Last year, I wrote a diary, provocatively titled Why I don't do charity and which criticized the acclaim given to Bill Gates and Warren Buffett for their decision to spend billions of dollars on selected diseases across the world.
My point was that charity does not make good public policy, and that the tasks undertaken by charity should rather be run and paid for by the government, using taxes. Despite my title, the diary was not against charity, but against the need to rely on charity, and its potential adverse effects.
This massive article in today's LA Times supports my points in all respects.
I wrote:
Solidarity should not be subject to the whims, prejudices and availability of individuals, however well intentioned and generous. This is not to say that charity should not happen, of course, but that the basic level of solidarity that a society wishes to see for its weaker or unlucky members should be provided to all that need it, all the time, and everywhere, in an organised, consistent and fair way, and not subject to the random decisions of individuals. That help is provided in addition is great, it is always useful, but it should not be needed.
The LA Times writes:
The focus on a few diseases has shortchanged basic needs such as nutrition and transportation, undermining the effectiveness of the foundation's grants. Many AIDS patients have so little food that they vomit their free AIDS pills. For lack of bus fare, others cannot get to clinics that offer lifesaving treatment.
I wrote:
Do not believe that those that provide such charitable services will not eventually make demands on the body politic. They will get power, but will not provide accountability. After all, they are giving out money, why on earth would anyone have the right to say anything about how they choose to spend it?
Large scale charity is feudalism, pure and simple. It's a primitive form of government, based on the cult of the individual, the lack of formal rules, and the might-is-right mindset.
I'd rather have my government do it.
I'd rather pay more taxes so that decent public policies can be put in place.
The LA Times writes:
By pouring most contributions into the fight against such high-profile killers as AIDS, Gates grantees have increased the demand for specially trained, higher-paid clinicians, diverting staff from basic care. The resulting staff shortages have abandoned many children of AIDS survivors to more common killers: birth sepsis, diarrhea and asphyxia.
(...)
Gates-funded vaccination programs have instructed caregivers to ignore -- even discourage patients from discussing -- ailments that the vaccinations cannot prevent. This is especially harmful in outposts where a visit to a clinic for a shot is the only contact some villagers have with healthcare providers for years.
I wrote:
Such massive amounts on any given topic will inevitably lead to reductions in public funding of the same, and transfer decision making on major public policy issues to people whom we may admire but who represent no one but themselves. Worse, once public money is gone, it is unlikely to come back, and policy will end up being decided by entities with no requirement to continue to provide their services, no accountability beyond what they are willing to give, and no coherence with other public policy objectives.
(...)
Letting the private sector in charge of major planks of our social policy or of our healthcare policy brings about the risk that it will provide a selective service, i.e. will choose who is "worthy" of help, and what conditions they must fulfill to benefit from such help.
And the LAT notes:
Using the most authoritative available data, maternal and child mortality and life expectancy show no statistical relationship -- for better or worse -- to Global Fund grants or to overall Gates Foundation spending in Africa.
Key health measures in countries that received less money per capita have been just as likely to improve or decline as in countries that received more money, according to data from the World Health Organization, World Bank and UNICEF.
(...)
As successful as vaccination drives have been in curbing targeted diseases, 2006 data, the most recent available, show a paradoxical relationship between GAVI funding in Africa and child mortality. Overall, child mortality improved more often in nations that received smaller than average GAVI grants per capita. In seven nations that received greater than average funding, child mortality rates worsened.
Go read the whole article.
Charity appears indispensable only when public authorities have been starved of funds. While giving to charity is easily justifiable in such circumstances, the long term political response has to be to argue for more public action, and more money for the corresponding policies - and more taxes to pay for it and create the solidarity we all need.