But last week he contemptuously dismissed proposals for increased aid to poor nations. And his justification -- that he "would like to see evidence of what works before making new commitments" -- was pure humbug.

For the truth is that we already know what works. Nobody expects foreign aid to perform miracles, to turn Mozambique into Sweden overnight. But more modest goals, such as saving millions of people a year from such diseases as malaria and tuberculosis, are quite reachable, for quite modest sums of money.

That is the message of a commission report just released by the World Health Organization, which calls on advanced countries to provide resources for a plan to "scale up the access of the world's poor to essential health services." The program would provide very basic items that many poor nations simply cannot afford: antibiotics to treat tuberculosis, insecticide-treated nets to control malaria, and so on. The price tag would be about 0.1 percent of advanced countries' income. The payoff would be at least 8 million lives each year.

This is not starry-eyed idealism. The report quotes Jeffrey Sachs, the Harvard professor who headed the commission: "I can be 'realistic' and 'cynical' with the best of them -- giving all the reasons why things are too hard to change." Sachs knows that it will be hard to persuade advanced countries to come up with the money -- and that the United States, in particular, is likely to be highly unreceptive. But this is one of those cases in which leadership could make a tremendous difference.

Right now, the United States is the Scrooge of the Western world -- the least generous rich nation on the planet. One of the tables in that WHO report shows the share of gross national product given in foreign aid by advanced countries; the United States ranks dead last, well behind far poorer countries such as Portugal and Greece. The sums proposed by the WHO would double our foreign aid budget, not because those sums are large, but because we start from so low a base -- about a dime a day for each U.S. citizen.

Still, doubling our foreign aid budget sounds like an impossible dream. But is it? We may be a Scrooge nation, but we are not a nation of Scrooges. Not only are Americans often generous as individuals, they are -- without knowing it -- apparently willing to give substantially more foreign aid than the nation actually does. When asked how much of the federal budget should be devoted to foreign aid, Americans typically come up with a number around 10 percent -- about 20 times what we currently spend.

Voters are, however, misinformed: They think that the share of foreign aid in federal spending should be cut to 10 percent. And they wonder why foreigners don't show more gratitude for all the money we give them. Americans are, in other words, living in the past: The Marshall Plan ended more than 50 years ago, but they haven't noticed.

The point is that we like to think of ourselves as generous. This suggests that a U.S. administration that really wanted to follow the WHO report's recommendations would not find it hard to build political support. All it would have to do is use the bully pulpit to inform the public of the difference between America's generous self-image and the less attractive reality.

Why bother? You might say that the United States has a selfish interest in helping the world's poor. The Sachs commission argues that there would be large collateral benefits from improved health care in the world's poorest nations. Disease, it argues, is a major barrier to economic growth, and economic growth in developing countries would make the world as a whole a richer and safer place.

You might also say that reducing the disconnect between America's words and its deeds would give us a better claim to the moral leadership we think we deserve.

But the key argument here is surely a moral one. A sum of money that Americans would hardly notice, a dime a day for the average citizen, would quite literally save the lives of millions. Can we really say to ourselves that this gift is not worth giving?

Paul Krugman is a columnist for The New York Times.

Copyright 2001 The New York Times.

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