Hey Seth, thanks for your thoughts! I agree it's pretty uncommon as an area of excitement for EAs, and I think it's because people have the (correct) intuition that interventions are much more expensive in the US. What I wanted to point out was that the problem can be framed differently, and that the broad EA intuition might be wrong here.

I'm not sure I agree with the attention budgeting point. Givewell and OpenPhil seem to look at funding interventions on the margin (eg, what is the return for this particular intervention) and plenty of those interventions are quite small-scale, so I think these interventions are in line with others they research. Indeed, Givewell's interest in Policy advocacy in developing nations suggests an interest in developing this muscle. Holden Karnofsky has taken US Policy intervention seriously enough to deeply research the topic, and make incarceration in America (1M people) a cause area for OpenPhil. From what I've seen, he focused more on preventative health interventions more than poverty interventions in his research.

I think this topic is overlooked in the community, and I wanted to draw some attention to it. I'd like to find a way to donate to cost-effective charities for reducing poverty in America, and part of my goal in writing this post was to research and develop some ideas about what those might be.

I think a fair amount of EAs also feel compelled to donate locally, but they designate those donations as "fuzzies." I don't think this has to be the case, and it would be great if more local donations went to truly cost-effective initiatives.

Anyway thanks for your thoughts, I appreciate you pointing out the relative scale and agree that poverty outside the US is much larger! I also care deeply about global health outside of the US and currently donate there.

QALY Assumptions
I agree, I was reflecting on the arguments and also felt that the QALY assumptions I made were very uncertain. The reasoning you point it is very sound; the 3 year estimate could easily be two orders of magnitude off. That would still leave it in a range worth looking at (I think Givewell targets something like $70 per QALY), but there's a big question about how we could get more certainty on the impact.

Most studies on the subject are observational, and I think this points to the need for government programs to actually do some experimental analysis. But since these are programs passed by law, it might be ethically tricky to provide access to a benefit for one county and not for another. Looking at families who utilize a benefit vs not is also not experimentally sound.

Counterfactual impact

That's a great point. I'm actually not sure how those funds get handled. I think they are typically earmarked in the budget, so they might not be automatically diverted. On the other hand, when legislators are creating a budget, they might factor in that 15% of eligible people won't use a benefit. 

Increasing budget with taxes on the ultra-rich

Yeah, I'm really curious about how hard this would be. Theoretically, a very rich person and their friends might band together to spend against this sort of proposition, but I'm not sure they would? I think a lot of progressive taxes fail because they their income limits are too low, and so there's a significant voting block which is loud and well-organized, who will call their representative in opposition. Since there is a lot of concentrated wealth at the top, it makes sense to me to focus on going after that money. However, I have no idea how much a tax like the one proposed would actually raise.

Thanks so much for the great points!

Very true, the study definitely does not provide a causal result, and the language I used about moving people out up an income tier definitely implied a causal attitude.

I also agree that health and pollution are major factors, and would argue that people with more income have more ability to improve these factors or mitigate their impacts. Eg, more income allows better access to health care, nutrition, moving to less polluted areas or being able to pay for Asthma treatment.

Thanks for calling this out!