> That is more than enough money to solve structural issues.But that's the thing, the money is not helpful when it comes to policy issues. As the Gates Foundation MO and your dad's experience probably shows, lasting change comes down to political will. I can only surmise that the reason more US non-profits don't achieve lasting change is because they are not able to or they are not trying to.
This is not to say they are deliberately being ineffective, e.g. consider that inner city infant mortality rates have socioeconomic and racial factors, so solving that would require "solving" poverty and racism. Offhand, I really can't see how non-profits would be able to address these with even billions of dollars.
Of note, a sibling comment mentions the book "Winner Takes All" and links its wikipedia page which has this quote:
> The Aspen Consensus, in a nutshell, is this: the winners of our age must be challenged to do more good. But never, ever tell them to do less harm. The Aspen Consensus holds that capitalism's rough edges must be sanded and its surplus fruit shared, but the underlying system must never be questioned. The Aspen Consensus says, "Give back," which is of course a compassionate and noble thing. But, amid the $20 million second homes and $4,000 parkas of Aspen, it is gauche to observe that giving back is also a Band-Aid that winners stick onto the system that has privileged them, in the conscious or subconscious hope that it will forestall major surgery to that system – surgery that might threaten their privileges. The Aspen Consensus, I believe, tries to market the idea of generosity as a substitute for the idea of justice."
Not saying I agree entirely, but that is the kind of thing that could lead to billions in spending without achieving lasting structural changes.