I suggest the common issue (between health care and foreign aid) is that of agents, who benefit from the current status quo, and provide arguments and generate memes to sustain the status quo. I don’t mean to say that the agents are generally doing this wilfully, almost no Doctor believes that “most health care is useless but I will continue the scam to maintain my income/status”, just like no aid worker believes what they are doing is useless. But human nature is very good at hiding motives and clothing them in altruistic seeming morality, even to yourself, sort of the reverse of the Smithian invisible hand/selfish baker.
Another way to look at this is incentives: which option has the better pay off (at the margin) for a doctor or aid worker; either convincing people that a given proposed treatment is effective (generating more income for the agent) or the alternative of creating more effective/efficient treatments (generating less income for the agent)?
Nick
My response is, evolution! Let’s say a genuinely (what ever that means) altruistic entity exists. He then is uploaded. He then observed that not all entities are fully altruistic, in other words they will want to take resources from others. In any contest over resources this puts the altruistic entity at a disadvantage (he is spending resources helping others that he could use to defend himself). With potentially mega intelligent entities any weakness is serious. He realises that very quickly he will be eliminated if he doesn’t fix this weakness. He either fixes the weakness (becomes selfish) or he accepts his elimination. Note that uploaded entities are likely to be very paranoid, after all when one is eliminated, a potentially immortal life is eliminated, so they should have very low discount rates. You might be a threat to me in a million years, so if I get the chance I should eliminate you now.
If your answer is that the altruistic entities will be able to use cooperation to defend themselves against the selfish ones, you must realise there is nothing to stop a genuinely selfish entity from pretending to be altruistic. And the altruistic entities will know this.
I don’t think that most people realise that the reason we can work as a society is that we have hardwired cooperation genes in us, and we know that. We are not altruistic through choice. Allow us to make the decision on whether to be altruistic and the game theory becomes very different.