Sometimes most efficient isn’t most effective
When I asked Sandefur about the broader lessons, he said that sometimes an effective, easy-to-implement solution can be the best choice, even if it flies in the face of a cost-benefit analysis.
“Close to home for me, working a lot on education, are school meals, which are, I think, fairly well demonstrated to be effective,” he said. “They help kids learn. They help get more kids in school. And they help with nutrition outcomes, clearly.”
But programs like India’s midday meal scheme, which feeds more than 100 million school children each day, often come up short on cost-benefit analyses, because other programs are seen as a more efficient way to improve educational outcomes.
Salience over science
The PEPFAR case also carries another lesson: Sometimes politics matter more than economics.
The constituency for AIDS treatment included evangelical groups with a lot of political influence within the Republican Party. Having Franklin Graham make calls alongside Bono probably made it easier to get the Bush administration’s attention, but it also lowered the political costs of spending U.S. government money on a huge new foreign-aid program.
In political science terms, saving the lives of H.I.V.-AIDS patients had better “salience”: activists connected with the cause emotionally, making it a priority for them.
My anecdotal experience definitely bears that out: I was a student in that era, and I remember many passionate debates among my classmates about how best to get treatment for people in poor countries. I’m sure that, if asked, all of them would have supported prevention measures too, but that wasn’t where their energy was focused. The bulk of people’s excitement and urgency were focused on the issue of getting medications to people who would otherwise die. That felt like an emergency.
So perhaps the bigger lesson here is just that policy is, at the end of the day, not divorced from politics. And that means that political costs and benefits will often beat out economic ones — even when that might seem irrational.