Bill Gates: Treating symptoms rather than causes

While reading a November Forbes interview with Bill Gates about his philanthropic activities, I had a few thoughts I wish he would consider.

In the interview, Gates explains his charitable efforts in public health and elimination of disease:

The logic was crisp and Bill Gates-friendly. Health = resources ÷ people. And since resources, as Gates noted, are relatively fixed, the answer lay in population control. Thus, vaccines made no sense to him: Why save kids only to consign them to life in overcrowded countries where they risked starving to death or being killed in civil war?

Gates is wrong on two accounts here.  Population control is not the answer and resources are not “relatively fixed.”

The western world enjoys the best standards of living ever on this planet not through population control, but by an abundance of resources that were developed and allocated through innovation and trade.  We’ve discovered how to use resources more effectively to sustain larger populations with a grand standard of living.

The true equation is:  Health = Freedom, innovation and trade.  Seeking ways to improve this equation is THE answer.

More from the interview:

In society after society, he saw, when the mortality rate falls—specifically, below 10 deaths per 1,000 people—the birth rate follows, and population growth stabilizes. “It goes against common sense,” Gates says. Most parents don’t choose to have eight children because they want to have big families, it turns out, but because they know many of their children will die.

“If a mother and father know their child is going to live to adulthood, they start to naturally reduce their population size,” says Melinda.

This doesn’t go against common sense.   It is common sense.  Too bad it took that long for him to figure that out and more unfortunate that he states it as if it’s some unique finding of his.  This is well-known from anyone who have given any thought to their own ancestry.  There are reasons why two to three generations ago the birth rate in my family was much higher than it is today.  One of those reasons is that there was a greater likelihood of death, so parents had more kids to improve their chances of keeping the family going.

What’s especially frustrating here is that the Gates’ only see part of the picture.  Low mortality rate is a result (or output) of something bigger than the availability of vaccines, it’s not an input to it.

Low mortality rates are a result of a wealthy society that derives from freedom, innovation and trading.

It’s no accident that free societies grow wealthy enough where vaccines and other things that save lives, like nourishment, shelter, low crime rates, drug stores, paved roads to get to the drug stores, indoor plumbing, hand soap, sanitary conditions, disinfectants, antibiotics, bandages and clean water aren’t that difficult to come by.

In the U.S., vaccines are usually cheap and plentiful.  Even the poorest families here don’t need a billionaire to give them a vaccine.

Would Bill Gates rather have societies that are dependent on his benevolence for addressing a part of the problem, or societies that could become self-sufficient in that regard and not only would he save lives from disease, but also make available all the other advances that help make our lives better?

I don’t fault the guy for wanting to make a visible impact.  Giving a vaccine to a child that otherwise wouldn’t have had it is good.

But, I think it’s important to recognize that this doesn’t address the root cause of why a child in a third world country has such a difficult time getting medical treatment that is plentiful and basic to children in first world countries.

And, think about what happens when Bill Gates’ money runs out.  Either more philanthropy will have to take its place or the conditions will return, because the root cause has not been addressed.  He’s creating a dependency.

So, what is this root cause?  It’s concentration of political power.

At a young age, I crossed the border into Mexico at Laredo, Texas and was befuddled by the drastic difference in the standards of living on the north and south side of that river.

This was an eye-opening test-and-control.  The difference in the standard of living didn’t derive from the richness of the soil, or the availability of natural resources or differences in climate.  Folks on the north and south side of the Rio Grande have all of this in common.

The only difference between the two was how political power was distributed.  Period.

If Bill Gates wants to make a lasting impact for third world countries, he could do no better than to find ways to de-concentrate political power in those areas.

That is THE answer to improve public health.  It also happens to be the answer to improving education.

This is from the same interview:

It wasn’t dissimilar from the formula that he was developing behind a multibillion-dollar push into education reform. In that case, he based his giving on this formula: Success = teachers ÷ students. Smaller class sizes would result in more attention per student and smarter kids.

But much as Gates loves elegant solutions, his greatest achievements have resulted from perseverance and adaptability. It took three versions to get Windows right, and the Xbox originally lost billions. He’s not afraid to challenge assumptions when they don’t work. And in education he’s had a clear reversal: Class size, it turns out, is not the best determinant of student outcome. Teacher quality is. So after spending a fortune, Gates shifted course.

Here again, Gates stops short of the root cause.  Teacher quality is important.  But, it’s an output, rather than an input.

High teacher quality is an output of a system that decentralizes political power and allows the users of the system to choose the best teachers.

In third world countries, political power is concentrated in the hands of the dictators and warlords who run those countries.  Similarly, in public education, political power is concentrated in the hands of teacher unions, school boards and the so-called “education experts” whose often incorrect preferences for how things should work subjugate the preferences of the people who directly use the system — the parents.

In both health and education, he would do well to look for ways to decentralize the political power bases, instead of reinforcing them.