Well the key is that there is no one person making this call. Some middle manager instructs a bunch of peons to look for places to cut costs. One of them finds

Well the key is that there is no one person making this call. Some middle manager instructs a bunch of peons to look for places to cut costs. One of them finds that doing X costs Y when doing it another way could cost Z. This all gets packaged to a higher up who just sees it costs Y to do X, and writes a report noting that X is a result of W. This goes up the chain to someone who needs to evaluate whether to cut U,V or W and they recommend W because it ultimately costs Y. This goes up another level to someone who approves a budget that cuts W to save Y and packages this into some nice talking points. The CEO then presents these talking points to the board and is congratulated for saving Y and then move on to questioning why X isn't being done any more. Every individual is making somewhat reasonable decisions from their myopic perspective but in aggregate they are incompetent. No one is deciding to let millions die, they simply don't take the time to understand what effects their actions have.