may state that the donor did not meet the program’s criteria for donation to help avoid difficult
social situations.” Organ Procurement and Transplantation Network, Guidance for the Development
of Program-Specific Living Kidney Donor Medical Evaluation Protocols (Richmond, VA: United
Network for Organ Sharing, 2008), 2.
 12 Introduction

Brokered Auctions22
This alternative creates a regulated market that does not allow direct exchanges
between buyers and sellers of kidneys. Patients would bid for kidneys offered by
potential donors (called vendors in this and the other alternative involving sale
of kidneys) through intermediary organizations. These intermediary organizations
would serve as brokers, or platforms, with fiduciary duty to patients and vendors in
terms of disclosure and confidentiality of information, liability for harm to patients
or vendors, and transparency.
Brokers would have responsibility for fully disclosing the medically relevant char-
acteristics of kidneys offered by vendors, and they would have responsibility for
fully informing potential vendors of all the costs and risks that they would bear
and the payments that they would receive. Brokers would be required to protect
the anonymity of patients and vendors by restricting the release of information not
needed specifically for medical purposes related to transplantation. To facilitate
competition, brokers would be required to make public on a timely basis the prices
paid to vendors and data on the kidneys supplied, such as the age and blood type
of the vendor. Brokers would have to make public the screening rules they apply in
determining how far to evaluate potential vendors. The broker organizations and
their chief executive officers would have legal liability for failure to discharge these
responsibilities and requirements.
Box 1.1 page 10

Several additional features would help protect the interests of vendors. First,
brokers would be prohibited from imposing any cost, such as charges for evalu-
ation or pre-transplant preparation, on vendors who withdraw from the process,
so that potential vendors who at some point agree to sell kidneys would have the
right to decide not to do so at any later time without financial penalty––at no time
would kidneys be removed without current consent. Second, the broker would have
responsibility for arranging for annual medical examinations of vendors and for
submitting data on the health of these vendors on a regular basis to the Scientific
Registry of Transplant Recipients, which has begun to collect data on live donors.
The broker would be required either to provide funds for these tasks in escrow or
to arrange for these tasks to be carried out by a transplant center under a long-term
contract. Third, vendors would be given the option of directing payments to chari-
table organizations. Thus a vendor could participate in the exchange on a purely
altruistic basis, providing a kidney to a patient and a monetary payment to a charity.

Expanded Reimbursement with Relative Listing

The Save Lives, Save Money Now Act, which is currently being advocated by Stop
Organ Trafficking Now!,23 would provide financial support for those making non-
directed kidney donations. The proposal has four key elements. First, the federal

22 This alternative and the purchase and chain auction alternative are adapted from Lara Rosen, Aidan
R. Vining, and David L. Weimer, “Addressing the Shortage of Kidneys for Transplantation: Purchase
and Allocation through Chain Auctions,” Journal of Health Politics, Policy and Law 36(4) 2011,
717–55
23 www.stoporgantraffickingnow.org
Another random document with
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 Yöksi jos veisi sen pirtin nurkkaan,
oisi se ihmisten tiellä;
jos sen saunaankin salpoaisi,
sirkat sen söisivät siellä.

Mihinkäpä hulivili kulkijapoika

henttunsa viedä voisi?
Jos sitä niityllä paimentaisi,
hulivili loppunut oisi.

Ainakin paimenen on paha olla, vaikka se kukkia kitkee.

Henttua on pahin paimennella, jos sillä pienoset itkee.

1899.

Mitäpä noista.

Mitä minä paljon huolisin noista tyttöluikkarista! Enemmin

saan minä riemumieltä pikkulintusista.

Mieli se käy niin haikeaksi,

jos sen neitoset voittaa,
vaan sen metsässä vilppahaksi
pienet lintuset soittaa.

Kun minä lähden näiltä mailta, neitoset kaipaa yksin.

Perässäni lentävät pienet linnut, lentävät liverryksin.

1899.
Kuohuvan kosken kunnaalla.

Kuohuvan kosken kunnahalla lemmenkukkia vilkuttaa. Tule

sinä tyttö, sun kanssasi tahdon hiukan tanssia nilkuttaa.

Sitten mä kosken kunnahalta lemmenkukkia taittelen.

Tyttöni, niitä mä hellin huolin rinnallesi laittelen.

1899.

Lintu lenti oksalle huojuvalle.

Lintu lenti oksalle huojuvalle, kuohuvan kosken kunnahalle.

Tuli tuuli oksaa huiskuttamaan, lintu ei koskeen
suistunutkaan.

Tuli tyttö karkelokentälle yksin, keinuen, leijuen

iloviserryksin. Kävi poika neitoa narrailemaan, neito ei narriksi
taipunutkaan.

1899.

Laulaja- ja tansijatyttö.

Minä olen laulaja-, tanssijatyttö, — kun minä tanssin ja

laulan, tuulonen — helavila — häilyttävi hulmuja punapaulan.
 Ihmiset ilojani ilmoittavan
luulevat laulelmilla,
lauluni on vaan kuohuva kupla
surujeni lainehilla.

Laululla tahtoisin surujeni laineet

unhojen virtaan painaa,
vaan minun suruni se nieluihinsa
ilojeni laulut lainaa.

Tahtoisin tanssia sikkareiksi

suruni mä ruskossa illan,
kaihojen kentästä kaunistella
riemujen karkelosillan.

Surujeni kentästä riemun silta ei tule tanssimalla, eivätkä

nouse ilojeni laulut surujeni aaltojen alta.

1899.

Pikkunen tyttö.

Minä olen pikkunen, pikkunen tyttö, kahdeksannellatoista.

Poikaset vilkuvat, pyydystävät, — mitä minä huolin noista!

Minä olen pikkunen, pikkunen tyttö,

kyllä mä arvoni tiedän.
Kaksi on poikaa jo rukkaset saanut,
yhtä mä hiukan siedän.
 Kun minä rannalta kummun alta lähteestä vettä kannan,
kiulua, jos hän kauniisti pyytää, hänen minä kantaa annan.

1899.

Kultaansa ihaileva.

Tuoltapa tulee pellon poikki poikia aika roikka, vaan yli

kaikkein katsoo Kalle, solakka ja hoikka.

Kanssani kiitää karkelossa

Kalleni nuori ja norja,
niin hän päätään nuojuttaa kuin
koivas solkeva, sorja.

Sorja on hän kuin solkeva koivu, minä kuin virpi tuomen.

Koivujen ympäri tuomen virvet kiertyvät rannoilla Suomen.

.1899.

Järvellä.

Loistava laiva se lahdella velloo, hihkuvi, huutavi

tullessaan, sinne ja tänne mun purttani telloo tieltänsä
vahvoilla aalloillaan.

Suuret ne aaltoja halkoellessaan tieltänsä viskovat pieniä

pois. Eiköhän rantoihin matkoellessaan pienoset riemuja
laulaa vois!
1897.

Meripojan morsian.

Meripoika, ponteva pohjalainen, kultana mull' oli ennen.

Kun hän purjehti salmen suitse, näin hänet tullen mennen.

Kultani tullessa lämmin tuuli

ulapalta liiti.
Ulapalle ulkosi vinha viima,
kun hän kauvas kiiti.

Kauvas kiiti hän merten teitse, hukkui tuulispäihin. Täällä on

talvi ja jäässä järvi, itsekin hyydyn jäihin.

1899.

Kullastansa jäänyt.

Kultani purjehti vieraille maille, vieraita kumpuja kulkemaan,

kotosille kunnaille tänne mun jätti kaihoja rintaani sulkemaan.

Kultani purjehti vieraille maille, rannalle jäin minä

suremaan, suru minun sydäntäni siitä päivin alkoi kummasti
puremaan.

1899.
Salainen lempi.

Poikasen mieli se kultansa luokse halajaa ja palaa, kun ei

päivillä jouda julki, hiipii illalla salaa.

Istuta tyttö sun aittasi eteen

kolme koivun oksaa!
Kun sua etsii kultasesi,
oksat se siitä hoksaa.

Kultasi kulkee luoksesi

illan rintamilla,
heittää kenkänsä veräjälle,
astuu sukkasilla.

Kultasi kulkee sukkasilla, ettei kukaan kuule, ettei häntä

juoruämmät kullaksesi luule.

1899.

Illalla ja aamulla.

Tyttö se katseli iltasella,

katseli päivän lasketessa,
kuinka taivon rantehella
punarusko hohti.

Poika se käyskeli metsätietä

ilman lintujen laulellessa.
Minne poika, ei sitä tiedä,
kulkuansa johti.

Tyttö se katseli aamusella,

kuinka sorjalla kummullansa
aamun ruusukoittehella
sulhon kontu hohti.

Poika se vieterirattahilla
ohjasi liinaharjojansa
silkkisillä ohjaksilla
kullan kotia kohti.

1898.

Lempi.

Lempi on kuin silmäneula säije silkkinen perässä. Se saa

paljon koristeita kehnollekin kankahalle.

1896.
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