The Virtues of Folding

President Obama has a bad hand in the poker game of Middle East peace. But bluffing or raising the stakes won't improve it.

"She crumbled," ace detective Phillip Marlowe observed in one of the greatest lines in Raymond Chandler's classic 1939 novel The Big Sleep, "like a new bride's pie crust."

And so, come to think of it, has the Obama administration's approach to Arab-Israeli peacemaking.

Thirty months in, a self-styled transformative president with big ideas and ambitions as a peacemaker finds himself with no negotiations, no peace process, no relationship with an Israeli prime minister, no traction with Palestinians, and no strategy to achieve a breakthrough.

Indeed, in the wake of the publicly orchestrated extravaganza also known as the Benjamin Netanyahu visit last week, we seem to have speechified ourselves farther away than ever from serious peacemaking. Israelis and Palestinians are running in the opposite direction: Mahmoud Abbas to virtual statehood at the United Nations in September; Netanyahu to the belief that Israel doesn't need a credible strategy to cope with what's coming.

There's great temptation in all of this to saddle the Obama administration with the lion's share of responsibility for this unhappy state of affairs. But that would be wrong, inaccurate, and decidedly unfair.

The president, to be sure -- perhaps with the best intentions and the worst analysis -- has made a complex situation more complicated. But the preponderance of blame surely rests with the locals' incapacity and unwillingness to get real and serious about what it would take to reach an agreement.

Let's be clear: The chance of a conflict-ending agreement (and I choose my words carefully here) that allows Israelis and Palestinians to resolve the four core issues -- borders, Jerusalem, security, and refugees -- appears to be slim to none. Anything short of that (borders first; an interim agreement, etc.) seems beyond the interest or will of the two sides to consider or take seriously. "Been there, done that," seems to govern Palestinian thinking. "I don't want to do that," seems to shape Israel's.

The reasons for this impasse aren't hard to identify.

There are big gaps on the big issues, even on territory (the least hopeless one) as evidenced by the brouhaha over Obama's mention of the June 1967 borders with mutually agreed swaps. The meaningless but oft-repeated line -- that everyone knows what the solution will be -- only serves to inspire false confidence and trivializes how hard it will be to get there.

Weak leaders, or at least leaders who are prisoners of their political constituencies (not masters of them), compound the problem. Bibi may want to be great, but coalition politics, ideology, and his own fears constrain him.

Abbas too wants legacy; but he's presiding over a national movement that despite newfound virtual unity with Hamas still looks like Noah's Ark: there are two of everything -- security services, charters, visions for Palestine, and patrons. It's a long way from the one gun, one authority, one negotiating position that is the essence of sovereignty -- and indispensable for a conflict-ending accord on the Palestinian side. Nor is the regional situation all that conducive for a breakthrough. (Or at least let's agree that it's an arguable proposition.)

Some believe that the transformative changes now loose in the Arab world have increased the incentives and the pressure for a deal. On one hand, democratic reforms and movements seem to be breaking out all over and the Arabs appear focused more on internal matters than wanting this issue resolved. On the other, Arab public opinion will now be more influential and could become more radicalized. So, let's hurry up and make a deal.

Some, like President Obama, think the situation calls for risk-readiness; others, like Prime Minister Netanyahu, see uncertainty and danger and are risk averse. Even Abbas isn't quite sure. One of the factors behind agreeing to unity with Hamas was the fear that Palestinian leaders who don't deliver will be swept away by their own public.

The Obama administration -- with the best of motives (Arab-Israeli peace is really important to U.S. interests) but lacking a real strategy -- made this situation worse, at least for America.

First came the elusive search for a comprehensive settlements freeze and confidence builders from the Arabs, veritable Missions Impossible. Failure here damaged the president's credibility because Arabs and Israelis said "no" without any cost or consequence. Next came the Sept. 2010 effort to launch actual negotiations and the follow-on attempt to bribe Netanyahu into accepting a 90-day freeze. More damaged credibility. And now, driven by hope and desire for change against the backdrop of the Arab spring and by the fear of a Palestinian U.N. initiative in the fall, President Obama gives a speech designed to recommit himself as peacemaker and to persuade the Europeans (on the eve of his G-8 trip) not to sign on the Palestinian U.N. gambit.

Well, no good (or ill-advised) deed goes unpunished. You pick a fight with Bibi, a guy you need but with whom you have no relationship; you send a message to Palestinians that you're worried about their U.N. plan and encourage them to hang tough in hopes you'll give them more; you make public (and insufficiently explain) an important tactic in the negotiations when there are no negotiations; you upset the pro-Israeli community at home with no purpose; you give the Republicans an issue on which to hammer you; and you annoy members of your own party. And for what? Neither the Palestinians nor the Europeans show much sign of backing away from the U.N. gambit.

That said, having offered up even more bad ideas than the Obama administration has in my 20-plus years of working on this issue, I can't be too hard on the president without practicing a galactic hypocrisy.

Government is about remedy and what's possible; not sitting around telling yourself why you can't make something happen. My colleagues and I convinced then Secretary of State James Baker to chase an Israeli-Palestinian dialogue in 1989 when the chances of success were near zero. He wasn't happy about it until Saddam invaded Kuwait, scrambling the region and providing him with real leverage over Arabs and Israelis to finally get serious. The Madrid Conference was the result.

Maybe that's the point. I hate the notion of "ripeness" as it pertains to conflict resolution; it turns Washington into a potted plant waiting for the right moment to act. But it's also pretty compelling metaphor. And right now the options either green or spoiled. Here are some of them:

1. Try quiet diplomacy between now and September. Shop the president's idea on borders with Netanyahu and Abbas; see whether you can't get some traction to preempt a loud and noisy fall at the United Nations. Prospects for success: near zero. Netanyahu's and Abbas's bottom line on swaps don't reconcile, not to mention Jerusalem and refugees.

2. Work with the Palestinians and Israelis on a reasonable U.N. resolution and try to trade it for beginning Israeli-Palestinian negotiations. Prospects for success: near zero. The gaps are just too big on core issues.

3. Oppose and veto any U.N. resolution that purports to create a Palestinian state outside of negotiations or one that sanctions Israel -- and try to get the Europeans to buy on. Prospects for success: pretty high (minus getting Europe on board). But this will lead to U.S. and Israeli isolation and predictable unhappiness just about everywhere.

4. Park the issue until 2012. Admit to yourself that barring some major move by one of the two sides or a crisis that forces an urgency, this dog just won’t bark now. Try to contain the damage and forestall the violence that may come in the fall. Prospects for success:not great  the Israeli-Palestinian issue won't stand still; no progress will likely mean a shaky status quo and deterioration.

5. Vote for the U.N. initiative on Palestinian statehood. Prospects for success: Hard to imagine, unless the text was so reasonably anodyne and had no operational impact. Even then it would be hard politically to leave the Israelis isolated as a result of a U.N. General Assembly resolution.

6. Put out the Obama plan on all the issues; persuade Arab foreign ministers to appear with the president in the Knesset and the Palestinian Legislative Council to promote it, along with raising billions of dollars to fund the two-state solution. Prospects for success: Near zero. You'd need a president with big balls for this one; it's an extremely high-risk enterprise designed to change the longer-term psychological climate of the conflict, with little expectation of early negotiations and agreement.

But what's the alternative?  An imposed solution? another lecture to the Israelis about how the status quo is unsustainable; a US plan which the Israelis and Palestinians are asked to take or leave or else?

In the end, probably the best thing Obama can do now is not beat himself up and try to keep the game alive. There are things in life that America just can’t fix; for now, this may be one of them. That he doesn’t have a plan or strategy that can work is no reason to embrace ones that won’t and that could make matters even worse. And something may turn up. The idea that to try and fail is somehow better than not trying at all is quintessentially American. It’s one of our most endearing qualities. But it’s a good slogan for a high-school football team -- and it’s not a substitute for the foreign policy of the most consequential nation on earth.

John Angelillo-Pool/Getty Images


The Rise of the Red Market

How the best intentions of the medical community accidentally created an international organ-trafficking underground.

On the night of Jan. 11, Turkish police officers burst into a villa in Istanbul's Asian quarter and arrested a 53-year-old transplant surgeon named Yusuf Sonmez. Interpol had been looking for Sonmez since 2008, when a Turkish man collapsed in the airport in Pristina, Kosovo, and reported that his kidney had been stolen. The incident led to an investigation by European Union prosecutors, who uncovered an international organ-stealing and smuggling ring of alarming scope. Sonmez and eight co-conspirators, prosecutors alleged in December, had lured poor people from Central Asia and Europe to Pristina, harvested their organs, and sold them at up to $100,000 a pop to medical tourists from Canada, Germany, Israel, and Poland. The clinic where Sonmez did his work, a separate report by the Council of Europe alleged, was part of an even vaster organ-smuggling network -- one which, incredibly, even involved Kosovo's prime minister, Hashim Thaci.

The trafficking operation was grisly, but hardly unusual. The World Health Organization estimates that approximately 10 percent of the world's organ transplants originate on the black market; as a rule of thumb, that figure seems to hold true across the trade in human body parts. And while occasional law enforcement successes like Sonmez's arrest do happen, for the most part no one is really seriously attempting to shut down a market that is not just lucrative, but, many would argue, inevitable.

It would be an understatement to say that the last century has been a golden age for medical science. The average human life span today is almost a 30 years longer than it was in 1900. We've seen the advent of once-unthinkable innovations such as antibiotics, blood transfusions, and the surgical wizardry of organ transplants. These once-miraculous feats depend on a supply infrastructure that those of us outside the medical profession rarely think about. We take it for granted that if we get into a car accident that the local hospital will have blood on hand for a lifesaving transfusion. If our kidneys fail, we expect a spot on the transplant list. If we are infertile, we expect to have access to someone else's sperm or eggs, or -- if we can afford it -- the services of a surrogate mother to bring a child to term.

Of course, every kidney, cornea, or pint of blood has to come from somewhere -- or, more precisely, someone. Forget the image of grass-skirt-wearing cannibals on tropical islands; no society has had as insatiable an appetite for human flesh as the developed world of the 21st century.

Because the idea of a marketplace in which body parts are bought and sold makes us squeamish, the growth in demand for human materials has been accompanied by an effort to build an ethically justifiable system for supplying them. Organs aren't supposed to be bought and sold; rather, they are donated by altruistic individuals, and we pay for the services necessary to acquire them rather than for the organ itself.

There's just one problem with this picture: It's a fiction. Regulation of the supply of human tissue is haphazard at best; in most cases, people looking to acquire an organ have only the assurances of doctors and social workers to persuade them that everything is aboveboard and ethical. And the very provisions we've built into the system to bring it in line with the ethical norms of medicine and charity have made it easy for criminals to reap outlandish profits buying and selling human flesh.

Half a century ago, the world was relatively comfortable with open commerce in human products. The rollback of that business, and the institution of the system we have today, began with blood. As of the mid-1960s, blood-collection clinics in the United States were amassing 6 million pints of blood a year, for which they paid about $25 apiece at the time to donors. The model was a holdover from World War II, when blood was badly needed for the war effort. But as the collecting centers became as common as cash-for-gold franchises in skid rows across the United States, they began to present problems for the medical system. Because poorer and accordingly less healthy people were more likely to sell their blood for a quick buck, paid blood collection led to higher rates of hepatitis transmission.

In the 1970s, a British social anthropologist named Richard Titmuss proposed a new system, one that would remove the risk of coercion and problematic incentives by eliminating payments to blood donors. In addition, the blood would be depersonalized -- marked with an identifying bar code rather than a name -- so that the recipient would feel indebted to the overall system of blood donation rather than a single individual. Officially, at least, blood was transformed from a product into a gift.

It was a revolutionary idea at the time, and it succeeded wildly, helping create one of the most robust and safe blood supplies in the world. Today, Americans donate so much blood in excess of the country's needs that the United States is the No. 1 blood exporter on the planet. It sends almost 1.5 million gallons of blood plasma abroad every year, enough to fill two and a half Olympic swimming pools.

Titmuss's model also applied to acquiring and selling body parts -- which has since become the gold standard throughout medicine. In 1984, the U.S. Congress passed the National Organ Transplant Act, forbidding the sale of body parts and effectively requiring an altruism-based system for acquiring them. Anonymity, too, has become the rule. In the 1960s, it was still possible for organ recipients to learn who donated the organ that saved their life. Now we take it as a given that such knowledge should be protected by the strictest standards of medical privacy. The prevailing logic has been that making it possible to connect the dots between donor and recipient could compromise the entire system, maybe even stopping people from donating their tissue in the first place.

Unfortunately, the anonymous, altruistic system has produced unintended consequences. Even Congress couldn't get rid of the market for body parts entirely: Individuals can't directly buy and sell bodies, but doctors, nurses, ambulance drivers, lawyers, and hospital administrators can all bill for their services. (You may not pay for a heart, but you definitely pay for a heart transplant.) And the flip side of anonymity is opacity: Although confidentiality provisions are meant to protect the interests of the donor, they also obscure the supply chain.

The result is a system whose best intentions create ample opportunities for criminally minded entrepreneurs. There are huge profits to be made by middlemen dealing in everything from kidneys to human eggs to sight-unseen surrogate pregnancies. In the age of globalization the brokers are adept at exploiting the knowledge and legal gaps between national jurisdictions to arrange just about any sort of organ acquisition, and advances in anti-rejection drugs allow people with widely diverse genetic backgrounds to swap organs. In Romania, Moldova, Turkey, and Egypt, brokers can easily acquire kidneys for $3,000 and sell them for $50,000 or more. In 2008, an Indian broker was arrested for kidnapping people from New Delhi slums and literally stealing their kidneys to sell to foreign transplant patients. In China, selling the organs of executed prisoners continues to be an official state policy.

Law and economics recognize three types of markets with varying degrees of legality: white, gray, and black. The trade in human flesh has evolved into its own category of commercial activity, what you might call the "red market" -- a market whose economic characteristics are complicated by the fact that customers owe their lives and family relationships to the supply chain, yet know perilously little about it. I spent the past six years tracking the red market across South Asia, Europe, and the United States, exploring the business practices of kidney traders, skeleton thieves, blood pirates, and child kidnappers. In every case, I was astonished to find that most people who bought a piece of a human being had no idea what series of events had to have occurred to make that body part available.

Obscuring the source of raw materials for any market is almost always a bad idea. We would never allow an oil company to hide the locations of their oil rigs or not disclose their environmental policies. And when an oil rig fails and leaks millions of barrels of petroleum into the ocean we demand accountability. Transparency is capitalism's most basic safety feature.

Solutions to the problem are hard to come by, however, and will likely require a wholesale revamp of the tissue donations system. Economists have argued that a commercial system similar to the one that exists in Iran for kidneys -- in which the state pays donors a modest sum for the organ -- could allow the market to regulate the human tissue supply. Others argue that it is possible to increase actual altruistic donation rates -- and cadaver donations for internal organs -- to the point at which supply and demand will be balanced, reducing the need for a red market.

In my view, neither is likely to work until we answer a simple question: At what point is one person entitled to use the flesh of another? The central problem with the human supply chain is that it has been dehumanized -- its very opacity allows us to elide the fact that we aren't just buying tissue, but a piece of a person, and one that comes with a history. Perhaps then we can accept that people are not commodities and our own lives are often predicated on the sacrifices of others.