Slate Money: Money Talks – "Altruism After USAID"

Date: December 23, 2025
Host: Felix Salmon
Guest: Mary Childs (host, NPR’s Planet Money and author)
Episode Theme:
A deep dive into the ripple effects of the abrupt end of USAID global aid funding, the scramble of NGOs like Alima to backfill that lost support, and the philosophy and practical reality of “effective altruism” through the lens of organizations like GiveWell.

Main Theme & Purpose

The episode explores what happens when a colossal source of foreign aid—USAID’s $40 billion budget—is suddenly destroyed, leaving global NGOs in crisis. Felix Salmon and Mary Childs follow the story of Alima, a medical NGO in Cameroon, and analyze how the world of “nerdy philanthropy”—especially organizations driven by effective altruism—tries, and often struggles, to fill a gap so vast private donors alone can’t cover it. The conversation examines practical dilemmas, moral philosophy, and the fraught relationship between data-driven funders and frontline aid workers.

Key Discussion Points & Insights

1. The USAID "Chainsaw" Moment and Its Fallout

• [02:30] Felix introduces the episode’s key event: Elon Musk’s hypothetical destruction of USAID, which erased $40 billion/year in aid and "has caused, by various calculations, hundreds of thousands of deaths already. It's a humanitarian disaster."
• [03:10] Many NGOs, like Alima—working in conflict zones to provide essential healthcare—lost their basic operating support.
• The cut affects not just direct aid (like malaria medicines) but the infrastructure allowing them to work: "If that chain goes away, then buying the drugs doesn’t help." (Felix, [03:50])
• Even "unconditional cash transfers" (simply giving money to those in need) become less effective if the basic system and supply chain collapse.

2. Inside the NGO Crisis: Alima and the Systemic Breakdown

• [04:35] Mary details how Alima was left in chaos: “Aleema, which is one of these charities that was receiving money from USAID, was like, shit, what the fuck do we do?”
• Many USAID staffers, left “inspired and bored and mad,” built a list of suddenly un- or underfunded projects—Project Resource Optimization—which was sent around the philanthropy world in hopes that donors like GiveWell could quickly plug the gaps. ([05:17])
• The largest donors try to coordinate, but confusion reigned—no one was sure which grants survived.

3. GiveWell’s Approach: Calculation Meets Crisis

• GiveWell tries to direct money to the most cost-effective interventions by comparing them against cash transfers: "So many spreadsheets." (Felix, [09:22])
• Data is vital, but in places like Cameroon, it’s almost impossible to collect: “We can't systematically count the population that we treat….They don't come back for fun follow-ups.” (Mary, [09:41])
• GiveWell’s dilemma: Its “promise” to donors is data-driven rigor, but humanitarian work in conflict zones resists neat measurement. “If they stray from that, what are they doing? They cannot stray.” (Mary, [10:54])
• Notable quote:
  • “I made people cry in multiple interviews because I asked basically that question, like, how do you choose who to save? Someone’s gonna die.” – Mary Childs ([07:10])

4. Moral Calculus & The Pain of Trade-offs

• The trade-off: Funding Alima may mean a different effective project loses out. Mary highlights how painful these choices are.
  • “The one that they didn't end up funding was maternal mortality stuff. And I was just like, well, what about the moms who die?...She’s crying and I was like, oh, my. This is a choice she has to make every day.” — Mary Childs ([14:38])
• Felix and Mary discuss how “effective altruism” (Peter Singer’s “drowning child” thought experiment) aims to force confrontation with these hard realities:
  • “At every moment there’s a child drowning in a lake and you can save them. It takes $4. Not really. But it’s incredibly inexpensive to save lives around the world.” — Mary ([16:01])
  • Felix clarifies that, even in these interventions, "it does actually cost like $5,000" to save a life—but that's still astoundingly efficient compared to Western medical care. ([16:37])

5. The Clash of Cultures: Data Demands vs. Frontline Reality

• GiveWell’s request for data is both a necessity and a burden. Alima’s staff, working in dire conditions, must “scrape up a bunch of fucking data. And they're like, look, we're in fucking Cameroon. People are gonna die. Can we have some money here? And they're like, well, actually, can you send me a spreadsheet?” — Felix ([18:56])
• Notable moment:
  • Alima’s Madeleine asks for a “probability” of funding—a nod to GiveWell’s quantitative language.
    • The answer: “55%.” Mary notes the emotional toll but also describes Madeleine’s pragmatic, professional acceptance. ([19:49]–[21:42])
  • “The brutality is like a kindness in this context.” – Mary, on GiveWell’s honesty ([21:04])

6. The Global Picture: Private Philanthropy Can’t Fill the USAID Gap

• The USAID catastrophe also triggered pullbacks from other donors (Norway, France, UK), compounding the crisis in already unstable places. “When the USAID cuts back, what do they do? They also cut back everyone else.” — Felix ([30:25])
• GiveWell’s "silver lining": With less systemic funding, each additional philanthropic dollar may have higher impact now—“human life is on fire sale right now.” ([30:58])
  • “If the going rate a year ago is $5,000, maybe it’s like $4,000. It’s like cheaper to save lives.” — Felix ([31:01])
  • But Mary notes, “as things degrade more and more, there’s more instability...it makes it harder and harder.” ([31:08])
• The tension between hope (“there’s always an intervention that you can do”) and worry (“the opportunity cost keeps rising, systems keep failing") is palpable.

7. Personal Reflections, Urgency, and Philanthropic Strategy

• “Everyone should just be spending all of their money right now, all of their like philanthropic capital right now, throwing it into sub Saharan Africa...because now it’s on sale. Now there’s an urgency.” – Felix ([33:17])
• Mary describes moments of existential angst over the story’s gravity: “What am I doing with my life? Do I need to go quit and work for an NGO?” ([34:04])
• Even among high-profile philanthropists (Mackenzie Scott), the majority of American charitable giving stays within the US, despite more acute needs abroad. ([15:03])
• Notable closing exchange:
  • Felix: “If you take one lesson from this podcast, go out and save some lives, anyone who can afford it should do it.” ([36:21])

Notable Quotes & Memorable Moments

• On Effective Altruism’s Challenges and Humanity:
  • “I made people cry in multiple interviews because I asked basically that question, like, how do you choose who to save?...I did not know it would be so close to the surface.” – Mary Childs ([07:10]–[14:38])
  • “It’s a way to discipline compassion…can feel very uncomfortable and sociopathic. But…this can provide a way to not get stuck and not get paralyzed by that.” – Mary ([18:01])
• On Philanthropy’s Limits and Potential:
  • “Private philanthropy cannot cover all of that…GiveWell stepped in with…$39 million…but the hole that USAID left is tens of billions of dollars.” – Mary ([28:49])
  • “Now everything is on sale. Everyone should just be spending all of their…philanthropic capital right now…because now it’s on sale. Now there’s an urgency.” – Felix ([33:17])
• Personal Impact:
  • “The best time to plant a tree is 20 years ago, but the second best time is today…and this is why I hate it when foundations only give away 5% of their capital every year…” – Felix ([32:54])

Important Timestamps

| Timestamp | Topic | |-------------|---------------------------------------------------------------| | 02:30–03:10 | USAID is defunded; catastrophic effect on global aid | | 03:35–05:17 | Alima in crisis; Project Resource Optimization circulates | | 07:10–07:27 | Mary on the emotional burden of choosing who gets saved | | 09:22–10:54 | GiveWell’s data-driven approach hits real-world obstacles | | 14:38–15:03 | Trauma of tradeoffs—“what about the moms who die?” | | 16:01–17:44 | Peter Singer, EA, and the “drowning child” thought experiment | | 19:49–21:42 | The “brutality” of honesty in the grant process for NGOs | | 28:04–31:01 | Effective altruism after system collapse: fire sale effect | | 33:17–34:04 | Philanthropy urgency and the case for giving now | | 36:21–37:02 | Key takeaway—“go out and save some lives” |

Tone & Language

The hosts mix serious moral philosophy, dark humor, and candid emotion. Mary Childs offers both a reporter’s detachment and genuine empathy for the “horrifying calculations” NGOs and meta-donors must make—feeling genuine pain for forced choices, while also laughing through the logistical absurdities and sylized nerdiness (“so many spreadsheets”) of organizations like GiveWell. Felix’s tone is dry, sometimes biting, but earnest in his appeal for more urgent, globally minded philanthropy.

Summary Takeaways

• The end of USAID funding has created a humanitarian catastrophe, and NGOs like Alima are scrambling to survive.
• Effective altruist organizations like GiveWell struggle to uphold their commitment to quantifiable impact—especially where the most desperate needs, in the world’s least stable places, resist neat measurement.
• Philanthropic dollars may in fact have higher impact right now, but the scale of need dwarfs what private giving can offer.
• Real human sorrow and moral agony lie behind every cold “opportunity cost” calculation: someone, somewhere, is not being saved.
• Despite the magnitude of suffering, listeners are urged to give what they can, because every major institutional help has a multiplier effect—but scaling up is vital.

Final Quote

“If you take one lesson from this podcast, go out and save some lives, anyone who can afford it should do it.” — Felix Salmon ([36:21])

For those unable to listen, this episode is an unflinching look at how the machinery of aid and philanthropy works—and breaks—in a world of rising chaos, urgency, and hard decisions. It centers the people caught in the system, from donors to doctors to the mothers and children whose lives are, quite literally, on the line.