Attention conservation notice: If you would like to solve the world’s water problems, I’m on board, but going after ALS is silly. Instead, go after fantasy football and botox, if you are going to equate dollars with importance.
Disclaimer: My beloved husband lost his mother and grandfather both to ALS, and he and I have spent years and years facing the shadow of his having that disease hanging over us. So I get rather shirty with the pronouncements that ALS is not ‘sufficiently important’ to merit the fundraising that has occurred around the Ice Bucket Challenge. I’ve lost track of how much they’ve raised–$70 million was my last count. So while others are able to talk about the disease and whose death matters in the abstract, I can’t do that here.
As Dickens has the Ghost of Christmas Present to Ebeneezer Scrooge:
Will you decide what men shall live, what men shall die? It may be that, in the sight of Heaven, you are more worthless and less fit to live than millions like this poor man’s child. Oh, God! to hear the Insect on the leaf pronouncing on the too much life among his hungry brothers in the dust!”
But I think the other reason I’m so grumpy, other than the facile way people seem to be deciding whose suffering is important and whose isn’t, is the way in which utilitarianism seems have to leapt forward as the default mode for thinking about the morals of the challenge. And that way madness lay. Friends don’t let friends become act-utilitarians.
The argument goes something like this: ‘only’ about 5,500 people die every year of ALS in the US. Then we tote up the body counts that occur from other things: lack of potable water, as one example, and the relative bigness of that number compared to the relative smallness of ALS, and then we conclude that people are over-giving to ALS because of the relative bigness of the other, bigger problems.
The problem with toting up bodies to decide relative social value of lives lost is that it’s unlikely, unless you are talking to economists, to convince anybody for any real length of time. Yes, of course, we can agree it’s worse when 10,000 people die than when 5,000 people die, but it’s not like that really decides resource allocation in human society. So one popular new thread is to note that 3.5 million people die from unsanitary water every year. So much more important than ALS. And I agree: it is a devastating loss of human potential, and absolutely unacceptable.
Except that we have the technology to save the victims of waterborne diseases. We’ve had relatively low cost solutions that could save millions and millions of lives, and we’ve had these solutions for decades. It’s not like ALS where there is no known cure, and money for research might find a cure; we’ve got the cure for waterborne diseases, but we won’t implement them. There’s evil here, but it’s not that ALS gobbled up all the resources, and there’s none left to solve the mystery for why some children die from waterborne diseases and others don’t.
According to the WHO, it would cost about $22 billion a year to get everybody access to clean drinking water. We could raise that money if every American would toss in $7.07. I’m in! By all means. Raise my sales tax on iced caramel lattes. They are bad for me anyway.
Or, everybody who plays fantasy football could knock that off and give that money to clean water. Fantasy football is a $70 billion-dollar-a-year industry when you factor in ad revenue, and $15 billion in hard sales. $15 billion a year isn’t the total bill, but it would more than halve the number of deaths from waterborne diseases.
So while we can denounce giving to ALS because it is ‘less important’ than waterborne diseases, people blow through over three times what it would cost to fix waterborne illness on fantasy football and selling other things we probably don’t need on fantasy football websites. I’m picking on fantasy football; we could easily go with the global beauty industry which is expected to hit $265 billion a year by 2017. We could provide clean water to every baby on the planet 12 times over (and some change) if people stopped buying lipstick, hairspray and botox. How clever of me to have solved the issue, eh?
The Mexican government once found $22 billion in cash stashed in the walls of one drug lord’s house. Boom. There’s one year of clean water, right there.
ALS’s 70 million is looking a little like chump change now, though, isn’t it, when we evaluate $$$ and priorities. So ALS might not be as important as waterborne disease, but I’m thinking that BOTH ALS and waterborne diseases are more important than pretending to manage teams where grown men play with a little ball. Or botox.
And yet. Here we are. Fantasy football and botox get to amble on, unquestioned in their moral importance because a market exists for them. But ALS and the people giving to it? Utterly wrong! Because waterborne disease!
Critics of the ALS challenge assume the ALS giving has displaced giving to other charities, but I’d sure like to see the data on that because I’m betting much of what they raised came from new gifts. We don’t know that the money given to ALS would have gone to another cause, let alone a worthier one. That’s what Kant helps us grasp: humility regarding the metaphysics of assumed values of future or counterfactual states. Maybe every single $ raised under the ALS bucket challenge would have otherwise been spent on Twinkies, bacon, cocaine, Vin Scully bobblehead dolls, pay-per-view mixed martial arts matches, and fantasy football etc, etc. etc. Thus debating the marginal benefit versus the opportunity cost is entirely speculative until we get the data. There are lot of places that money could have gone (cigarettes, porn, Halloween costumes for your iguana, etc) other than worthier diseases.
Even settling that empirical question does not settle the moral questions, and this is where the universe of spending on social welfare has, to me, gotten even murkier in our neoliberal world. The idea that we might, somehow, as a society suss out what social concerns (like disease and cures) should be funded and what should wait might be adjudicated through the welfare state charged with figuring out what society’s most important problems are. But one of the idealogical bases for deconstructing the welfare state has been to avoid forcing people through taxation to give their money to solve social ills they don’t agree are either a) ills or b) solvable or c) more important than their own priorities for that money. Thus, dismantle the welfare state and leave people alone to do what they WANT to give their money to, into the hands of the voluntary, private sector, both private and nonprofit, where atomistic organizations, like ALS and my little rescue nonprofit, compete for the hearts and minds and dollars of donors. That environment rewards innovation and entrepreneurship…like deriving cute and fun fundraising strategies which get celebrities involved.
That is a much different moral context than the assumption that we can wind up with a collective, unitary, public interest ranking for spending on social ills that truly captures an aggregate social welfare function. That context creates analogues in charitable giving for consumer sovereignty where it is entirely possible that people enjoy doing the bucket challenge and prefer to give their dollars to ALS, and to be a part of a particular circle of giving, than to give to some other, supposedly worthier cause that offers them less fun ways of giving and less of a chance to be part of something. So what if your cost-benefit rationale shows society would be better off with that money going to cancer or mosquito netting, under these circumstances? I’m sure we could do a c-b that shows society would be better off if consumers bought more brussels sprouts and fewer onion rings, but voluntary transactions depending on individual utility curves don’t work that way. Whatever distribution results from individual choice has its own prima facie legitimacy based on noncompulsion unless we can make a case for externalities or other information problems. If ALS really isn’t worth curing and the Ice Bucket Challenge was not what people really ought to be doing, then…why did so many people do it, and why do so many people continue to do it even after potential information problems in the market were addressed? That is, as soon as the challenge went viral, claims that ALS doesn’t merit such largesse came up almost immediately and in high-profile venues. And yet there are still buckets going over heads.
Finally, and this is the big surprise: the fact that ALS is a “small” disease might actually make it much, much worthier of charitable giving based on need than big-number diseases. Big number diseases, like cancer, offer some pretty damn good incentives for private companies to stay in the hunt for research and treatments. The lab who develops the anti-diabetes pill and the anti-cancer treatment will stand to make money. That’s much less likely to be true for for a disease that ‘only’ kills off a relatively small number of people. In that instance, charitable giving may have a huge role to play in shoring up what is likely to be a consumer set undervalued by the for-profit part of private sector because of the relative size of future revenue streams compared to other markets. Isn’t charity supposed to fill exactly those kinds of market gaps?
There is absolutely nothing preventing somebody from responding to the challenge with “Cancer/Clean Water/Foster kids are closer to my heart than ALS, but here’s my bucket, and here’s my checks for these other causes, and I challenge Bob and Judy and Marcus to give to their favorite charities, too.” And again, that could be an empirical question. Maybe all those shaking their fists at the ALS challenge have taken this moment to write that check to the cause that meets their standard of importance, and giving overall to every worthy cause might go up as the challenge got people thinking about giving when they otherwise might not. I can’t think of a downside to that.
Instead, I strongly suspect that people are just complaining and opining. Because, you know, the social value of those activities? Utterly priceless.