Eliminating major diseases like AIDS, malaria, and tuberculosis in poor countries has been a top grant-making priority of the Bill & Melinda Gates Foundation. It has poured billions of dollars into promoting global health and made a tremendous difference.
But why hasn't the foundation given similar priority to improving the delivery of health services to low-income people in the United States?
The world's biggest philanthropy could take inspiration from the Health Wagon, a heroic effort in Appalachia financed by a few donors and volunteers. The group's work got attention this spring from "60 Minutes," which followed the organization's bus, operated by two nurses, as they toured the hollows and blighted areas of the region dispensing medicine and treatment to people who could not afford health care or health insurance. Only a heroic effort by a few donors and volunteers has kept the bus running.
In the rest of Appalachia and in many other rural areas of the country, similar health conditions deny poor citizens the opportunity to receive essential health services and medicines. The cost of providing health buses, financing local clinics, and paying for physicians to work in deprived areas would be minimal by the Gates foundation's standards.
Other low-cost opportunities abound. The Gateses could start a national program to subsidize the training of doctors and nurses for service for three or so years in parts of the country that lack sufficient medical services. Their money could resuscitate a federal program that once successfully channeled doctors and nurses to places where needy people had little access to health care, one that was eliminated in government budget-cutting fervor.
Or couldn't they do something about the fact that in 25 states, a total of over 5 million people won't be able to get Medicaid because legislatures and governors refused to take advantage of opportunities under the Affordable Health Care Act?
The foundation has spent more than $230-million to influence states to adopt the Common Core standards for public education. By giving loads of money to state departments of education, state politicians, think tanks, academic institutions, and media outlets, the Gateses have thus far persuaded the education establishment and the public to accept the standards, although a recent backlash against the program has forced the foundation to temper its efforts.
A similar campaign could be waged, at a much lower cost, to persuade recalcitrant states to extend their Medicaid coverage. Now that would be an extraordinary benefit to America's shaky health system.
Given the priorities of the foundation, it seems fair to ask why it doesn't focus on health in the United States. Are its more than 1,200 staff members too busy to pay attention to health problems at home? Does the foundation think the large global issues are so important, it is acceptable to ignore the plight of poor people suffering from a dysfunctional health system in America? What will it take for the foundation--as well as other grant makers--to take practical measures to give Americans better health? Millions of lives are at stake.