Talk about a well-timed release. Linsey McGoey’s No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy came out just weeks before Mark Zuckerberg and Priscilla Chan announced the Chan Zuckerberg Initiative and set off an Internet-wide firestorm about philanthropy and its relationship with inequality and democracy.

This was almost the book I had been waiting for. But it only goes half way, pointing out what’s wrong in billionaire philanthropy without any substantive analysis of how to make things right, or at least slightly better. It builds on the work of other thoughtful critics, including Rob Reich, Mark Dowie, Gara LaMarche, and Joanne Barkan, and applies it to the work of the Gates Foundation (disclosure: my former employer). But it doesn’t offer any new arguments or solutions. And, as Andy Beckett points out in his review, it doesn’t seem like McGoey spoke to many Gates Foundation employees to better understand how the structure and management of the foundation contribute to its shortcomings.

McGoey depicts those of us who work at foundations as naive, idealistic “TED Heads” that jet around in business class from one to the next faddish conference without ever understanding the roots or realities of the problems we purport to address. Sure, you can find those types at many foundations, and sadly their ilk is on the rise as foundations increasingly recruit MBA generalists on the assumption that they are more efficient and “outcome focused.” But if she had spoken with more foundation employees, McGoey would have discovered that many of philanthropy’s toughest critics are those of us that work on the inside — even at the Gates Foundation. Each time we go through an existential crisis about our work, we ask ourselves a question that McGoey mostly avoids: given the current political realities, if not this, then what?

The strongest section of the book looks at the implications of the Gates Foundation’s choice to work with rather than against Big Pharma to make progress against diseases  that affect the poorest. That decision is rooted in Bill Gates’ belief that philanthropy can help attract “the smartest minds to the most important problems.” It’s a noble goal that necessitates some ugly trade-offs. Supporters of the foundation’s partnerships with pharmaceutical companies argue that, as a result, poor people get access to new medicines faster and cheaper while pharmaceutical companies gain access to new markets. Critics, like McGoey, point out that Big Pharma is making record profits that it uses to lobby governments for strict patent protections against generic equivalents — government-sanctioned monopolies that deny life-saving medicine to poor people. Hepatitis C, for example, affects 150 million people worldwide and kills 700,000 people each year. There is a treatment, but it will cost you $1,000 per daily pill — $84,000 for the full treatment. The state of Illinois has paid tens of millions of dollars for the drug, and was forced to restrict Medicaid patients from treatment. Generic versions of the drug in developing countries (where 73% of all people with hepatitis C live) could be as low as $100 for the full treatment, leading to healthier citizens and more productive economies.

I fully agree with McGoey that patent protections shouldn’t keep people from accessing medicines that could save their lives. It was one of the areas I was most interested in when I worked at Open Society Foundations (yes, an evil private foundation). But even as I nodded in agreement, I was frustrated that McGoey didn’t substantively address the tradeoffs of working with versus against Big Pharma, and that she didn’t dig into the details of Gates Foundation’s Global Access policy. The foundation’s approach to intellectual property is much more nuanced than just “patent protection at all costs.”

She also joins the chorus of voices demanding that the foundation’s trust divest from oil companies, without recognizing research that shows that divestment campaigns rarely work. All that activist effort to get private foundations to divest from oil companies is a distraction from what would really make a difference: higher taxes on carbon extraction and consumption, and cheaper renewable energy.

To the degree that McGoey offers a solution, it’s that wealthy people should pay more taxes, and governments should provide quality public services and a basic safety net. I agree, and both Bill Gates and Warren Buffet are on record for supporting higher taxes. (Buffet has been especially vocal.) But McGoey’s faith in governments to be the sole financier of public goods, scientific research and the arts makes me think she’s never lived in a developing country. It’s a model that works well at the University of Essex, where she works, but just ask researchers, activists and artists in Mexico what they have to go through to get government support.

Finally, when I ponder the book’s central premise that private foundations amount to unaccountable, institutionalized plutocracy (and this is something I think about frequently), I ultimately come to the same conclusion. Private foundations aren’t the problem, and getting rid of them isn’t the solution. As Larry Kramer (disclosure: president of the Hewlett Foundation, where I work) argues, the problem is large aggregations of wealth. Allocating those large aggregations of wealth to private foundations (compared to, says, campaign finance, lobbying or luxury yachts) is the least of our worries.

I’d recommend this book to anyone who works in philanthropy, and to anyone interested in the relationship between wealth, idealism and democracy. It reveals the many contradictions rampant in my field. McGoey is a deep, subtle thinker who rewards her readers with great passages from 19th century literature, sociological theory and political philosophy. It’s an especially important read for all those attracted to the hype of social entrepreneurship and the next TED conference. For those of us who have been pondering philanthropy’s shortcomings for some time, however, this is not the book to help us advance our thinking on how to improve philanthropy and its relationship with democracy.

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