The May 3 City File cited a report from the Citizens Against Government Waste (“AIDS Programs: An Epidemic of Waste”), which noted that while AIDS is not among the top 15 causes of death in the U.S., the federal government spends far more per death by AIDS than it spends per death by other diseases.

However, the correct measure of health-care spending efficiency is not, as “Citizens” claims, “dollars spent per death”; the correct measure is “dollars spent per death prevented.” The reason why AIDS is not now in the top 15 causes of death in the U.S. is that the government (and private sector) wisely spent money to stop the epidemic that was spreading a decade ago. For example, securing the nation’s blood supply was a particularly efficient activity because for a relatively small amount of money, tens of thousands of deaths were prevented. Of course, the success of that spending leads to a situation in which the dollars spent per death is very high, because so very few people now die from receiving tainted blood. That’s the whole point! Following “Citizens'” perverse logic, the model of health-care spending efficiency would be Africa, where very little money is spent and millions of people die, creating an efficiently (?!) low level of dollars spent per death.

Peter Bernstein

Vice president

RCF Economic and Financial Consulting, Inc.