The PEPFAR+Economic Case For Harris

How Trump might cause hundreds of thousands of deaths and be worse for the economy

Edit 8/30: the original version of this article said a 20% PEPFAR cut would cost 300,000 lives—this was based on a misreading. I apologize!

I recently wrote a rebuttal to

Richard Hanania

’s case for Trump, arguing that Harris was clearly the better choice. But didn’t go into enough detail about why he was wrong about the economy and I left out one important factor: PEPFAR (fortunately, I did bring up PEPFAR in my debate with Hanania). PEPFAR is among the most important issues for a president to get right, yet is almost entirely ignored by the press—in part because Americans don’t really care about people in other countries. And one of the candidates is clearly better on the subject.

PEPFAR is an international program designed to fight HIV. It’s saved, in total, about 25 million lives since it began under George W Bush, meaning that the number of lives saved by that program outstrips the lives lost in the Iraq war by a factor of ~50. PEPFAR programs run the gamut from preventative programs that spread important information about HIV to ones that provide drugs to treat HIV.

PEPFAR has, since its inception, saved just over a million lives a year—it’s been the most helpful international development program carried out by the U.S.. 20 million people who are alive currently—that’s about one in 400 people worldwide—are dependent on medicine from the program. And these numbers underestimate its positive effect, as Saloni Dattani of Vox notes:

As great as PEPFAR’s impact has been, it is likely underestimated, because it has also helped build health infrastructure and train health care workers across countries as it has grown, supporting treatment for malaria and tuberculosis, which kill 600,000 and 1.3 million people respectively each year.

This is one of the most important government programs to get right. Having never passed PEPFAR would be like causing 50 Iraq wars in terms of lives lost—and that’s a highly conservative estimate. There’s thus an extremely strong reason to vote for the candidate that’s better on PEPFAR.

That candidate is clearly Harris. The Trump budget proposed cutting PEPFAR almost by half. The Republicans have become a party supportive of cutting the PEPFAR program, as indicated by their concerted effort to do so during the Biden administration.

You might not like a lot of what Harris will do, but it’s hard to imagine most of it killing hundreds of thousands of people. That’s a major point in favor of Harris.

Hanania’s case for Trump was almost entirely based on Trump’s supposed superiority on the economy. I’m extremely suspicious that this is a good reason to vote for Trump and think that even if I were voting on the economy, I’d vote for Harris. Let me give six reasons.

First, just as a factual matter, the economy grows much faster under Democrats. The last five times a Republican administration has been replaced by a Democratic administration, growth has gone up, while the five ten times a Democratic administration has been replaced by a Republican administration, growth has gone down. I’m skeptical of our ability to figure out, from the arm chair, which political party is better for the economy, so it’s worth looking at the data.

Second, Trump is much worse on immigration. Hanania admits this; Trump supports severely curtailing immigration, both legal and illegal. About half of innovation—the primary engine of growth—comes from immigrants or their children, so the candidate who is worse on immigration will almost definitely be worse on growth. This has particularly deleterious effects in the long run.

Third, Trump supports a sweeping 10% tariff. He started a trade war with China that majorly hurt the GDP, and is likely to impose more tariffs. Harris may not be perfect on the economy, but she’s not supporting that.

Fourth, Hanania is much more confident that the sorts of regulations that Democrats impose are bad than I am. Take, for instance, environmental regulations. Pollution kills between 100,000 and 200,000 people a year in the United States, around a thirtieth of total deaths. Pollution makes people’s health worse, making them less likely to contribute to the economy. I don’t find it at all obvious whether, say, environmental regulations are worse under Democrats.

Many of the economic policies that Democrats support redistribute wealth from the rich to the poor. But this seems like a good idea, and explains some of the reason why the incomes of the bottom 20% grow nearly twice as fast under Democrats as Republicans! People don’t work that much less in response to higher taxes, and giving money to poor people makes them better off—increasing the wealth of poor people produces much greater benefit to them than costs to rich people:

Fifth, Trump supports all sorts of other policies that are bad for the economy.

Jeff Maurer

(author of an absolutely hilarious newsletter) gives two examples:

It is absolutely insane that Republicans threaten to destroy America’s credit rating every couple of months. Opposition to raising the debt ceiling is a quintessentially MAGA issue because it: 1) Slouches out of the Fox News/AM Radio fever swamp like some deformed beast, and 2) Is supported most passionately by people who completely misunderstand the issue. Allow me to be the billionth commentator to say: The debt ceiling does not allow the government to accrue more debt, it allows the government to pay debt it has already accrued. But saying that at this point is like reciting Tennyson to your dog — it’s simply not going to penetrate. Republicans strap on a suicide vest a few times a year and threaten to blow the economy to hell, Trump thinks that’s super cool, and the fact Republicans deem that behavior acceptable is a sign that they can’t be trusted to govern.

Trump’s desire to reduce the independence of the Federal Reserve is a threat to break something that’s been working stupendously well. The Fed’s overall track record is excellent, and that record recently includes sticking the “soft landing” from inflation that some people thought was impossible. The notion that we should let a singular idiot like Trump have a larger role in their decision-making process is like suggesting that my three year-old nephew should start calling plays for the Kansas City Chiefs. To the extent that anti-Fed lunacy gets succor, it’s from the right side of the aisle, which is more evidence that economic crankery is not evenly distributed among the two parties.

Hanania’s case for Republicans being better for the economy is mostly about the sorts of people they’ll appoint to various obscure federal regulatory agencies. But I don’t have any idea which party is better at that. Republicans will support more conservative administrators, but it’s hard to know how the average conservative administrator compares to the average liberal administator. I care much more about competence in agency appointees than ideology, for this reason, and Trump is far less competent.

Sixth, economists tend not to like Trump’s economic policy. A poll of them finds they mostly think he’d be worse on inflation than Biden would (this poll was before Biden dropped out). Recently, 16 Nobel Prize winners predicted Biden being better for the economy. Most economists are Democrats, and I tend to think they’re quite trustworthy on economic issues.

For these reasons, I think Trump is quite a bit worse on the economy than Biden. While my vote won’t primarily be determined by the relative economic impact of the various candidates, if it were to be, I’d still vote for for Harris:

To sum up then (putting it in bold to show I mean business—I don’t mess around when it comes to 10% tariffs!):

Democracy is on the ballot.

Decency is on the ballot.

An in expectation maybe 20% PEPFAR cut is on the ballot!!!!^100000

Independence of the Federal Reserve is on the ballot.

A 10% tariff is on the ballot.

I’m more concerned about the PEPFAR cut and the tariff than Democracy and decency, but all seem like good things!