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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 Those articles mentioned the concerns you give around inequality and outdated technology and systems.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.