Scott argues that debates about prioritizing Americans over foreigners in the PEPFAR controversy miss the point, as cancelled foreign aid money wouldn't automatically fund effective domestic programs but would instead be spent much less efficiently. Longer summary

Scott Alexander critiques recent discussions about PEPFAR, a successful AIDS program in Africa that was briefly paused. He argues that debates about whether we should prioritize Americans over foreigners miss the key point: money saved from canceling highly effective programs like PEPFAR wouldn't automatically go to equally effective domestic programs. Instead, it would likely fund much less effective initiatives or get lost in general federal spending. The post explains how government spending tends to be inefficient, and argues that even if you value American lives more than foreign ones, the effectiveness gap between PEPFAR and likely alternative uses of the money is so large (around 100x) that you would need to value foreign lives at literally zero to justify canceling it. Shorter summary