• what orphan diseases really need is fundamental research, and that is (i)usually a good investment overall, even if it is impossible to tell beforehand precisely what research will yield new breakthroughs, and thus (ii) definitely within the purview of the government, precisely for that reason that it needs to be spread over enough topics to have a chance to find the major new thing that will yield results/progress in many other sector;

• there is a qualitative difference between investing EUR 1 billion to save a  average 50 statistical, unidentified lives (the "return" of building bridges instead of railway crossings), and investing EUR 20 million to save the life of one identified person (or doing that 50 times). One is in the realm of macro policies, and needs to be compared to other macro policies (say, investing EUR 1 billion in carbon scrubbers will save, statistically, 1,000 lives from respiratory diseases, for a net gain of 950 lives). The other is in the realm of solidarity, and public support for rare life accidents that one cannot bear on one's own;

• limiting waste/inefficiency in macro policies will precisely free more resources for other smart macro policies AND for solidarity spending on individual, identified cases.

Then again, for-profit medical research concentrates in treatment, not prevention. Malaria vaccine research is unlikely to get a lot of impetus from Big Pharma. Massive vaccination campaigns and worldwide eradication are a socialist policy. Today's world would never set out to eradicate Small Pox.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman

Two kind-of-counterpoints on this, one of more general significance, the other only for your example.

I wonder if this will make me appear even more cynical in the eyes of your wife, but there are deaths, and there is economic damage - and one accident in a railway crossing can cost more (in property damage, losses due to cancelled traffic, emergency services) than a hundred car accidents, and more than the costs to secure railway crossings. So here is the apparently cynical economics argument: it can make sense to attack a safety problem causing even very few deaths, if doing so saves money (which money, to show that this argument only appears cynical, could be spent on attacking other, less money-expensive but more deadly safety problems).

The other is that railway crossing accidents are road accidents (with the fault being that of a car driver in 95% of cases), though much of those tremendous amounts of outrage seem oblivious to that.

But, my wife asks, who will take care of rare diseases / orphan diseases?

Or indeed, who will take care of the persons behind the statistical numbers we discuss? Your wife's reaction reminds me of something De told me, but that'll wait until her next diary.

_{*Lunatic*, n.
One whose delusions are out of fashion.}

However, that's not how people think. Single events where lots of people die are much more interesting than multiple events. Furthermore, events where the victims were not in control of the situation are also interesting.

This is what causes people to get upset when a hundred people die in a single airplane accident, or a single building bombing, or a single chemical plant explosion. It doesn't matter that coal kills more people than nuclear energy, what matters is that the coal deaths happen one at a time spread out across the world, and the miners could have not gone into that line of work.