In 2026, the world’s first trillionaire—following the recent stock debut of SpaceX—Elon Musk has remained one of the most influential figures in American politics. After campaigning for Donald Trump in 2024 and initially playing a leading role in the Department of Government Efficiency (DOGE), Musk has remained a constant presence in the headlines.

One of his latest political clashes came with Rep. Ro Khanna (D-CA) over the impact of DOGE’s cuts to the U.S. Agency for International Development (USAID). Citing a 2025 Lancet study, Khanna argued the reductions were “potentially a death sentence for an estimated 4.5 million children around the world.”

The Lancet report is substantial. Drawing on data from 133 countries over two decades, it found that higher levels of USAID funding were associated with lower mortality, particularly from HIV/AIDS, malaria, and other infectious diseases. Given the scale of the analysis and its methodology, the findings warrant serious consideration.

The larger question, however, is whether USAID itself is the only—or even the best—institution capable of producing those outcomes. While the study identifies strong associations, it does not establish causation, nor does it distinguish between USAID’s many different programs, ranging from public health initiatives to democracy promotion.

Likewise, its projection of fourteen million additional deaths by 2030 assumes that other governments, NGOs, private charities, and international organizations would be unable to meaningfully fill the gap left by USAID.

That distinction matters. Demonstrating that foreign aid saves lives is not the same as demonstrating that a large federal bureaucracy is the only or most effective vehicle for delivering that aid.

Dr. Ron Paul has long made a similar argument about agencies such as FEMA—not out of opposition to disaster relief, but from the belief that many of those functions could be handled more effectively by states, local communities, and private organizations. The same question applies to USAID.

Beyond questions of effectiveness lies another concern: USAID’s role as an instrument of American foreign policy. While many of its programs are unquestionably humanitarian, the agency has also long operated alongside broader U.S. geopolitical objectives.

Historical precedent raises further questions about that dual role, and USAID’s involvement in Serbia provides one of the clearest case studies of the agency’s political activities abroad. The Office of Transition Initiatives launched its Serbia program in July 1997—three years before Slobodan Milošević was removed from power—and expanded its activities in the years leading up to the 2000 election.

Combined with efforts by the State Department, the National Democratic Institute (NDI), and the International Republican Institute (IRI), at least $41 million flowed into Serbia between 1999 and 2000, much of it routed through NGOs in neighboring countries. Former USAID official Krishna Kumar later described Serbia as a “case study,” with lessons learned there serving as a model for similar efforts in what he called other “laboratories,” including former Soviet states.

In Venezuela, journalist Eva Golinger argues in El Código Chávez that USAID and the National Endowment for Democracy (NED) provided more than $20 million for “democracy promotion.” Likewise, ahead of Georgia’s Rose Revolution, USAID and NED allocated roughly $20.4 million to democracy programs in 2003.

Support continued in Ukraine during the 2004 Orange Revolution. As Anatoliy Rachok of the Razumkov Ukrainian Center for Economic and Political Studies—an organization that received U.S. and Eurasia Foundation assistance—explained, “U.S. aid helped us to conduct the poll that showed Yushchenko won while the authorities intended to falsify the elections.”

In Kyrgyzstan, roughly $68 million in U.S. assistance was allocated beginning in 1994, directed toward training human rights NGOs, supporting civic education programs through the U.S.-funded IFES, and strengthening independent media in the lead-up to the Tulip Revolution.

The results of these efforts were later highlighted in USAID’s Rising Democracy pamphlet, published in September 2005. The document states that “the colorful revolutions were created by citizens from Ukraine to Lebanon, with U.S. and other support.” It goes on to discuss the Orange, Rose, Cedar, and Tulip Revolutions as examples of successful democratic transitions supported by the United States and its partners.

The pamphlet is perhaps most revealing for what it suggests about USAID’s larger mission. It describes democracy promotion not only as a humanitarian objective but also as a matter of “national security,” while explaining that U.S. assistance sought to “help sympathetic forces expand democracy.” Whether viewed as democracy assistance or political intervention, the agency’s own framing makes clear that USAID’s mission extended well beyond traditional humanitarian aid.

Initiatives such as PEPFAR (the President’s Emergency Plan for AIDS Relief), which has provided life-saving medication to approximately 6.3 million people, illustrate the impact these programs can have. Similar credit belongs to the President’s Malaria Initiative, which has protected hundreds of millions through mosquito nets, treatments, and training. These are the kinds of programs that many can readily support.

Yet these successes occur alongside—and are often intertwined with—the agency’s more overtly political activities. While health and development programs can produce clear and meaningful humanitarian benefits, their placement within USAID raises more questions about scope, purpose, and implementation.

It is with this in mind that Elon Musk’s current position becomes more understandable, regardless of where one ultimately comes down on the issue. Even if his statements may read as overstated, they do highlight a deeper truth.

For non-interventionists, the issue isn’t indifference to suffering but opposition to coercive taxation funding political activity abroad. If USAID were limited to humanitarian assistance, many would likely view the agency very differently.

But after decades of intertwining aid with other foreign policy objectives, that distinction may be difficult to recover.