This was an enlightening article (as I wasn't too familiar with the history of TB), but I'm struggling to grasp the overall point. If USAID is all that's standing between us and TB taking over the world, that's a _seriously_ lousy place to be in. Why are we not spending time talking about resolving that issue instead? You could argue that restoring USAID gives us more time to resolve the issue, but then I would ask what has been happening during the time the funding was active?
Everything is Tuberculosis [1] answers just that. Essentially it boils down to staggering wealth inequality and the aftershocks of colonialism
. The west “cured” TB 70 years ago then stopped caring about it. There isn’t a enough profit in preventing a million deaths a year in the rest of the world, so we just.. don’t.
Oh yes, the billions of dollars and decades of work specifically for the 3rd world to fight TB never happened and the cash was burned in a big bonfire.
The premise sounds interesting, but it seems a bit reductionist if it boils down to that, no? Is the book looking at it through the lens of government actions or private charities? I'm not aware of any evidence that suggests charities simply stopped operating because of capitalism.
The book includes privates charities and governments, but looks at TB through many more lenses than just those. There is a reason it’s a whole book and not just a comment on an Internet forum. I just finished the book and highly recommend the read, if only to learn about something that I suspect most of us (myself at least, certainly), is known only as _history_, not the raging health crisis that is continues to be.
It’s systemically really hard to treat TB in places without a lot of health infrastructure. USAID can mitigate this but it doesn’t follow that “more USAID” can eradicate TB.
I'm not sure th article had a singular point, it was more like a book review with some topical references.
The author of the book suggested in a YouTube video (based on his contacts in the medical teams) that the sudden and unexpected cut of USAID funds led to people half way through TB treatment being abandoned which is entirely unnecessary even if you strongly politically believe that the US should not be doing this and increases the risk of new strains mutating.
A lot of Americans like to help (clearly we do since we funded it for so many years). But, a lot of Americans also believe it's not the government's job to do those things. It's not necessarily 'cowardice / avarice' - just principles. But, if someone set up the NGO and opened it to donations, I'm sure a lot of Americans would support it.
Not the governments job to address exogenous threats that could negatively impact the health and wellbeing of every American?
Are you saying the government shouldn’t have a military either?
What, pray tell, is the governments job?
By the by, avarice and cowardice ARE values. Very few people outright say “I’m a coward”, or “my wealth is more important than your life”.
Instead, when faced with a difficult choice, say for instance, have more personal disposable income or lessen the suffering of others, those values are often expressed more euphemistically, and when even that is unpalatable, then the old “it’s wasteful and inefficient” argument comes into play.
You’ll note that those who argue “waste and inefficiency!” never seem to actually attempt to address the problem that money was “wasted” trying to address. (If they did, they’d soon discover why it’s so hard, complicated, and expensive to try to actually address social issues, which is what folks who actually care about governance have known all along.)
That’s because generally speaking the “the government is wasteful and inefficient” people’s real values are greed, not frugality.
This is a complex topic. A lot has to do with "American culture". Culture, as you know, can last for millennia.
First, I'm personally not against a moderately sized government. I'm an urbanite and lean kind of socialist, to be honest. I'm ok with there being lots of well-paid government workers. Good for them. I want everyone to have opportunity, access, and safety nets. But, I also believe in the system and respect my fellow citizens enough to understand their perspectives.
The overarching American culture is anti-government. Some of it is because of waste. But, most of it comes from an innate distrust of government and the belief that government trends toward corruption, and corruption is the bane of a functioning society.
A small number of Americans believe that the government's role should only be rule of law, policing, border defense, and tax collection. A larger number believe that government should manage common infrastructure, standards, public services, intelligence, and markets. A small number believe that the US federal government should support and defend the world.
But, Americans like control. This is rooted in a founding mythos centered on rebellion and self-determination. The further removed they are from having control over government, the more anxious they get. Local government is good - state government is tolerable - federal government is bad. Federal government means academics and experts who don't know anything and only bring biases, agendas, and corruption. The federal government leads to tyranny.
Also, once a govenment program starts, it's very difficult to shut it down. Bureaucracies tend toward mission creep, institutional inertia, and self-preservation.
For TB specifically, most of it could have been managed by now if there was broad support and action from wealthy nations over the past 100 years. It could have been treated like Polio. But, wealthy nations don't see TB firsthand, so they don't think it's important. It's not just a US problem.
Hayek, of “Road to Serfdom” fame believed that the government should provide universal healthcare.
That said, the only trick in the history of the human experience that consistently improves the lot of a society is taking a portion of the private surplus an applying to the public good.
Best of luck making your own interstate highway system with you and your friends though. The ROI on that one is absolutely bananas, by the by.
That said, don’t get me started on the ROI of the sewer system? Bonkers. Medicaid ? About 150% ROI in 1-2 years.
What is missing from the simple ROI analysis is the counterfactual: if Medicaid didn’t exist, what would the actual aggregate cost to the economy be?
Conservative estimate? ~$500 billion in economic growth lost annually if Medicaid didn’t exist. We spend approximately $800 billion on it annually, and get $1.6 trillion of ROI over 2 years.
This is a great outlook, but I think it's slightly short-sighted if you don't consider that there are several ways to achieve the same outcome outside of USAID. I think the US can lead the world through public example rather than trying to set that same example through the government.
For example, I treat my charitable donations with the same seriousness that I apply towards my 401k. I am researching organizations, determining their overall efficacy, and splitting my funds to where I think they would be the most beneficial, given the current global climate.
I would love to see this principle applied more broadly to the public. There might be services out there that already provide such "charity portfolios," but I'll admit that I'm pretty content doing it myself, so I haven't looked much. But, given our government's history of mismanagement, I think this sort of approach would have far more impact than funneling everything through a large organization like USAID.
This (cost/benefit analysis of non-profits, mutual fund type investment vehicles for non-profits, etc. take a look at social impact bonds, Robin Hood Foundation, etc. ) has existed for ages, and they vastly underperform us govt agencies in terms of $/outcomes for reasons that should be obvious: economies of scale.
There are very few ngo agencies that outperform the us government, and usually they operate in fields/domains that the government can’t because of political risk aversion: the voting public doesn’t like drug addicts treated like humans, and vote out politicians who do.
The single most effective non-profit dollar for dollar in terms of saving lives is UNICEF.
It is extremely easy to say the government is mismanaged/inefficient. It’s been basically the consistent drumbeat for centuries. Yet, once “reformers/efficiency/deficit hawks” take power, they discover quite quickly (if they are keen on retaining their positions) that the current state of affairs is deeply imperfect, but perfection is impossible.
What folks fail to realize is that government operates under EXTREMELY DIFFERENT CONSTRAINTS and extremely different capabilities than businesses or individuals.
They have totally different goals! Turns out, predictability > efficiency. Because people can make long term investments against predictability. Inefficiency, below a certain threshold of course, gets priced in as a fixed cost, and business routes around it/operates around it.
Interesting. I'll have to dig into the data more, then. I wouldn't be surprised if they beat out NGO's dollar-for-dollar (it's expected for the government to have far more funding via taxes), but I'm more curious about the average efficacy of those dollars.
People don't donate to charity. Mostly. And even if they did, charities are subject to fracturing money that could be doing good many different ways when what's really needed is a concerted push in a particular direction. Saying we need to shift the focus from government spending to charity is to say that we should defund the effort entirely. I am entirely against privatizing the public good.
Current TB vaccines and treatments are not incredibly effective against it. The effort is toward not letting it get so much worse than it already is by aggressively fighting it with the mediocre tools we have.
>"Even after treatments emerged to combat TB, their geographic availability revealed the prevalence of prejudice. Starting in the 1980s, the emergence of HIV/AIDS *allowed TB to spread more quickly through weakened immune systems*"
This is the statement that stood out to me. We've had 5 years of weakening immune systems, which has, with a high probability, contributed further to the spread of TB. History is repeating, again.
Poorer countries and generally countries with worse governance have a real trouble controlling tuberculosis. Given how much of it is asymptomatic, you have to have a real screening program including X-rays in order to catch cases, and that is beyond the ability of most developing countries - which are precisely the countries where most of the population boom is taking place.
I don't believe that USAID can cover, say, the whole of Africa with preventative care. The US cannot cover even all of its own citizens, for a host of reasons, much less 1,5 billion people in exotic regions far from its borders.
Purge of USAID is likely to make the situation worse, but only marginally worse. The real problem is that at least third of humanity doesn't yet have any reasonable healthcare infrastructure, reliable grid (for medical machines to work), public safety (for doctors to survive), etc., etc., etc. If we had a functional recipe to solve such problems, they would likely be solved already.
About a quarter of the entire humanity is infected with TBC bacteria. Two billion people, often in the most remote and poorest places in the world, like Niger or Afghanistan.
You don't have to be a public health professional to calculate that USAID can put a dent to this massive problem, but cannot even dream about reducing it to, say, half of its current size.
My point is that I don't think OP is qualified to say whether or not USAID is putting a meaningful dent in the TB problem.
It's entirely possible that, for example, if you deploy resources amongst individuals that are known to travel, for example, you could significantly eliminate the probability of others being infected (including you and I in the developed world).
> The US cannot cover even all of its own citizens,
The US already spends enough on healthcare to provide gold-standard best-in-the-world coverage to all of its citizens.
It could take any random system better than the one extant in the United States, CTRL-F the country's names in all of the rules and regulations for that system and change it to "The United States", implement that system, and have enough money left over to cure poverty, hunger, and homelessness for $0.00 in extra spending.
We choose not to.
There is too much money to be made so a constant campaign of disinformation and vilification is waged to stop that from happening.
My theory is any system you pick would work if it was run with good faith. The problem with the US system is the financial oligarchy that runs the US sees bad faith as a feature.
Bruce Sterling's "Heavy Weather" was a surprisingly accurate prediction of the 2020-2040s for coming out in 1995 at the peak of "the end of history". He called this one re: tuberculosis.
People can have latent TB, which causes no symptoms and is not contagious. If it reactivates, it can cause permanent damage to the lungs and/or other areas such as the bones, joints, kidneys, and brain. Diagnosis and treatment are important just the same. Lazy doctors can miss out on testing for TB when the lungs appear clear, with symptoms present in just the lymph nodes, bones, joints, kidneys, or brain, indicating possible extrapulmonary TB.
This was an enlightening article (as I wasn't too familiar with the history of TB), but I'm struggling to grasp the overall point. If USAID is all that's standing between us and TB taking over the world, that's a _seriously_ lousy place to be in. Why are we not spending time talking about resolving that issue instead? You could argue that restoring USAID gives us more time to resolve the issue, but then I would ask what has been happening during the time the funding was active?
Maybe I misunderstood the author's assertion.
Everything is Tuberculosis [1] answers just that. Essentially it boils down to staggering wealth inequality and the aftershocks of colonialism . The west “cured” TB 70 years ago then stopped caring about it. There isn’t a enough profit in preventing a million deaths a year in the rest of the world, so we just.. don’t.
[1]: https://everythingistb.com/
Oh yes, the billions of dollars and decades of work specifically for the 3rd world to fight TB never happened and the cash was burned in a big bonfire.
The premise sounds interesting, but it seems a bit reductionist if it boils down to that, no? Is the book looking at it through the lens of government actions or private charities? I'm not aware of any evidence that suggests charities simply stopped operating because of capitalism.
The book includes privates charities and governments, but looks at TB through many more lenses than just those. There is a reason it’s a whole book and not just a comment on an Internet forum. I just finished the book and highly recommend the read, if only to learn about something that I suspect most of us (myself at least, certainly), is known only as _history_, not the raging health crisis that is continues to be.
Sounds interesting, I'll add it to my list. Appreciate the response.
It’s systemically really hard to treat TB in places without a lot of health infrastructure. USAID can mitigate this but it doesn’t follow that “more USAID” can eradicate TB.
I'm not sure th article had a singular point, it was more like a book review with some topical references.
The author of the book suggested in a YouTube video (based on his contacts in the medical teams) that the sudden and unexpected cut of USAID funds led to people half way through TB treatment being abandoned which is entirely unnecessary even if you strongly politically believe that the US should not be doing this and increases the risk of new strains mutating.
The answer to the problem of the US’s work as only mitigating, rather than solving is not abandonment: it is true leadership and collaboration.
Smallpox, the hole in the ozone layer, etc.
It is possible.
Shrinking away because you can’t fully solve it alone or others aren’t helping as much as you’d like?
Cowardice and/or avarice to a degree that is, in my humble opinion, indistinguishable from evil.
A lot of Americans like to help (clearly we do since we funded it for so many years). But, a lot of Americans also believe it's not the government's job to do those things. It's not necessarily 'cowardice / avarice' - just principles. But, if someone set up the NGO and opened it to donations, I'm sure a lot of Americans would support it.
Not the governments job to address exogenous threats that could negatively impact the health and wellbeing of every American?
Are you saying the government shouldn’t have a military either?
What, pray tell, is the governments job?
By the by, avarice and cowardice ARE values. Very few people outright say “I’m a coward”, or “my wealth is more important than your life”.
Instead, when faced with a difficult choice, say for instance, have more personal disposable income or lessen the suffering of others, those values are often expressed more euphemistically, and when even that is unpalatable, then the old “it’s wasteful and inefficient” argument comes into play.
You’ll note that those who argue “waste and inefficiency!” never seem to actually attempt to address the problem that money was “wasted” trying to address. (If they did, they’d soon discover why it’s so hard, complicated, and expensive to try to actually address social issues, which is what folks who actually care about governance have known all along.)
That’s because generally speaking the “the government is wasteful and inefficient” people’s real values are greed, not frugality.
This is a complex topic. A lot has to do with "American culture". Culture, as you know, can last for millennia.
First, I'm personally not against a moderately sized government. I'm an urbanite and lean kind of socialist, to be honest. I'm ok with there being lots of well-paid government workers. Good for them. I want everyone to have opportunity, access, and safety nets. But, I also believe in the system and respect my fellow citizens enough to understand their perspectives.
The overarching American culture is anti-government. Some of it is because of waste. But, most of it comes from an innate distrust of government and the belief that government trends toward corruption, and corruption is the bane of a functioning society.
A small number of Americans believe that the government's role should only be rule of law, policing, border defense, and tax collection. A larger number believe that government should manage common infrastructure, standards, public services, intelligence, and markets. A small number believe that the US federal government should support and defend the world.
But, Americans like control. This is rooted in a founding mythos centered on rebellion and self-determination. The further removed they are from having control over government, the more anxious they get. Local government is good - state government is tolerable - federal government is bad. Federal government means academics and experts who don't know anything and only bring biases, agendas, and corruption. The federal government leads to tyranny.
Also, once a govenment program starts, it's very difficult to shut it down. Bureaucracies tend toward mission creep, institutional inertia, and self-preservation.
For TB specifically, most of it could have been managed by now if there was broad support and action from wealthy nations over the past 100 years. It could have been treated like Polio. But, wealthy nations don't see TB firsthand, so they don't think it's important. It's not just a US problem.
Hayek, of “Road to Serfdom” fame believed that the government should provide universal healthcare.
That said, the only trick in the history of the human experience that consistently improves the lot of a society is taking a portion of the private surplus an applying to the public good.
Best of luck making your own interstate highway system with you and your friends though. The ROI on that one is absolutely bananas, by the by.
That said, don’t get me started on the ROI of the sewer system? Bonkers. Medicaid ? About 150% ROI in 1-2 years.
What is missing from the simple ROI analysis is the counterfactual: if Medicaid didn’t exist, what would the actual aggregate cost to the economy be?
Conservative estimate? ~$500 billion in economic growth lost annually if Medicaid didn’t exist. We spend approximately $800 billion on it annually, and get $1.6 trillion of ROI over 2 years.
But yeah, donate to the Shriners.
> it is true leadership and collaboration
This is a great outlook, but I think it's slightly short-sighted if you don't consider that there are several ways to achieve the same outcome outside of USAID. I think the US can lead the world through public example rather than trying to set that same example through the government.
For example, I treat my charitable donations with the same seriousness that I apply towards my 401k. I am researching organizations, determining their overall efficacy, and splitting my funds to where I think they would be the most beneficial, given the current global climate.
I would love to see this principle applied more broadly to the public. There might be services out there that already provide such "charity portfolios," but I'll admit that I'm pretty content doing it myself, so I haven't looked much. But, given our government's history of mismanagement, I think this sort of approach would have far more impact than funneling everything through a large organization like USAID.
This (cost/benefit analysis of non-profits, mutual fund type investment vehicles for non-profits, etc. take a look at social impact bonds, Robin Hood Foundation, etc. ) has existed for ages, and they vastly underperform us govt agencies in terms of $/outcomes for reasons that should be obvious: economies of scale.
There are very few ngo agencies that outperform the us government, and usually they operate in fields/domains that the government can’t because of political risk aversion: the voting public doesn’t like drug addicts treated like humans, and vote out politicians who do.
The single most effective non-profit dollar for dollar in terms of saving lives is UNICEF.
It is extremely easy to say the government is mismanaged/inefficient. It’s been basically the consistent drumbeat for centuries. Yet, once “reformers/efficiency/deficit hawks” take power, they discover quite quickly (if they are keen on retaining their positions) that the current state of affairs is deeply imperfect, but perfection is impossible.
What folks fail to realize is that government operates under EXTREMELY DIFFERENT CONSTRAINTS and extremely different capabilities than businesses or individuals.
They have totally different goals! Turns out, predictability > efficiency. Because people can make long term investments against predictability. Inefficiency, below a certain threshold of course, gets priced in as a fixed cost, and business routes around it/operates around it.
> they vastly underperform us govt agencies
Interesting. I'll have to dig into the data more, then. I wouldn't be surprised if they beat out NGO's dollar-for-dollar (it's expected for the government to have far more funding via taxes), but I'm more curious about the average efficacy of those dollars.
The key thing here, which again, is something that governments must consider but individuals and nonprofits do not is the breadth vs depth.
Your gift of $10 provides 50 meals to 50 families. Well done!
It did absolutely nothing for tens of millions of other families.
The implications of the loss of tax revenue as a result of charitable giving is an exercise I will leave up to the reader.
People don't donate to charity. Mostly. And even if they did, charities are subject to fracturing money that could be doing good many different ways when what's really needed is a concerted push in a particular direction. Saying we need to shift the focus from government spending to charity is to say that we should defund the effort entirely. I am entirely against privatizing the public good.
Current TB vaccines and treatments are not incredibly effective against it. The effort is toward not letting it get so much worse than it already is by aggressively fighting it with the mediocre tools we have.
>"Even after treatments emerged to combat TB, their geographic availability revealed the prevalence of prejudice. Starting in the 1980s, the emergence of HIV/AIDS *allowed TB to spread more quickly through weakened immune systems*"
This is the statement that stood out to me. We've had 5 years of weakening immune systems, which has, with a high probability, contributed further to the spread of TB. History is repeating, again.
Poorer countries and generally countries with worse governance have a real trouble controlling tuberculosis. Given how much of it is asymptomatic, you have to have a real screening program including X-rays in order to catch cases, and that is beyond the ability of most developing countries - which are precisely the countries where most of the population boom is taking place.
I don't believe that USAID can cover, say, the whole of Africa with preventative care. The US cannot cover even all of its own citizens, for a host of reasons, much less 1,5 billion people in exotic regions far from its borders.
Purge of USAID is likely to make the situation worse, but only marginally worse. The real problem is that at least third of humanity doesn't yet have any reasonable healthcare infrastructure, reliable grid (for medical machines to work), public safety (for doctors to survive), etc., etc., etc. If we had a functional recipe to solve such problems, they would likely be solved already.
> Purge of USAID is likely to make the situation worse, but only marginally worse
Do you have a degree in public health?
What?
About a quarter of the entire humanity is infected with TBC bacteria. Two billion people, often in the most remote and poorest places in the world, like Niger or Afghanistan.
You don't have to be a public health professional to calculate that USAID can put a dent to this massive problem, but cannot even dream about reducing it to, say, half of its current size.
>but only marginally worse
My point is that I don't think OP is qualified to say whether or not USAID is putting a meaningful dent in the TB problem.
It's entirely possible that, for example, if you deploy resources amongst individuals that are known to travel, for example, you could significantly eliminate the probability of others being infected (including you and I in the developed world).
The answer was, no.
> The US cannot cover even all of its own citizens,
The US already spends enough on healthcare to provide gold-standard best-in-the-world coverage to all of its citizens.
It could take any random system better than the one extant in the United States, CTRL-F the country's names in all of the rules and regulations for that system and change it to "The United States", implement that system, and have enough money left over to cure poverty, hunger, and homelessness for $0.00 in extra spending.
We choose not to.
There is too much money to be made so a constant campaign of disinformation and vilification is waged to stop that from happening.
My theory is any system you pick would work if it was run with good faith. The problem with the US system is the financial oligarchy that runs the US sees bad faith as a feature.
Bruce Sterling's "Heavy Weather" was a surprisingly accurate prediction of the 2020-2040s for coming out in 1995 at the peak of "the end of history". He called this one re: tuberculosis.
People can have latent TB, which causes no symptoms and is not contagious. If it reactivates, it can cause permanent damage to the lungs and/or other areas such as the bones, joints, kidneys, and brain. Diagnosis and treatment are important just the same. Lazy doctors can miss out on testing for TB when the lungs appear clear, with symptoms present in just the lymph nodes, bones, joints, kidneys, or brain, indicating possible extrapulmonary TB.
Well Trump does not care about the WHO and what is says, didn't he force the US to leave the WHO.
And yes, his cuts will ensure TB and many other once close to extent diseases come back. Just look at measles in the South.
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