On the day he released his $34 billion foundation's annual report, Gates talks about his planetwide battle against disease—and assesses America's economic prospects
Your sights are now set on fighting polio. Why?
Well, the Foundation does work on lots of health issues. The one that's our top priority, though, is polio because we have a chance now—if we stay the course—to drop the number of cases to zero, to eradicate the disease. And if we don't really execute well in these next several years, it'll spread. … And then we'll be back to having 100,000 or more cases of kids dying or being paralyzed.
How do you define eradication?
It means zero, none, gone. And that's only happened with one human disease—smallpox.
Conquering a disease like that sends a signal, doesn't it?
If you improve health, you do three things for children. You save the lives, and that's big. The second is there's lots of the kids who survive who are damaged; their brains never develop. And finally, the one that's the most amazing is that if you improve health, parents choose to have fewer kids. So instead of better health growing the population, it's actually the only thing we've ever come up with that actually shrinks population growth. That's the only way you get your hands around all the big issues. Can you educate them all? Can you provide them all jobs? So from a human and an environmental perspective, this health stuff is the most leveraged thing there is. Polio would energize that. It would show we can get something hard done.
Let's shift to malaria. Has your opinion changed on that front?
The year I was born, 1955, the World Health Assembly resolved to eradicate malaria. That's partly why people were reluctant to take on smallpox. Malaria made them look bad. With malaria, you have to think in terms of a 15-, 20-year time frame. The Bill & Melinda Gates Foundation is spending hundreds of millions a year on the tools. The tools include a vaccine, and we have one that's in a late-stage trial now. You have to have really cheap diagnostics so you can find out who's carrying the parasite. There's really good progress, [but] you've got to get polio done first.
Education is another target of yours. What are the big hurdles there?
I'm very excited that … there will be a way of measuring teachers and showing teachers how to improve. I don't know when exactly that will catch on, but by using videos and surveys I feel very good that the work that we're helping to back will make a huge contribution to identify what it is that great teachers do. The difference is awareness of when the kids start to get bored. That interactive element is so strong in these great teachers, and people can learn to do that better.
What do you conclude about U.S. spending on health care vs. the rest of the world?
We spend 17.8 percent of our GDP on health care. And the next highest is at 12 percent. You have some, like Britain, who are down at 9 percent. That is just mind-blowing. And our outcomes aren't better. The incentive system exists to have all sorts of ways of spending money on 70-year-olds and 80-year-olds—spend $100,000 on this, spend a half-million dollars on that. You're taking resources away from the young. Anything you can invent, we have no metric that would hold us back. So, innovation is inventing ways of taking resources away from the young, whether that's education or anything else.
Do you expect to see an American state declare bankruptcy?
That's tricky. From a pure accounting point of view the answer would have to be yes. If you take Greece's fiscal problems and you take Illinois, New Jersey—it's very, very similar.
Is there the political will to do something about the deficit?
Look, you have to cut spending. We're up to [a deficit of] $1.5 trillion a year. I wish I was innumerate. These numbers are truly upsetting.
Technology has been good to the U.S. Are we losing our momentum?
We'd have to keep making a lot of mistakes for several decades before we'd lose that edge. It's great that other countries are more innovative. When my child gets sick, I won't look at the pill and say, "Oh, my gosh, it's made in China." If they invent something that can save my child's life, I'll say, "Hallelujah." But the U.S. lead is very strong. Our universities, our funding of research, it's pretty amazing. Smart people still want to come to this country. Do we make it as easy for them as we ought to? I don't think so. But we have time to renew our excellence in how we educate, the excellence of our immigration system, in how we invest in young people.
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