I.
PEPFAR - a Bush initiative to send cheap AIDS drugs to Africa - has saved millions of lives and is among the most successful foreign aid programs ever. A Trump decision briefly put it “on pause”, although this seems to have been walked back; its current status is unclear but hopeful.
In the debate around this question, many people asked - is it really fair to spend $6 billion a year to help foreigners when so many Americans are suffering? Shouldn’t we value American lives more than foreign ones?
This is a fun thing to argue about - which, as usual, means it’s a purely philosophical question unrelated to the real issue.
If you cancelled PEPFAR - the single best foreign aid program, which saves millions of foreign lives - the money wouldn’t automatically redirect itself to the single best domestic aid program which saves millions of American lives.
Instead, it would go into the general federal discretionary budget, taking it from its current $1,500 billion dollars all the way to . . . $1,506 billion dollars. From there, it would be go to the same kinds of programs the rest of the budget goes to - like the Broadband Equity And Deployment Program, a $42 billion effort to give rural Americans Internet which, after endless delays, has failed to connect a single rural American.
It’s a little unfair to focus on BEAD or other especially bad programs, because money gained by canceling a good program will on average be redirected to a merely average program. How bad is this? When studying charities, Toby Ord found that of two randomly chosen charities, one will be (on average) 100x more effective than the other. Government programs aren’t charities, but common-sensically we might expect similar dynamics to apply.
(if this sounds common-sensically impossible, remember that PEPFAR probably saves ~250,000 lives/year1, so a 100x efficacy difference would require the average 6 billion/year government program to save 2,500 American lives or do something equivalently good. When we average out the few really good ones that do much better with the massive amount of total waste, this sounds doesn’t sound like a crazy underestimate to me.)
Can you instead choose to redirect it to the single best domestic program? If so, why hasn’t money already been redirected to the single best domestic program, until you fill up its need for more funding and a different program becomes the best? Why are we wasting money on non-best programs at all when the best one is right there? I think an honest answer to this would involve admitting that the government is a giant mess not really under anyone’s control, that you can’t guarantee PEPFAR money would be spent any more efficiently than any other money. So I think the original methodology - assuming it would go to other programs of approximately average effectiveness - is correct, and we can keep our 100x worse number.
So in a discussion of the ethics of canceling PEPFAR, I don’t think it’s enough to say that you care about Americans more than foreigners. You would have to care about Americans more than 100x more than foreigners. I doubt anyone has a specific finite foreigner-to-American ratio which is more than 100x, so I think it’s effectively saying that the lives of foreigners have zero value, at least from a government perspective.
II.
The debate du jour is over JD Vance’s invocation of ordo amoris, the classical Christian theory that you should value the life of your brother more than that of a complete stranger (while continuing to value both). I am not qualified to debate the doctrinal issues here, although I have seen smart Christians come out both for and against Vance’s interpretation.
But again, this is a distraction from any real issue! Oh, you should value the life of your brother more than a stranger? You don’t say? I’m hearing this for the first time! Now let’s kill five million foreign children to fund one sixth of a broadband boondoggle.
I am happy to “concede” that if you face a choice between saving a stranger and saving your brother, save your brother! Or your cousin, or your great-uncle, or your seven-times-great-nephew-twice-removed. I’ll “concede” all of this, immediately, because it’s all fake; none of your relatives were ever in any danger. The only point of this whole style of philosophical discussion is so that you can sound wise as you say “Ah, but is not saving your brother more important than saving a complete stranger?” then doom five million complete strangers to death for basically no benefit while your brother continues to be a successful real estate agent in Des Moines.
In case this isn’t clear enough, my positions are:
I have no principled method for deciding how much of the US budget should go to foreign aid, but the current amount of ~1% doesn’t seem excessive. Even if it was, PEPFAR is among the best foreign aid programs and should be one of the last to get cut, so I think you would have to believe that less than 0.1% of the budget should go to foreign aid before you started cutting it.
I have no principled method for determining the relative value of your own life vs. that of your brother vs. that of your countryman vs. that of a foreigner, but I don’t think your brother/countryman/foreigner are literally zero. I think even valuing each step 100x less than the preceding (eg a foreigner 100x less than a US national) would be compatible with continuing to support PEPFAR. I’m not a theologian, but I would be surprised if Christianity could be invoked to justify multipliers greater than 100x.
I think people should donate 1-10% of their income to effective charities, then not feel obligated to worry about altruism beyond this level. If someone’s brother is actually in danger in some way such that they can only be saved by not donating the 1-10% to charity, I think it is only human, and not morally blameworthy, to screw the 1-10% donation and give it to their brother. If your brother is not in danger, or you don’t have a brother, why are you worrying about this?
I say “millions” above, but here I’m using 250,000 as a per-year estimate to remain equivalent to the $6 billion/year spending.
