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There is (this will be no news to anyone who’s been awake for the last forty years) a debate about whether state-provided social services are too expensive to be continued, whether they’re actually beneficial to their recipients or reduce them to the status of helpless dependents, whether they’re more or less efficient than some hypothetical market mechanism– in sum, whether they should exist at all. At least as presented in the relatively highbrow newspapers and magazines that cross my threshold, the matter of cost is always framed in relation to current expenditures: health and education as a fraction of GDP, or as compared to defense, etc.

That way of framing the math, however, renders invisible many dimensions of benefit and cost that become perceptible only when we look at matters in a longer view (say over a lifetime) and dice more finely the categories of payers and recipients. It turns out that for the overwhelming majority of British rate-payers, and by overwhelming I mean 93%, the amount paid in over a lifetime exceeds the amount received in benefits. So you can forget about the welfare queens, the “culture of dependency,” and all that stuff. Who knew, you may ask, that the public was always stepping up to the plate and giving a little more than necessary to help the less fortunate?

In another way, social services such as education, healthcare, and unemployment insurance act as a collective savings account to get people through the hard times. The number of people who will at one point or another need to call on these collective savings is large. Only a few people never experience need over their lifetimes. The few lucky standouts shouldn’t begrudge the majority whom social investments kept from going broke at one point or another: if the unlucky folks really had to eat garbage or steal on a regular basis in order to survive, surely the lucky ones would be sleeping less well at night. And need is not a lifetime thing; it happens in moments or cycles and, once again, the impact can be cushioned by the whole society’s willingness to think and pay ahead.

Admittedly, these results are from Great Britain, where some 70 years of Labour-inflected policy have created a long enough statistical run to give useful data. But surely in the US, even without a National Health Service and despite our patchwork of state governments, some more provident than others, the numbers exist to show what entitlements really do and don’t do, under a variety of conditions, over a lifetime. I’d be glad to read a factual comparative study. In the meantime, here’s the report on lifetime outcomes from the Nuffield Foundation’s Institute for Fiscal Studies:



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Can Phentermine Be Bought Online, this time from the New Republic, and I fear the overall effect of such think-pieces will be to validate the indifference of people who were looking for a reason not to help others anyway. It’s true that celebrity jaunts to Africa, etc., have little lasting effect except perhaps on the celebrity’s public image. That’s a problem with the culture of celebrity, not of aid. It’s also true that sudden infusions of money into an economy are apt to destabilize and to have perverse effects. That’s a problem of bad planning. White Land Rovers? I would recommend steering clear of any project that involves the purchase of many white Land Rovers.

The article suggests that low overhead is not in and of itself a good marker of charitable effectiveness, that spending money on fund-raising is often a precondition for having an effect: well, here I think you must use your judgment about what is the tail and what is the dog. A low tail-to-dog ratio matters when deciding where to put one’s donations, but it’s best to concentrate on questions such as these (also legible between the lines of the article): have the intended beneficiaries themselves expressed a desire for the planned interventions? Is there a concrete plan for engagement on the part of the beneficiary population, rather than a scheme in the heads of well-intentioned First Worlders to build something, feel good about it, and abandon it? “First, do no harm” is a rule worth following even if you’re not a medical worker.

Most important is to have an accurate sense of the economic flows among which a development-assistance plan will exist. How much of the money flowing in and out of a given country is dedicated to arms procurement, to food assistance, to financial whizzbangery (including corruption)? How much does the local economy rely on expatriates remitting their paychecks? What’s up for sale, in terms of natural resources or the vital interests of the residents, and what is protected (and how well) from rent-seeking investors? The perplexed, such as yours truly, appreciate a sense of proportion about all these things.


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(Introducing Paul Farmer, Human Rights Program Kirschner Memorial Lecture, June 5, 2014)

Good evening and welcome to tonight’s Kirschner Memorial Lecture. I’m delighted to see so many of you here tonight, a direct acknowledgment of the significance of our Human Rights Program and a hint that our benefactors’ generosity has not been totally misplaced. The questions examined in the Human Rights Program are among the most serious questions raised in a university, and I would say that for us, specifically, in this country, with our history and assumptions, the area of health and human rights has the greatest power to change the way we see ourselves and others.

For many of us in Paul’s and my generation in the United States, the first time we heard about human rights as a field of activism, it was in connection with the denial of people’s rights to free speech and assembly, their right to emigrate, their right to seek redress, their implicit right to representative government. And we learned about this in the context of the Cold War, when it seemed self-evident that people in some part of the world benefited from the recognition of those rights, while people lacked them in many other parts of the world—not only the Soviet bloc and China, but also Latin America, Asia and Africa, where the client states of the great powers all seemed to repress their dissidents with the greatest indifference. Of course, it didn’t stop there. The response to human rights activism by official representatives of the socialist countries and by some of our own home-grown leftists was to point out how inequitably the market system distributed such basic goods as food, housing, education and medical care, goods which, it was implied, were a fair trade for civil and legal rights. The funny thing about this answer is that it was taken just as a rebuke of the West’s hypocrisy. Despite some laudable exceptions, we did not experience, even in the Carter era which made such a noise about making human rights the driving force of our foreign policy, a large-scale effort to wrap social and economic rights around the uncontestable but rather abstract goods of free speech and fair elections at home. The struggle for civil rights and equality within the US, which had concluded in the courts with a handful of imperfect measures for instituting fairness in civil life, did not carry over into an effective War on Poverty. The Great Society spent most of its surplus on weaponry, with a small percentage allocated to nagging our rivals about their bad human-rights record.

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