Seriously? As mentioned, it’s 5 dollars for the average tax payer and 0.08% of the U.S. federal budget. It’s a small prize to pay for millions of lives.
”It didn't address concerns about American tax dollars going outside of America“
It didn't really address the objections or look at the other side. It didn't mention the harms of taxation or the huge debt crisis looming. It didn't address concerns about American tax dollars going outside of America. Also the tone created very negative associations with this viewpoint and people who hold it.
I think this fails to address the most common objections to PEPFAR: "I Don't Know How To Explain To You That You Should Not Give The Tiniest Flying Fuck About Other People And You Are A Gay Libtard If You Do", and "I am extremely racist and I love it when people in Africa die"
Don't take it personally, he thinks that about almost everything. Saying "X is not about X, X is about signalling" is basically Robin Hanson's catchphrase.
thanks for doing this. Much needed. It's an historic tragedy - maybe a crime - that the US is killing people by destroying our foreign assistance system. The US has never been especially generous in foreign aid, but due to our size, we've always been very important. It's a trivial amount of money for the US, but keeps millions alive. A good estimate of the human mortality of the 90-day aid freeze is 100,000 dead. https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.26431. This isn't quite right for several reasons, but gives you a sense of the order of magnitude.
Shouldn't that money go towards Americans? Why are the lives of non-Americans being considered in how American tax dollars are spent?
And also, what about the debt? We're hugely in debt and this is a crisis that, much like global warming, needs to be addressed right away before it causes a huge disaster.
Apply the reversal test - should we go a lot more in debt to save a lot more non-Americans, at the expense of future Americans?
1) American prosperity is largely due to America's presence at the center of an international system it built to benefit itself and its allies. The cost of goods in your local store is dependent on a network of trade agreements, the maintenance of the world's largest navy keeping waterways free of pirates, and numerous other soft-power flexes sometimes involving USAID. Asking this question is like asking why a business should spend money on the products of other companies instead of just dividing its bank account between its employees: any short-term gain experienced by the employees would be quickly outweighed by the loss of income owing to not having jobs.
Furthermore the lives of non-Americans are considered in American tax spending because a majority of Americans place non-zero value on the lives of foreigners and vote to spend money in ways that reflect this belief. As noted by the author, we all pay taxes for things that we don't like. This is how democracy works. If you believe that all taxes should be opt-out on an item-by-item basis, you are welcome to run for Congress and propose a bill to that effect.
2) You may not have noticed, but the Republican party is currently attempting to cut taxes such that net government revenue will be decreased by much more than the disassembly of USAID could ever increase it. If the deficit concerns you, I suggest that you write to your representatives asking them to cease attempting to cut taxes and raise them instead.
3) Recall that PEPFAR consists of 0.08% of the federal budget. Review point 1) above.
I thought this was about PEPFAR, not USAID. The grounds for dismantling USAID are that it generally does bad things.
I don't see what PEPFAR has to do with America's prosperity - that certainly was not discussed in Ozy's piece.
I did notice that the GOP is increasing the debt with tax cuts, yes. I think that's very bad policy. But the debt is a looming huge crisis, and raising taxes is not politically feasible, so we have to cut spending. Ideally we'd both massively cut spending and massively raise taxes, yes.
Honest question: Have you read the first thing about these topics you apparently care so deeply about? For example the first paragraph of the introduction of the detailed report this post links to in its own first paragraph? It would tell you that USAID implements such vital parts of PEPFAR as drug orders, a very important thing for a program that distributes antiretroviral therapy.
You see, agencies in the US government do multiple things. They help each other. When you delete one without accounting for all of its functions, apparently unrelated projects regarding numerous areas of concern are rendered inoperable. This is why it's very important to not do what Trump just did.
If you are truly concerned that some USAID activities destabilize foreign governments, I suggest isolating those programs and halting their operation in a controlled way instead of disbanding the whole agency.
As for what it has to do with American prosperity, a known behavior of diseases is that they spread. With the novel inventions of boats and airplanes, diseases have been known to spread between landmasses separated by water, such as Africa and North America. Indeed, this is how a disease native to Africa arrived in the United States to begin with! Thus, improving global health has significant knock-on effects for local health. You may feel confident that no extant virus will ever mutate into a more severe form that resists conventional treatment due to our allowing it to brew unchecked among billions of people, but I think most people will recall that this in fact happened just five years ago. It also did serious damage to the global economy and local prices, another point for defending American prosperity by not suffering diseases to spread.
Regarding the budget, going to go over this one more time, just to make sure you have seen all the numbers. As of FY 2023:
Do you perhaps see that cutting foreign aid to zero would make no difference to the deficit?
If you would object to raising taxes on political feasibility grounds, I invite you to consider the feasibility of cutting medicare, medicaid, and social security, which make up the vast majority of federal spending and would have to be severely cut to zero out the deficit without raising taxes. The Republicans' new spending bill details exactly this plan. They are trying to make this proposal palatable to the average voter through the rhetoric method known as 'lying'. This is because they know everyone hates that way more than they hate raising taxes. If anything, negative sentiment towards people in top income brackets is higher than at any point since the Great Depression. If you would like to explore serious solutions to reducing the deficit, I repeat what others have said and invite you to read the work of Jessica Riedl: https://xcancel.com/JessicaBRiedl
HIV is an *infectious* disease. If a bunch of people on another continent get HIV and then it acquires ART resistance - that will absolutely be our problem, sooner or later. Americans will die over it.
I'd happily take that reversal test! If I could double PEPFAR's lives saved I would spend 0.08% more of the federal budget.
If you're that concerned about the national debt, going after 0.08% of the federal budget is a waste of time.
I believe being born poor and/or in another country shouldn't be a death sentence. All lives have (equal) value. So, yes I think American tax dollars should be spent this way. Also it's a trivial expense in the scheme of the US federal budget or US economy. Cutting Pepfar and killing many hundreds of thousands of people will not meaningfully reduce the US deficit or debt.
So yeah, all the dead babies, but also for a minuscule portion of our budget we get to wield enormous leverage over nations that provide us with goods and resources? Leverage which will now fall to Russia/China/Iran/Whatever country you're afraid of? Why are we giving up a valuable foreign policy tool that costs us a tiny portion of our tax dollars and probably provides economic benefits far in excess of that? Even if you're a genuinely evil person and don't care that we get to save millions of lives at extremely low cost, maybe you aren't stupid?
Great post, I will likely link it and/or the Report directly next time I'm trying to defend USAID online (which will no doubt be in the next 10 minutes).
One thing, though- your link for 'quack science that puts innocent people in prison' is just to a book about forensic science. Is there a specific citation intended to support that assertion? What even is the assertion? Are you saying forensic science, in general, is quackery? Because that seems obviously wrong.
Most forensic science is quackery! DNA isn't, obviously, and some areas of forensic science like fingerprinting or ballistics have limited use. But mostly the entire field is pseudoscientific nonsense. I particularly recommend chapter 5 of the linked report, where the National Academy of Sciences exhaustively debunks numerous kinds of forensic science.
I think what people think of when they think of forensic science is mostly fingerprinting and DNA, though. And they do in actuality make up a significant portion of the practice of forensic science. So it seems at least very misleading, if not outright incorrect, to say that 'mostly the entire field is pseudoscience', when it largely comprises methods you agree are scientifically valid, and those valid methods are exactly what people take to mean by 'forensic science'.
Either way, when you link a whole book about forensic science as your citation for 'quack science', it gives the apparently misleading impression that that's your opinion of the field in its entirety, I think. Maybe the citation should specify chapter 5?
PEPFAR is just one part of the US' foreign aid. It's not hard to defend USAID at all, because they do lots of important and demonstrably effective things like PEPFAR.
First, while the cost of this program may be small, it's one of many. This same logic would apply to many, many other government programs. Accept it, and what are the grounds for rejecting other programs? Once you accept this, you're on the hook for hundreds of others.
Second, we're dealing with a huge looming disaster that we need to start addressing as soon as possible - the debt. This money that's being spent is money we don't have. It's one thing to debate how to spend money we have. It's quite another to be over our heads in debt, out of money, and debating how to spend more. Apply the reversal test - should we go more into debt and save more non-American lives, at the cost of impoverishing future Americans? American tax dollars should be used for Americans.
The debt is like global warming: no one wants to think about it, people hope we can somehow solve the problem through less painful means, but it will take painful cuts and reductions to prevent a disaster.
Finally, I just looked at the law authorizing this program ( https://www.congress.gov/bill/108th-congress/house-bill/1298/text ), and I'm incredibly disturbed. It says the government should be promoting abstinence and monogamy and should be opposing sex work, and no money can go to any organization unless it has an explicit policy against sex work! This is truly terrible. I do not want my money going to this and I don't understand how anyone pro-poly and pro-sex-work can support it.
I find it genuinely baffling why you wouldn't care about people thousands of miles away dying horrible preventable deaths, but would care about them being taught to be monogamous.
Many Americans care about people in other countries, and elected Congresspeople who passed a popular bipartisan law that saved 19.5 million lives. This IS for Americans! Specifically, the portion of Americans who want their money to be spent this way!
If you want to tackle the debt you need to tackle Social Security and the military! Jessica Riedel, a conservative commenter who has spent her entire career researching how to reduce the budget deficit, has come out in favor of PEPFAR: https://x.com/JessicaBRiedl/status/1895227195771232406 It is not that much money, and it saves an extraordinary number of lives. The U.S. government does almost no programs as good as PEPFAR.
If there really were "hundreds of other" programs as effective as PEPFAR (there aren't), then the US could save a billion lives with 4% of it's budget. And you view this as a BAD thing?
The grounds for accepting PEPFAR over other programs is that it has a greater impact than most of them. I don't see what's complicated about this. Run a cost-benefit analysis, set a standard for how much altruistic bang for our buck we want, and cut everything below that number. This is budgeting 101.
Honestly, the more important question is not whether PEPFAR or other foreign aid should be funded.
The question is who should decide.
The US is a democracy with the elected president in charge of the executive branch. So even if you or I disagree, protecting democracy is a lot more important, and it needs to be the president's decision.
It is, in fact, *Congress's* decision, not the president's. But also, that's just an entirely separate matter? This is straight out of "Arguments From My Opponent Believes Something" (https://slatestarcodex.com/2013/06/13/arguments-from-my-opponent-believes-something/). (Indeed, I thought this one was in the sequel, but I can't find that right now?) We can, in fact, argue both over the object level of the correct course of action and separately over the decision system for the government to use. Saying "we should do X instead of what the government is currently doing" means you think the people in charge of the government should make different decisions -- not that you think you should overthrow the government!
Well, I don't think it is "in fact" Congress's decision - Congress *could* certainly legislate specifically on this, but has not.
I agree, both are valid questions. I'm saying the political one is much more important. And often people conflate the two.
As to your last point, a lot of people seem to think it means that it shouldn't be the president's decision. Tell that to all the people filing litigation on things like this.
> Well, I don't think it is "in fact" Congress's decision - Congress *could* certainly legislate specifically on this, but has not.
Is this not, in fact, the purpose of the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003? Like, what, you think George W. Bush just authorized PEPFAR on his own? He cannot in fact do that! The money has to come from a Congressional spending bill!
> As to your last point, a lot of people seem to think it means that it shouldn't be the president's decision. Tell that to all the people filing litigation on things like this.
Yeah, because it's Congress's! The President does not, in fact, have the authority to unilaterally impound funds! They're saying it *factually is not* the president's decision -- not making the argument you seem to be imputing to them, that because the president is getting it wrong it isn't his decision!
> I agree, both are valid questions. I'm saying the political one is much more important.
Yes, it does appropriate money for various purposes, including antiretroviral treatment. Interestingly, it also says:
"the President is authorized to furnish assistance, **on such terms and conditions as the President may determine**, for HIV/AIDS" (p. 18 of the pdf)
So it does seem that the president has some discretion. How much wiggle room does this give him? Unclear. The impoundment control act does prevent him from withholding funds, but it may be unconstitutional - we'll have to see what happens. Also, what if he doesn't withhold the funds, but once the funds are distributed to his Coordinator, he instructs the Coordinator to slow-walk them? Or what if he doesn't appoint a Coordinator, or appoints only people Congress rejects?
The law also provides for the president to make a determination, regarding money going to the Global Fund, that a country supports terrorism and can withhold money on that basis. (p.15)
In the spirit of this FAQ, today I learned that there are currently two elective absolute monarchies in the world: Vatican City and the United States of America.
Nope, the president is not an absolute monarch. He's just in charge of the executive branch.
But please tell me, since I hear this from people (mostly on the left) quite a lot - what is causing this misunderstanding?
Do you genuinely not see a difference between being in charge of the executive branch and being an absolute monarch? Are you exaggerating for effect? Do you know that there's a difference but you're pretending there isn't for political purposes?
"exaggerating for effect, but with increasing concern"
Restated: I think that de facto wholesale destruction, by the executive, of agencies created by law is, at best, a clear abuse of executive power, as the executive has a constitutional duty to faithfully execute the law. I therefore believe that your view to the contrary reflects a dangerously expansive view of executive power. This is particularly so because you said not just that the president has a right to make the decision, but that "protecting democracy is a lot more important, it needs to be the president's decision", as if it's undemocratic for the president to be subordinate to democratically enacted law.
(I am of course assuming that Congress has appropriated money for this specific purpose, I haven't checked.)
No, of course the president has to follow properly enacted law, but that law is subordinate to the constitution, which puts the president in charge of the executive branch, and so there's a limit as to how much congress can limit executive power.
I was of course assuming that Congress hadn't passed a law specifically requiring this program to continue. Typically there's some discretion given to the executive.
The point of the executive branch is to *execute* policies passed by Congress. Congress has passed a bill funding PEPFAR. The President has refused to execute this policy. Either:
1) You agree that the power of the executive is limited to reasonable discretion in carrying out laws passed by Congress and outright refusing to carry out a law constitutes a breach of authority, in which case welcome to the Resistance.
2) You think that the President can just decide to do or not to do things as suits their mood, making the authority of Congress mostly hypothetical and the distance between the US government and an elected monarchy an increasingly theoretical question.
I agree, protecting democracy is important. In fact, that's why we all went to Maidan when our president started abusing his powers and why he's still hiding from us in moscow with his dictator friends.
The Vox article you link to is very weird in that it seems to assume that there is no value to great works of art. Clearly there is - a great cathedral or painting is worth many, many people's lives.
"Clearly there is - a great cathedral or painting is worth many, many people's lives."
The word "clearly" is doing a lot of work in that sentence. What's your rationale for saying a painting (however great you like) is worth many, many lives?
No it doesn't? Where are you getting that from? The article actually explicitly calculates and compares the costs of the two, inviting the reader to compare their value, which you'll notice is basically the exact opposite of assuming one has none.
> It’s useful to imagine walking down Main Street, stopping at each table at the diner Lou’s, shaking hands with as many people as you can, and telling them, “I think you need to die to make a cathedral pretty.” And then going to the next town over and doing it again, and again, until you’ve told 47,500 people why they have to die.
> can I imagine going down Main Street and telling people they need to die for Notre Dame? Of course not.
> If I were to file effective altruism down to its more core, elemental truth, it’s this: “We should let children die to rebuild a cathedral” is not a principle anyone should be willing to accept. Every reasonable person should reject it.
Where in that is there discussion or even recognition of the value of art to humanity? It's trivialized down to "make a cathedral pretty" as though the Repugnant Conclusion were the only value.
Yeah, I think that quite clearly does *not* assume works of art have no value. In fact I think it assumes the opposite!
Clearly, the author does not think that the Notre Dame is worth fifty thousand human lives. But the whole passage wouldn't really make sense if she thought it had *zero* value. And beyond 'clearly less than 50 thousands human lives', she doesn't even make it clear what that value is! It could be quite large.
The point of the passage is to be an intuition pump, to make you realise how many people 47,500 is. The point is not to denigrate the importance of art, but to illustrate the scale of good that could be done with it instead. If you have a contrary intuition to the author's (and I suspect most readers'), and truly think you *would* kill tens of thousands of peopel to rebuild a cathedral, you're entitled to that view- but you've misinterpreted the passage if you think it "assumes there is no value to great works of art".
Well, we disagree on the interpretation of that passage, then. I think it takes it for granted that no reasonable person could value art as worth human lives, and says that explicitly. I think the passage makes no sense if the author does value art. It doesn't even seem that the author thinks discussing the value of art is worth considering.
It's hard for me to imagine most readers would agree with the author, as that's a pretty extreme EA viewpoint.
Also, no one is talking about "killing" anyone, just letting people die by not spending scarce resources on them, people who we have no duty towards.
> I think it takes it for granted that no reasonable person could value art as worth human lives, and says that explicitly.
Well it simply... doesn't. The passage does not say those words, nor anything semantically equivalent.
> I think the passage makes no sense if the author does value art.
Well, it does. I think everyone else understood it! It would make no sense if the author valued *this* work of art at more than 47,500 lives- but I don't think anyone sincerely does, as the thought experiment was meant to illustrate.
> It's hard for me to imagine most readers would agree with the author, as that's a pretty extreme EA viewpoint.
Agree with the author about what? The author doesn't really even express a view in the passage in question. She simply describes a thought experiment, that I don't think you've quite followed.
> Also, no one is talking about "killing" anyone, just letting people die by not spending scarce resources on them, people who we have no duty towards.
Well the thought experiment assumes there is no act/omission distinction, as I think is clearly correct. Killing someone and letting someone die if you could easily prevent it are morally equivalent; if you disagree, you're welcome to argue for a distinction, but no-one in the history of analytic philosophy has yet managed to do so convincingly:
> The passage does not say those words [no reasonable person could value art as worth human lives], nor anything semantically equivalent.
> Agree with the author about what? The author doesn't really even express a view in the passage in question.
Huh? The passage does clearly say exactly that. I already quoted it:
"If I were to file effective altruism down to its more core, elemental truth, it’s this: 'We should let children die to rebuild a cathedral' is not a principle anyone should be willing to accept. Every reasonable person should reject it."
> no-one in the history of analytic philosophy has yet managed to do so convincingly
Thanks for the SEP link. But it says the opposite of your last claim: for instance, Foot, Quinn, and Kamm are all cited in that SEP article as giving accounts of the distinction, and many other philosophers have done so as well.
This is of course a heavily debated question in moral philosophy with solid arguments on both sides. Most people - and most moral philosophers - generally think there is a difference though. I think it is clear that the government deliberately and cold-bloodedly killing a bunch of innocent people is much worse than making the budgeting decision to not spend money that we don't have in order to save a few more lives.
> It would make no sense if the author valued *this* work of art at more than 47,500 lives- but I don't think anyone sincerely does, as the thought experiment was meant to illustrate.
Hmm? Many people sincerely do. I certainly do. The flaw in the thought experiment / intuition pump is that it relies mostly on the emotional power of imagining telling someone you're condemning them to death and then making your reason sound as trivial as possible.
No, it really doesn't. It covers other topics but doesn't actually justify spending money to help people in other countries. It seems to adopt the effective altruist position that people are worth the same no matter what country they're in.
you are correct that the post is built on an assumption that it is good to help people. even if you must stipulate that some people are of more value than others many people would still agree that it is good to help them. this is a common assumption in our culture and you should focus on disagreeing with it (if that is how you feel) instead of pretending it isn't there.
I can kinda see it? You could see the US government as Americans forming a club to help each other (for coordination and redistribution), and putting money in a common pot for that purpose. It's a bit rude if George then waltzes in and demands to use the club's funds for some emergency rather than for club activities, even if the emergency is genuinely dire and the club is a tad frivolous.
I think I'd be pretty sympathetic to that argument in the context of paying down the national debt (rather than increasing the deficit by several trillion) and stopping programmes that don't help and indeed harm Americans (Ozy gives many examples).
Because they are paid by Americans. And not by choice, but because we have to. By threat of force.
The justification for that is that we're participating in this society and taxes are the price for that. So if taxes go to help the country, that's one thing, but when they are forcibly stolen from you and given to help another country, that's at least presumptively wrong.
You could make a case that some foreign aid is in the US's interest, but Ozy didn't do that, and that has to be balanced against the huge looming crisis facing our country: the debt. Just like global warming, the debt has to be dealt with using painful cuts to avoid disaster.
Worth the same in some abstract moral sense, sure.
We're talking about using American tax dollars to pay for this, though, and those should be used for Americans. This is not an "edgelord" position. I suspect it may be the majority view.
What do you mean an "abstract moral sense"? When you questioned the "effective altruist position that people are worth the same", what else did you think that was but a claim about morality?
In any case, I'm glad you now seem to have accepted that "effective altruist position".
It seems incoherent, though, to accept that and nonetheless think we should arbitrarily prioritise certain people. What's your reasoning for that?
I meant, people may have the same intrinsic worth, in some objective sense, but that doesn't dictate how we should allocate resources.
Like a friend or family member has the same worth as a stranger, but if you are personally choosing who to save, you'd presumably save the person you're close to.
I thought the EA position was a claim not just about moral worth, but about action. I don't agree with it.
I don't believe it's arbitrary in any way to prioritize Americans with American tax dollars. As I explained in another comment, that money was stolen from Americans based on the justification that it's the cost for living in American society. So that money should go to benefit American society.
Very few people truly believe that we should spend the same amount of money to help strangers as we do to help those of the same nationality. Indeed, we do not. However, most people agree that if somebody could get lifesaving medicine for an amount of money that is insignificant to your personal wellbeing, you should give them that money. Considering PEPFAR's cost per-person is approximately $4-5, it appears to pass this test. Further evidence for this claim is that it has been passed by a majority of the representatives of the American public, suggesting most people are in favor of it.
If you truly believe all tax spending should be completely self-contained, most of the people in the country appear to disagree with you.
He did not, in fact, do this. Project 2025 was written with the goal of gutting the federal government, but Trump repeatedly disavowed having anything to do with this idea. If anything, it's likely that about half of his voters were betting that we would have something like the impotent Trump 2016 who talked about crazy nonsense every week but accomplished nothing other than appointing two Supreme Court justices. Trump ran on "America First", whatever that means, but to most people it meant deporting undocumented immigrants and reducing legal immigration. That much I will gladly concede a majority of Americans are in favor of. As for USAID, I doubt most people knew it existed a month ago.
As for your second point, uh, yeah? There was not anybody running on the "no foreign aid" platform because people didn't want that? Do you think all those republicans kept voting to extend PEPFAR for kicks? Anybody could have formed the Zero Foreign Aid block of congressional representatives at any point without a change in presidential administration. Seriously, how are you having trouble with this concept?
I'm saying that if you divide PEPFAR's annual cost by the population of the United States, it costs each taxpayer about $4-5 per year. This is proportionate with giving a five dollar bill to a homeless person to buy lunch, something that I would guess most Americans do at least once a year. Given that the typical American is willing to make at least one trade per year at the cost/benefit ratio of $5/one meal, I think there is substantial evidence that they would be in favor of paying $5 to reduce global HIV by the amount shown in this post's graph.
I think I speak for the entire choir when I say that this was some truly excellent preaching.
As someone not in the choir, it did not convince me at all - if anything, it made me more determined to stop all foreign aid and vote conservative.
Why?
“It didn't mention the harms of taxation“
Seriously? As mentioned, it’s 5 dollars for the average tax payer and 0.08% of the U.S. federal budget. It’s a small prize to pay for millions of lives.
”It didn't address concerns about American tax dollars going outside of America“
What exactly do you mean by that?
It didn't really address the objections or look at the other side. It didn't mention the harms of taxation or the huge debt crisis looming. It didn't address concerns about American tax dollars going outside of America. Also the tone created very negative associations with this viewpoint and people who hold it.
I think this fails to address the most common objections to PEPFAR: "I Don't Know How To Explain To You That You Should Not Give The Tiniest Flying Fuck About Other People And You Are A Gay Libtard If You Do", and "I am extremely racist and I love it when people in Africa die"
I’ve been so frustrated about this that I’ve been bothering to fight people on Twitter/X about it https://x.com/lydialaurenson/status/1893709188552909144
What are we even doing as a society anymore
ps however I gotta say I disagree that Christianity is about signaling, though I can also see why someone would think that
Don't take it personally, he thinks that about almost everything. Saying "X is not about X, X is about signalling" is basically Robin Hanson's catchphrase.
It depends on the Christian, of course. Jesus explicitly criticized the people who treat it as signaling.
thanks for doing this. Much needed. It's an historic tragedy - maybe a crime - that the US is killing people by destroying our foreign assistance system. The US has never been especially generous in foreign aid, but due to our size, we've always been very important. It's a trivial amount of money for the US, but keeps millions alive. A good estimate of the human mortality of the 90-day aid freeze is 100,000 dead. https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.26431. This isn't quite right for several reasons, but gives you a sense of the order of magnitude.
Shouldn't that money go towards Americans? Why are the lives of non-Americans being considered in how American tax dollars are spent?
And also, what about the debt? We're hugely in debt and this is a crisis that, much like global warming, needs to be addressed right away before it causes a huge disaster.
Apply the reversal test - should we go a lot more in debt to save a lot more non-Americans, at the expense of future Americans?
1) American prosperity is largely due to America's presence at the center of an international system it built to benefit itself and its allies. The cost of goods in your local store is dependent on a network of trade agreements, the maintenance of the world's largest navy keeping waterways free of pirates, and numerous other soft-power flexes sometimes involving USAID. Asking this question is like asking why a business should spend money on the products of other companies instead of just dividing its bank account between its employees: any short-term gain experienced by the employees would be quickly outweighed by the loss of income owing to not having jobs.
Furthermore the lives of non-Americans are considered in American tax spending because a majority of Americans place non-zero value on the lives of foreigners and vote to spend money in ways that reflect this belief. As noted by the author, we all pay taxes for things that we don't like. This is how democracy works. If you believe that all taxes should be opt-out on an item-by-item basis, you are welcome to run for Congress and propose a bill to that effect.
2) You may not have noticed, but the Republican party is currently attempting to cut taxes such that net government revenue will be decreased by much more than the disassembly of USAID could ever increase it. If the deficit concerns you, I suggest that you write to your representatives asking them to cease attempting to cut taxes and raise them instead.
3) Recall that PEPFAR consists of 0.08% of the federal budget. Review point 1) above.
I thought this was about PEPFAR, not USAID. The grounds for dismantling USAID are that it generally does bad things.
I don't see what PEPFAR has to do with America's prosperity - that certainly was not discussed in Ozy's piece.
I did notice that the GOP is increasing the debt with tax cuts, yes. I think that's very bad policy. But the debt is a looming huge crisis, and raising taxes is not politically feasible, so we have to cut spending. Ideally we'd both massively cut spending and massively raise taxes, yes.
Honest question: Have you read the first thing about these topics you apparently care so deeply about? For example the first paragraph of the introduction of the detailed report this post links to in its own first paragraph? It would tell you that USAID implements such vital parts of PEPFAR as drug orders, a very important thing for a program that distributes antiretroviral therapy.
You see, agencies in the US government do multiple things. They help each other. When you delete one without accounting for all of its functions, apparently unrelated projects regarding numerous areas of concern are rendered inoperable. This is why it's very important to not do what Trump just did.
If you are truly concerned that some USAID activities destabilize foreign governments, I suggest isolating those programs and halting their operation in a controlled way instead of disbanding the whole agency.
As for what it has to do with American prosperity, a known behavior of diseases is that they spread. With the novel inventions of boats and airplanes, diseases have been known to spread between landmasses separated by water, such as Africa and North America. Indeed, this is how a disease native to Africa arrived in the United States to begin with! Thus, improving global health has significant knock-on effects for local health. You may feel confident that no extant virus will ever mutate into a more severe form that resists conventional treatment due to our allowing it to brew unchecked among billions of people, but I think most people will recall that this in fact happened just five years ago. It also did serious damage to the global economy and local prices, another point for defending American prosperity by not suffering diseases to spread.
Regarding the budget, going to go over this one more time, just to make sure you have seen all the numbers. As of FY 2023:
-Spending on all foreign aid was $71.9 billion.
-Total Federal spending was $6.1 trillion.
-Total Federal revenue was $4.4 trillion.
https://www.pewresearch.org/short-reads/2025/02/06/what-the-data-says-about-us-foreign-aid/
Do you perhaps see that cutting foreign aid to zero would make no difference to the deficit?
If you would object to raising taxes on political feasibility grounds, I invite you to consider the feasibility of cutting medicare, medicaid, and social security, which make up the vast majority of federal spending and would have to be severely cut to zero out the deficit without raising taxes. The Republicans' new spending bill details exactly this plan. They are trying to make this proposal palatable to the average voter through the rhetoric method known as 'lying'. This is because they know everyone hates that way more than they hate raising taxes. If anything, negative sentiment towards people in top income brackets is higher than at any point since the Great Depression. If you would like to explore serious solutions to reducing the deficit, I repeat what others have said and invite you to read the work of Jessica Riedl: https://xcancel.com/JessicaBRiedl
HIV is an *infectious* disease. If a bunch of people on another continent get HIV and then it acquires ART resistance - that will absolutely be our problem, sooner or later. Americans will die over it.
I'd happily take that reversal test! If I could double PEPFAR's lives saved I would spend 0.08% more of the federal budget.
If you're that concerned about the national debt, going after 0.08% of the federal budget is a waste of time.
How do you feel about the program pushing Christian anti-sex anti-poly anti-sex-work moral values? That doesn't concern you?
If that's what it takes to keep the program running, I can make my peace.
I believe being born poor and/or in another country shouldn't be a death sentence. All lives have (equal) value. So, yes I think American tax dollars should be spent this way. Also it's a trivial expense in the scheme of the US federal budget or US economy. Cutting Pepfar and killing many hundreds of thousands of people will not meaningfully reduce the US deficit or debt.
So yeah, all the dead babies, but also for a minuscule portion of our budget we get to wield enormous leverage over nations that provide us with goods and resources? Leverage which will now fall to Russia/China/Iran/Whatever country you're afraid of? Why are we giving up a valuable foreign policy tool that costs us a tiny portion of our tax dollars and probably provides economic benefits far in excess of that? Even if you're a genuinely evil person and don't care that we get to save millions of lives at extremely low cost, maybe you aren't stupid?
The EU comission shall step in. Pelase, send a letter to President von der Leyen:
https://forum.effectivealtruism.org/posts/CCHwPXCTRNKdnyYbk/the-anti-aids-program-pepfar-the-european-union-must-replace
Great post, I will likely link it and/or the Report directly next time I'm trying to defend USAID online (which will no doubt be in the next 10 minutes).
One thing, though- your link for 'quack science that puts innocent people in prison' is just to a book about forensic science. Is there a specific citation intended to support that assertion? What even is the assertion? Are you saying forensic science, in general, is quackery? Because that seems obviously wrong.
Most forensic science is quackery! DNA isn't, obviously, and some areas of forensic science like fingerprinting or ballistics have limited use. But mostly the entire field is pseudoscientific nonsense. I particularly recommend chapter 5 of the linked report, where the National Academy of Sciences exhaustively debunks numerous kinds of forensic science.
I think what people think of when they think of forensic science is mostly fingerprinting and DNA, though. And they do in actuality make up a significant portion of the practice of forensic science. So it seems at least very misleading, if not outright incorrect, to say that 'mostly the entire field is pseudoscience', when it largely comprises methods you agree are scientifically valid, and those valid methods are exactly what people take to mean by 'forensic science'.
Either way, when you link a whole book about forensic science as your citation for 'quack science', it gives the apparently misleading impression that that's your opinion of the field in its entirety, I think. Maybe the citation should specify chapter 5?
Fingerprinting is also basically junk science
USAID? Or PEPFAR? Defending PEPFAR is one thing, but it's hard to defend USAID...
PEPFAR is just one part of the US' foreign aid. It's not hard to defend USAID at all, because they do lots of important and demonstrably effective things like PEPFAR.
For people who are interested and want to help, some orgs have set up temporary bridging funds for USAID: https://forum.effectivealtruism.org/posts/FTTPCtkizkAQ9fkvM/unicode-wvyp
There are a couple things that you're missing:
First, while the cost of this program may be small, it's one of many. This same logic would apply to many, many other government programs. Accept it, and what are the grounds for rejecting other programs? Once you accept this, you're on the hook for hundreds of others.
Second, we're dealing with a huge looming disaster that we need to start addressing as soon as possible - the debt. This money that's being spent is money we don't have. It's one thing to debate how to spend money we have. It's quite another to be over our heads in debt, out of money, and debating how to spend more. Apply the reversal test - should we go more into debt and save more non-American lives, at the cost of impoverishing future Americans? American tax dollars should be used for Americans.
The debt is like global warming: no one wants to think about it, people hope we can somehow solve the problem through less painful means, but it will take painful cuts and reductions to prevent a disaster.
Finally, I just looked at the law authorizing this program ( https://www.congress.gov/bill/108th-congress/house-bill/1298/text ), and I'm incredibly disturbed. It says the government should be promoting abstinence and monogamy and should be opposing sex work, and no money can go to any organization unless it has an explicit policy against sex work! This is truly terrible. I do not want my money going to this and I don't understand how anyone pro-poly and pro-sex-work can support it.
I find it genuinely baffling why you wouldn't care about people thousands of miles away dying horrible preventable deaths, but would care about them being taught to be monogamous.
Many Americans care about people in other countries, and elected Congresspeople who passed a popular bipartisan law that saved 19.5 million lives. This IS for Americans! Specifically, the portion of Americans who want their money to be spent this way!
If you want to tackle the debt you need to tackle Social Security and the military! Jessica Riedel, a conservative commenter who has spent her entire career researching how to reduce the budget deficit, has come out in favor of PEPFAR: https://x.com/JessicaBRiedl/status/1895227195771232406 It is not that much money, and it saves an extraordinary number of lives. The U.S. government does almost no programs as good as PEPFAR.
If there really were "hundreds of other" programs as effective as PEPFAR (there aren't), then the US could save a billion lives with 4% of it's budget. And you view this as a BAD thing?
Yes, I don't think it's the government's job to save a billion lives of people thousands of miles away when we are facing a catastropic debt crisis.
The grounds for accepting PEPFAR over other programs is that it has a greater impact than most of them. I don't see what's complicated about this. Run a cost-benefit analysis, set a standard for how much altruistic bang for our buck we want, and cut everything below that number. This is budgeting 101.
Honestly, the more important question is not whether PEPFAR or other foreign aid should be funded.
The question is who should decide.
The US is a democracy with the elected president in charge of the executive branch. So even if you or I disagree, protecting democracy is a lot more important, and it needs to be the president's decision.
It is, in fact, *Congress's* decision, not the president's. But also, that's just an entirely separate matter? This is straight out of "Arguments From My Opponent Believes Something" (https://slatestarcodex.com/2013/06/13/arguments-from-my-opponent-believes-something/). (Indeed, I thought this one was in the sequel, but I can't find that right now?) We can, in fact, argue both over the object level of the correct course of action and separately over the decision system for the government to use. Saying "we should do X instead of what the government is currently doing" means you think the people in charge of the government should make different decisions -- not that you think you should overthrow the government!
Well, I don't think it is "in fact" Congress's decision - Congress *could* certainly legislate specifically on this, but has not.
I agree, both are valid questions. I'm saying the political one is much more important. And often people conflate the two.
As to your last point, a lot of people seem to think it means that it shouldn't be the president's decision. Tell that to all the people filing litigation on things like this.
> Well, I don't think it is "in fact" Congress's decision - Congress *could* certainly legislate specifically on this, but has not.
Is this not, in fact, the purpose of the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003? Like, what, you think George W. Bush just authorized PEPFAR on his own? He cannot in fact do that! The money has to come from a Congressional spending bill!
> As to your last point, a lot of people seem to think it means that it shouldn't be the president's decision. Tell that to all the people filing litigation on things like this.
Yeah, because it's Congress's! The President does not, in fact, have the authority to unilaterally impound funds! They're saying it *factually is not* the president's decision -- not making the argument you seem to be imputing to them, that because the president is getting it wrong it isn't his decision!
> I agree, both are valid questions. I'm saying the political one is much more important.
Well it's not the question this post is about!
Thanks for the reference to the law! I just looked at the text.
https://www.congress.gov/bill/108th-congress/house-bill/1298/text
Yes, it does appropriate money for various purposes, including antiretroviral treatment. Interestingly, it also says:
"the President is authorized to furnish assistance, **on such terms and conditions as the President may determine**, for HIV/AIDS" (p. 18 of the pdf)
So it does seem that the president has some discretion. How much wiggle room does this give him? Unclear. The impoundment control act does prevent him from withholding funds, but it may be unconstitutional - we'll have to see what happens. Also, what if he doesn't withhold the funds, but once the funds are distributed to his Coordinator, he instructs the Coordinator to slow-walk them? Or what if he doesn't appoint a Coordinator, or appoints only people Congress rejects?
The law also provides for the president to make a determination, regarding money going to the Global Fund, that a country supports terrorism and can withhold money on that basis. (p.15)
In the spirit of this FAQ, today I learned that there are currently two elective absolute monarchies in the world: Vatican City and the United States of America.
Nope, the president is not an absolute monarch. He's just in charge of the executive branch.
But please tell me, since I hear this from people (mostly on the left) quite a lot - what is causing this misunderstanding?
Do you genuinely not see a difference between being in charge of the executive branch and being an absolute monarch? Are you exaggerating for effect? Do you know that there's a difference but you're pretending there isn't for political purposes?
"exaggerating for effect, but with increasing concern"
Restated: I think that de facto wholesale destruction, by the executive, of agencies created by law is, at best, a clear abuse of executive power, as the executive has a constitutional duty to faithfully execute the law. I therefore believe that your view to the contrary reflects a dangerously expansive view of executive power. This is particularly so because you said not just that the president has a right to make the decision, but that "protecting democracy is a lot more important, it needs to be the president's decision", as if it's undemocratic for the president to be subordinate to democratically enacted law.
(I am of course assuming that Congress has appropriated money for this specific purpose, I haven't checked.)
No, of course the president has to follow properly enacted law, but that law is subordinate to the constitution, which puts the president in charge of the executive branch, and so there's a limit as to how much congress can limit executive power.
I was of course assuming that Congress hadn't passed a law specifically requiring this program to continue. Typically there's some discretion given to the executive.
The point of the executive branch is to *execute* policies passed by Congress. Congress has passed a bill funding PEPFAR. The President has refused to execute this policy. Either:
1) You agree that the power of the executive is limited to reasonable discretion in carrying out laws passed by Congress and outright refusing to carry out a law constitutes a breach of authority, in which case welcome to the Resistance.
2) You think that the President can just decide to do or not to do things as suits their mood, making the authority of Congress mostly hypothetical and the distance between the US government and an elected monarchy an increasingly theoretical question.
Congress has, in fact, passed a law specifically requiring this program to continue. It has done so on three separate occasions, in 2013 (https://www.congress.gov/bill/113th-congress/senate-bill/1545), 2018 https://www.congress.gov/bill/115th-congress/house-bill/6651), and 2024 (https://www.congress.gov/bill/118th-congress/house-bill/10457/text/ih), the last extension covering the program through 2030. I appreciate your keen attention to such critical details.
I agree, protecting democracy is important. In fact, that's why we all went to Maidan when our president started abusing his powers and why he's still hiding from us in moscow with his dictator friends.
The Vox article you link to is very weird in that it seems to assume that there is no value to great works of art. Clearly there is - a great cathedral or painting is worth many, many people's lives.
"Clearly there is - a great cathedral or painting is worth many, many people's lives."
The word "clearly" is doing a lot of work in that sentence. What's your rationale for saying a painting (however great you like) is worth many, many lives?
No it doesn't? Where are you getting that from? The article actually explicitly calculates and compares the costs of the two, inviting the reader to compare their value, which you'll notice is basically the exact opposite of assuming one has none.
From this:
> It’s useful to imagine walking down Main Street, stopping at each table at the diner Lou’s, shaking hands with as many people as you can, and telling them, “I think you need to die to make a cathedral pretty.” And then going to the next town over and doing it again, and again, until you’ve told 47,500 people why they have to die.
> can I imagine going down Main Street and telling people they need to die for Notre Dame? Of course not.
> If I were to file effective altruism down to its more core, elemental truth, it’s this: “We should let children die to rebuild a cathedral” is not a principle anyone should be willing to accept. Every reasonable person should reject it.
Where in that is there discussion or even recognition of the value of art to humanity? It's trivialized down to "make a cathedral pretty" as though the Repugnant Conclusion were the only value.
Yeah, I think that quite clearly does *not* assume works of art have no value. In fact I think it assumes the opposite!
Clearly, the author does not think that the Notre Dame is worth fifty thousand human lives. But the whole passage wouldn't really make sense if she thought it had *zero* value. And beyond 'clearly less than 50 thousands human lives', she doesn't even make it clear what that value is! It could be quite large.
The point of the passage is to be an intuition pump, to make you realise how many people 47,500 is. The point is not to denigrate the importance of art, but to illustrate the scale of good that could be done with it instead. If you have a contrary intuition to the author's (and I suspect most readers'), and truly think you *would* kill tens of thousands of peopel to rebuild a cathedral, you're entitled to that view- but you've misinterpreted the passage if you think it "assumes there is no value to great works of art".
Well, we disagree on the interpretation of that passage, then. I think it takes it for granted that no reasonable person could value art as worth human lives, and says that explicitly. I think the passage makes no sense if the author does value art. It doesn't even seem that the author thinks discussing the value of art is worth considering.
It's hard for me to imagine most readers would agree with the author, as that's a pretty extreme EA viewpoint.
Also, no one is talking about "killing" anyone, just letting people die by not spending scarce resources on them, people who we have no duty towards.
> I think it takes it for granted that no reasonable person could value art as worth human lives, and says that explicitly.
Well it simply... doesn't. The passage does not say those words, nor anything semantically equivalent.
> I think the passage makes no sense if the author does value art.
Well, it does. I think everyone else understood it! It would make no sense if the author valued *this* work of art at more than 47,500 lives- but I don't think anyone sincerely does, as the thought experiment was meant to illustrate.
> It's hard for me to imagine most readers would agree with the author, as that's a pretty extreme EA viewpoint.
Agree with the author about what? The author doesn't really even express a view in the passage in question. She simply describes a thought experiment, that I don't think you've quite followed.
> Also, no one is talking about "killing" anyone, just letting people die by not spending scarce resources on them, people who we have no duty towards.
Well the thought experiment assumes there is no act/omission distinction, as I think is clearly correct. Killing someone and letting someone die if you could easily prevent it are morally equivalent; if you disagree, you're welcome to argue for a distinction, but no-one in the history of analytic philosophy has yet managed to do so convincingly:
https://plato.stanford.edu/entries/doing-allowing/#Bib
> The passage does not say those words [no reasonable person could value art as worth human lives], nor anything semantically equivalent.
> Agree with the author about what? The author doesn't really even express a view in the passage in question.
Huh? The passage does clearly say exactly that. I already quoted it:
"If I were to file effective altruism down to its more core, elemental truth, it’s this: 'We should let children die to rebuild a cathedral' is not a principle anyone should be willing to accept. Every reasonable person should reject it."
> no-one in the history of analytic philosophy has yet managed to do so convincingly
Thanks for the SEP link. But it says the opposite of your last claim: for instance, Foot, Quinn, and Kamm are all cited in that SEP article as giving accounts of the distinction, and many other philosophers have done so as well.
This is of course a heavily debated question in moral philosophy with solid arguments on both sides. Most people - and most moral philosophers - generally think there is a difference though. I think it is clear that the government deliberately and cold-bloodedly killing a bunch of innocent people is much worse than making the budgeting decision to not spend money that we don't have in order to save a few more lives.
> It would make no sense if the author valued *this* work of art at more than 47,500 lives- but I don't think anyone sincerely does, as the thought experiment was meant to illustrate.
Hmm? Many people sincerely do. I certainly do. The flaw in the thought experiment / intuition pump is that it relies mostly on the emotional power of imagining telling someone you're condemning them to death and then making your reason sound as trivial as possible.
I still think we should stop all foreign aid. This still doesn't explain why we should care.
It very clearly does, you just disagree with it.
No, it really doesn't. It covers other topics but doesn't actually justify spending money to help people in other countries. It seems to adopt the effective altruist position that people are worth the same no matter what country they're in.
you are correct that the post is built on an assumption that it is good to help people. even if you must stipulate that some people are of more value than others many people would still agree that it is good to help them. this is a common assumption in our culture and you should focus on disagreeing with it (if that is how you feel) instead of pretending it isn't there.
The problem is that you're talking about using American tax dollars to do so.
There should be a presumption that those should only be used to help Americans, and I don't see any argument for rebutting that.
I don't understand why taxes should only be used to help Americans.
I can kinda see it? You could see the US government as Americans forming a club to help each other (for coordination and redistribution), and putting money in a common pot for that purpose. It's a bit rude if George then waltzes in and demands to use the club's funds for some emergency rather than for club activities, even if the emergency is genuinely dire and the club is a tad frivolous.
I think I'd be pretty sympathetic to that argument in the context of paying down the national debt (rather than increasing the deficit by several trillion) and stopping programmes that don't help and indeed harm Americans (Ozy gives many examples).
Because they are paid by Americans. And not by choice, but because we have to. By threat of force.
The justification for that is that we're participating in this society and taxes are the price for that. So if taxes go to help the country, that's one thing, but when they are forcibly stolen from you and given to help another country, that's at least presumptively wrong.
You could make a case that some foreign aid is in the US's interest, but Ozy didn't do that, and that has to be balanced against the huge looming crisis facing our country: the debt. Just like global warming, the debt has to be dealt with using painful cuts to avoid disaster.
Do we need to start by proving the sky is blue? Obviously people are worth the same no matter what country they're in.
Don't start with this edgelord bullshit, we're having an adult conversation.
Worth the same in some abstract moral sense, sure.
We're talking about using American tax dollars to pay for this, though, and those should be used for Americans. This is not an "edgelord" position. I suspect it may be the majority view.
What do you mean an "abstract moral sense"? When you questioned the "effective altruist position that people are worth the same", what else did you think that was but a claim about morality?
In any case, I'm glad you now seem to have accepted that "effective altruist position".
It seems incoherent, though, to accept that and nonetheless think we should arbitrarily prioritise certain people. What's your reasoning for that?
I meant, people may have the same intrinsic worth, in some objective sense, but that doesn't dictate how we should allocate resources.
Like a friend or family member has the same worth as a stranger, but if you are personally choosing who to save, you'd presumably save the person you're close to.
I thought the EA position was a claim not just about moral worth, but about action. I don't agree with it.
I don't believe it's arbitrary in any way to prioritize Americans with American tax dollars. As I explained in another comment, that money was stolen from Americans based on the justification that it's the cost for living in American society. So that money should go to benefit American society.
Very few people truly believe that we should spend the same amount of money to help strangers as we do to help those of the same nationality. Indeed, we do not. However, most people agree that if somebody could get lifesaving medicine for an amount of money that is insignificant to your personal wellbeing, you should give them that money. Considering PEPFAR's cost per-person is approximately $4-5, it appears to pass this test. Further evidence for this claim is that it has been passed by a majority of the representatives of the American public, suggesting most people are in favor of it.
If you truly believe all tax spending should be completely self-contained, most of the people in the country appear to disagree with you.
And yet we elected Trump, who ran on a platform of stopping foreign aid.
As far as the representatives, few if any people back then were running on a platform of no foreign aid, so there wasn't much we could do pre-Trump.
I'm sorry, are you saying PEPFAR saves lives at $4-5 per person? That seems too low.
He did not, in fact, do this. Project 2025 was written with the goal of gutting the federal government, but Trump repeatedly disavowed having anything to do with this idea. If anything, it's likely that about half of his voters were betting that we would have something like the impotent Trump 2016 who talked about crazy nonsense every week but accomplished nothing other than appointing two Supreme Court justices. Trump ran on "America First", whatever that means, but to most people it meant deporting undocumented immigrants and reducing legal immigration. That much I will gladly concede a majority of Americans are in favor of. As for USAID, I doubt most people knew it existed a month ago.
As for your second point, uh, yeah? There was not anybody running on the "no foreign aid" platform because people didn't want that? Do you think all those republicans kept voting to extend PEPFAR for kicks? Anybody could have formed the Zero Foreign Aid block of congressional representatives at any point without a change in presidential administration. Seriously, how are you having trouble with this concept?
I'm saying that if you divide PEPFAR's annual cost by the population of the United States, it costs each taxpayer about $4-5 per year. This is proportionate with giving a five dollar bill to a homeless person to buy lunch, something that I would guess most Americans do at least once a year. Given that the typical American is willing to make at least one trade per year at the cost/benefit ratio of $5/one meal, I think there is substantial evidence that they would be in favor of paying $5 to reduce global HIV by the amount shown in this post's graph.