
Bill and Melinda Gates Are Spending Their Money the Wrong Way, Critics Say - petethomas
http://bloomberg.com/news/2014-12-22/gates-left-ebola-door-open-with-aids-focus-critics-say.html
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vince_refiti
“But they should move away from disease-specific funding into health-system
strengthening.”

Disease-specific funding goes to research organisations. Health-strengthening
funding goes to politicians. Given the history and current state of corruption
in many of these client countries, giving them money to strengthen the health
system is a very bad idea.

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sebleon
"corruption in many of these client countries"

You say that as if governments in donor countries like the US were responsible
with public funds.

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raverbashing
Very funny

There's a tendency of people think their problems are as bad as everybody
else's

They are _a lot more responsible_ it's not even funny (also because of more
stringent controls)

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readme
"many officials say spending billions of dollars to fight ailments such as
AIDS, malaria, and polio rather than supporting basic health services has left
nations unprepared for epidemics like Ebola."

So, these people are actually criticizing Gates for not strengthening the
overall system? He is not God, you can't just say "Hey, great that you
improved W,X, and Y, but we think you should've improved Z instead, then we'd
be free of all our problems!"

So sure, the critics are right: Gates should instead be an omnipotent god with
knowledge of the future and the ability to improve basic healthcare services
with the stroke of a pen. Maybe he thought putting his money in places with
clearly defined goals was a better idea.

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dogma1138
What they are saying is that instead of spending that money on say buying
malaria meds which are then distributed by western volunteers spending that
money on say grants for med and nursing schools for the local population might
be a better cause for the long run even tho i might not directly save anyone
for a decade or two. I actually agree with the general premise of this
criticism and have had similar thoughts about how the west had been dealing
with the situation in Africa for quite some time. It seems that pretty much
all the west does it to make Africa more and more dependent on external "help"
than developing local resources. You can see this across the board from
cutting direct investment to undesirable governments to blocking the formation
of pan-African military alliances that could provide assistance for conflicts
without needed to call in 15,000 Chinese peace keepers. On other projects
especially in agriculture it seems that the West(and China too in this case)
are insisting on tying African countries to life time mortgages in forms of
super advanced engineered crops which African countries can't self sustain
without global corporations instead of local traditional farming and
homesteading which has been proven to improve communities much faster than
Monsanto donating some seeds in a hope of building another captive market.

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jeffdavis
"money on say grants for med and nursing schools for the local population
might be a better cause for the long run even tho i might not directly save
anyone for a decade or two"

Building out general healthcare infrastructure could have a lot of problems.
For example, the government might reduce its own funding of the infrastructure
by an equal amount, effectively making the foundation a giant taxpayer.

I am pleased with the progress the Gates foundation is making. If they
actually eradicate polio, that will be a real step forward for all of
humanity. Also, it seems like there's a lot of merit in focusing resources
when dealing with contagious diseases.

~~~
dogma1138
Give a man a fish... As it currently stands it's much less about funding and
more about the fact that they have no infrastructure, no doctors, no nurses,
nothing. Doctors are actually in very high demand in Africa the funny thing is
that you would probably get paid much more there than in the west atm (in the
countries that at least some what hold it together). A class mate(from high
school) of mine actually went to work in Nairobi he's getting paid about 300K
US a year working a vascular surgeon(i think). On the polio thing.. sure
eradicating polio might sound like a great cause (and a spiffy headline), but
global polio cases in the 21st century are below 500 per year, and considering
that polio causes muscle damage in less than 1% of infections, and the
mortality rates of that percentage are about 10% i would dare to say that now
there might be better things to spend money on. Especially considering that
good sanitary conditions (clean water, sewage systems, and heck toilers)
prevent the spread of polio almost as well as vaccination.

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sanxiyn
I disagree with you on polio eradication. Eradication is a risky bet, but it
is also one time investment that yields benefits year after year. It is risky
because most of benefits are realized only if you reach zero: below 500 per
year is very different from zero. In other words, it is a risky bet in part
because people think like you.

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Wissmania
These critics overestimate the impact of Ebola. Even with this current weak
system, the recent Ebola outbreak has had a death toll of 7,645 as of Dec 23.
A million people die every year from Malaria, and some (optimistic) estimates
say that the Gates' efforts could save 5 million lives.

This seems like a classic example of our tendency to overestimate the
importance of singular, cataclysmic impacts, as opposed to predictable,
systemic ones.

~~~
sebleon
The whole point of the article is that Gates' efforts focus on singular
diseases, as opposed to investing in healthcare infrastructure that can
support predictable, systemic outbreaks of new diseases.

Then again, it's much easier for Gates to elevate his status as a
philanthropist by investing in projects that can come up with sexy headlines
like "we saved X million people from AIDS!"

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kartman
Based on how he talks and goes about doing his philanthrophy, it doesnt seem
like Gates is doing it or for that matter, need it, to elevate his status. It
is best to assume positive intent in such things.

~~~
sebleon
You're right, definitely best to give the benefit of the doubt.

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jfoster
I don't think this is a helpful article.

Given this amount of money, it is pretty much impossible to spend it and be
able to answer the question "is this the absolute best way to spend the
money?" with an honest & confident "yes."

It's good to try and think of more efficient or better uses of the money, but
solving the problems around some of the world's most persistent ailments is
quite a good use, in my opinion.

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Mythrl
This is an inflammatory headline that does justice neither to the NGOs nor to
the people commenting about the NGOs.

A better headline would be "Health experts believe Bill and Melinda Gates
could save more lives by modifying resource allocation" or something like
that.

I'm not a writer so it could probably be stated better but you get the idea.
The guy isn't saying what they are doing is bad, which the headline implies,
but rather that resource spending could be further optimized.

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IvyMike
> The guy isn't saying what they are doing is bad

But he kinda is...

> Such groups “are doing more damage than good; I want the world to hear it,”

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Mythrl
Ah I missed that line while I was reading. But in that vase he is just being
inflammatory as well. A more measured statement would be more accurate.

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morgante
It's a sad day when choosing to donate billions of dollars to charity makes
you a target for critics.

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Ar-Curunir
Spending money on charity is good, and people should be free to spend it as
they please, but if the aim is to help as many people as possible, perhaps
consulting experts so that the money can be spent fro maximal effectiveness
would be better.

~~~
rixon
The Gates certainly have done their homework, and I believe that this is an
understood issue, but they only have so many resources, and want to work on a
particular set of goals.

I used to really dislike Bill Gates, Microsoft, and all that he stood for. I
heard of his charity, thought "hey that's nice" but that was about it. Then, I
saw him on Charlie Rose, and everything changed. He answers a lot of questions
about the health care issue of impoverished nations, and shows a great deal of
understanding of the problems they're dealing with, and what will happen when
they do what they can.
[http://charlierose.com/watch/60331104](http://charlierose.com/watch/60331104)

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sanxiyn
"Many officials say spending billions of dollars to fight ailments such as
AIDS, malaria, and polio rather than supporting basic health services has left
nations unprepared for epidemics like Ebola."

This is nonsense. Does anyone disagree AIDS, malaria, polio are higher
priority than Ebola?

"You get treatment if you're a woman with malaria or if you're a woman with
HIV, but if you've got cervical cancer or cardiovascular disease, you're not
covered, Evans said."

Cancers and cardiovascular diseases are not infectious. Does anyone disagree
infectious diseases are higher priority?

"You'd get more for your money if you supported a broad range of health system
strengthening activities, Daulaire said by phone from Oslo, where he's a
visiting scholar at the Norwegian Institute for Public Health. That's a much
more difficult message."

This may well be true but very unobvious. While I understand difficulty of
analysis and presentation, burden of proof of "You'd get more for your money"
lies on health system strengthening proponents. You can't argue as if it is
given.

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Mikhail_Edoshin
I remember reading Bill Gates's own writings on how he chooses where to put
those money. He has a very clear and developed strategy; it's basically
investment except that the profits come back not directly to to Gates, but to
the society as a whole. He doesn't just spend the money, he tries to find the
spots where applying money would give the greatest and most lasting effect.

For example, his donations to malaria researches nearly doubled the overall
money that went to these researches over the world and it's not that his
donations were so huge, it's just that these researches did not get much
funding (compared to the effect of malaria). Similarly, he wanted to fund a
program in education of teachers, but he specifically picked a program that
looked it could make the greatest profit/expense ratio: filming great teachers
as they work and distributing these films to other teachers.

That said, I'm sure Mr Gates will be very interested in hearing any sound
businesslike proposition in regard to where to invest his money :)

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georgeg
I am happy with the Gates foundation and the strengthening of basic scientific
research that has come about from their grants particularly in resource poor
countries. Respective governments have a role to play in improving the health
systems research and I am not sure that is the mandate of the Gates foundation
or any other charity. Furthermore, it may mean meddling with political forces
in their respective areas of support and I am not sure if that would really
ease the situation.

After all what has the Brenton Woods institutions gained or improved in
resource poor countries? Have they not poured billion of dollars in loans and
grants and even given conditions (some very painful) on how to administer the
monies? What has improved? I think Gates foundation is doing a commendable job
in supporting and raising awareness for neglected infectious diseases for
example and supporting grass root solutions to common problems. I am no expert
in these areas and I stand to be corrected.

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ck2
WTF is it the responsibility for private organizations to fund basic health
care in other countries?

That is the responsibility of nation states like the USA to help other
countries with basic health care like preventing Ebola so it doesn't arrive on
their shores.

Except since all single single digit people stopped having Ebola in the USA,
the news decides that people in other countries dying like flies didn't matter
so all pressure on Congress to do anything stopped entirely and they went home
for their many weeks of vacation.

The 2015 Congress most certainly won't fund a damn thing. It's just not as
sexy to them as dropping million dollar bombs on people.

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briandear
When is it the responsibility of the United States? Isn't it the
responsibility of the affected countries to mind their own store? After seeing
what happened to rice shipments in Somalia, something could be said for the
value of a bomb. Personally, I prefer Bono's approach -- develop markets so
countries can afford to help themselves.

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johnny99
"Politicians in wealthy countries are more interested in supporting groups
that produce measurable results such as the number of lives saved by
vaccinations than in less-quantifiable goals such as building health
infrastructure."

I don't get that at all. Building 14 clinics, adding 700 hospital beds,
training a thousand nurses... all infrastructure, all far more quantifiable
than measuring lived saved by vaccinations.

In any case I agree with those who find the whole thing a false dichotomy.

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qwerta
Czech Army had mobile hospital in Afganistan for locals. There was a huge
queue of people, some family would carry their relative for a week, just to
get to hospital. We simply have no idea what is it there like.

Money could be probably spend more efficient way (exterminate mosquitoes
rather than fight malaria). But running hospital in country without basic
infrastructure is always very expensive.

~~~
amorphid
A friend of mine worked as a volunteer nurse at a make shift hospital in a
remote part of Ethiopia. There was a group that carried a dead person for more
than a day to the hospital to see if they could save her. I have no idea what
it is like to provide health care services in an area like this.

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briandear
When the critics make their billions then perhaps they can criticize how
others spend theirs. I'm not the biggest fan of Gates, but he certainly puts
his money where his mouth is and is certainly leaving a positive mark on
humanity. The world is a better place because of Bill Gates. Windows ME aside.

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noonespecial
Well, I have some fantastic news for these critics. They are completely free
to make their own billion dollars and then spend it on whatever aid they think
would be better.

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JacobAldridge
Critics are welcome to spend their money the 'right' way, I say. I certainly
feel the world is a better place with Bill and Melinda 'in the arena'.

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tn13
These critics simply want a share of the pie which they dont own. That is why
they criticize. These peopel should be ignored.

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hkmurakami
Some good done through a suboptimal approach is better than no good done as a
result of seeking the perfect solution.

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muriithi
How is funding new and efficient ways of fighting disease not part of "health-
system strengthening"?

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curiousDog
I'd love to hear Peter Thiel's thoughts on his efforts.

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SwellJoe
I think this is an interesting data point in the story of an over-arching
shifting of philosophies. That philosophical shift has been brought on by the
historically unmatched availability of data. The old way tasked experts with
figuring out where to spend money and resources to do the most good; the best
of those experts found their way to the top spots of the UN, WHO, the world
bank, etc. These folks are the best in the world at what they do. The problem,
for them, is that Bill Gates isn't interested in doing it the way it's always
been done. He doesn't want a bunch of experts in a room deciding how resources
are used.

He's talked about this a lot over the years, and the people who handle the
nitty gritty details of his organization have talked about it some too. Data
comes first for the foundation. Certainly, that data is filtered through a
particular, somewhat pro-capitalist, and competitive, lens. But, the data is
driving the decisions...it has much less room for experts in the decision-
making process.

I honestly don't know enough about the person making these assertions, or the
problems of improving world health; they may very well be right. But, I
remember reading about the early days of the foundation, and thinking,
"Hmm...this might actually do some amazing stuff." And, I think they really
have. Solving malaria with a cheap, safe, vaccine, would be a miracle on the
order of achieving world peace (more people have died from malaria, mostly
young children, than in all the wars ever fought).

Further, I question anyone who asserts that responding to Ebola would be a
more valuable use of resources than saving the lives of as many as 1 million
children per year who would have died of malaria. As someone else mentioned,
it sounds like someone thinking like a human, and making the mistake of
valuing catastrophic events higher in terms of their importance over the data-
driven approach of attacking the biggest problems. It's like the difference
between the old school hacker who micro-optimizes a program by inlining
functions or converting the whole thing from an interpreted to compiled
language, vs. someone who profiles the code and finds the bottlenecks and
knocks those out by using more efficient algorithms with less time/effort and
better results than the micro-optimization strategy.

This may be that, despite my general dislike of Bill Gates, I simply think
more like Gates. I guess a lot of us here do, and that may be why the general
consensus in this thread is to dismiss the article and side with Gates. That
may be an indicator that we should all do a bit more research and thinking on
the subject. I may make myself a homework project of coming up with an equally
compelling argument for why this article is right, and Bill Gates is still an
asshole after all these years.

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dr_bloodmoney
Everyone's a critic

