Captioning sponsored by Rose Communications from our studios in new york city, this is charlie rose. We cant think of these as one block of developing countries because now china, mexico, so many are up here. And of course the developed countries are doing even better. But huge progress on health and income and age has been a big part of it. So its a myth that we havent made progress and that aid hasnt helped. Rose bill gates is here. He did three great things in his life, he founded a Great Technology company, he married a great woman and together they built a Great Foundation that ought to be enough for one lifetime but he in melinda through the bill and Melinda Gates foundation do something remarkable. They save lives, their goal is to dramatically reduce the number of children in the world who die before theyre five years old. Yet hes worried because he fears myths about the poor and foreign aid and overpopulation might impede progress. This is in fact the subject of his 2014 annual letter which has been released today. Im pleased to have bill gates back on this program. Welcome. Great to be here. Rose lets talk about this and youve said some remarkable things in this letter which is almost like a conversation from you to the people that you want to reach. You say by almost any measure, the world is better than it has ever been. People live longer, healthier and also nations are now more self sufficient. Talk about where you think we are and then where were not. And then get to the myths. Well several hundred years ago, everybody was poor. About 30 of kids died before their fifth birthday. And then a miracle happened in a small part of the world. Europe eventually the united states, after the war japan, came into that as well. We have this rich world but most of the world was poor. In fact when i grew up we sort of thought of the west, the soviet block and then this third world, these poor countries where i didnt know much about what happened there. I knew i was supposed to finish my food because otherwise it would be some kid in china didnt have enough food. Something like that. And so if you looked at income, it was bimodal, the rich and then these poor countries. But over the last 60 years, those countries by and large, not all of them, but most of them have moved up. And so most people live in middle income countries, brazil, mexico, thailand, malaysia. And countries in that can the country no longer receive aid. They get aid but they still have poor people in their country. They use their own taxation and resources. They get new technologies from the rest of the world but we can focus our aid on the remaining poor countries. And my view is were very close to finish this job of getting every country up to that level. In 20 years i think it will be less than 10. So the world is wonderful. Rose its been ten. Ten countries that will be in that category. There will be ones where something really, you know, top conditions. Land locked africa, north korea. And im amazed at how this good news about the progress in the world, health, longevity, every aspect, really runs against common wisdom, and it really holds people back. It gives them kind of a negative view of all these investments weve made and the progress going on. And so i think thats debilitating. And people have a hard time explaining why melinda and i are spending money the way we are when they see that, they think poor countries are just destined and we havent made much progress. Rose but you worry because people dont believe that there has been change and that there can be even more remarkable change. Where does that, are that resistance come from . Why are there these myths about the poor will always be poor, about foreign aid and about the fact that if we do a lot of these things with development will come overpopulation. Where is the myth coming from. Well i believe these myths before i got involved in this work. Rose you believed them. Yes. I think when somebody wants to appeal to you to help out the poor, they show you the worst conditions. When somebody wants to be cynical about poor countries, they show you the top conditions. And so whose job is it who say things have improved. Its not a headline piece of news. Bad things are headlines. Tornados, earthquakes. But the fact you have this gradual day by day decrease in deaths, increase in literacy, increase in longevity, increase in gdp. Theres no moment where theres all of a sudden some big announcement. And thats why i took a contrast of going to mexico city in 1987 and going wow, this is a poor country. People are spending a lot of time just carrying jugs of water around. A recent visit where sure theres poor people but its mostly middle income, middle class. And thats why they are now a lot of work to do but theyre taking care of themselves, improving education, improving taxation. And so it creeps up on you. And unless you work in the field, youre just seeing those headlines and kind of this bad news that may make you think gosh, we havent made this progress. Rose and if in fact people believe that progress is being made and can be made theyre more willing to support. Oh, absolutely. What they do is look at okay what happened in mexico happened vietnam. How do you get education right, how do you get infrastructure. How do you get farmers to have triple the productive so for kids to have enough nutrition. They make sure the expertise and resources get there. So all these countries get out of this poverty trap, this income level where you cant afford the schools, the health. Your kids have such bad nutrition that even if you are able to educate them, theyre not going to learn and contribute. And so until people come along, youre going to stay there. And without that knowledge it almost feels like tenants rather than a hand up. Rose theres also this. This notion as you point out, there are one billion people still on the planet that are in extreme poverty. One billion out of seven billion. Exactly. And you point out that your concern is primarily with the bottom two billion people. Thats where you want to focus your attention. Right. Rose yet at the same time as i suggested this morning, we have and i just want you to connect the two, this report that came out today. Everybodys talking about income inequity. The popes talking about it, the president s talking about it. Its the thing theres going to be a subject of income and equality. So this comes out and says 75 or 85, the rich est people have enough money as the bottom 50 of the global population. Connect those to some people here that say thats the extreme example of income inequality in the world. Well if those numbers which im sure theres some construct that they feel thats correct. If that makes you think the poor arent improving their livelihoods, then that is just another example of misleading people. What really counts, your children survive, you have enough nutrition. You live a long life, youre literate, you have economic freedom. Eventually you can have a refrigerator, a tv, a mobile phone. And so amongst those 85, im sure they count me maybe as number one. But my money is here for the poorest thats going to buy vaccines. Say that youve just gone to medical school and youre 100,000 in debt. Okay. You look like somebody with a net worth of negative 100,000. Well the fact youre about to become a doctor. If you look at your consumption, youre not starving. The number of people starving on the planet is way less than at any time in history. And so its the kind of statistic that might make you think hey redistribution. Growing the health of the world is not the answer. Just purely redistribution, thats what this is all about. And yes, Different Countries can have taxation policies. We are on the side of taxing the rich a little bit more in this country would not be that harmful. But thats not whats going to get the world, thats not the primary thing that will move the world forward. Better education. If i had one wand, take away all that wealth and give it to poor or improve the education system. The education would be a hundred times more powerful because then youre developing peoples capabilities. And then they pit professions and do things. So you know, im not disagreeing with the figure but it does not lead people to see whats gone well and encourage them to do more of it. Rose well the point you also make is that if you look at all these countries where theres been an emerging middle classes, what emergence into the middle class means is you get a better education. You have Better Health and therefore youre able to do more in terms of contributing to an economy that will let more people into the middle class. Right. Rose lets talk about foreign aid as a myth too because there are many people that believe foreign aid doesnt work. People believe theres corruption and people who believe theres a better way to do it. You say . Foreign aid is, has a significant responsibility for improving health, improving agriculture. And those are antecedents. Those are necessary elements for a country to advance its economy. What weve done with vaccines, reducing measles, deaths, getting polio near eradication. Thats why kids can develop physically and mentally and have countries that go on to look like we want. Like these middle income countries. So attacking foreign aid in the past when it was cold war payments, where people arent good at measuring these things, yes. I wont stick up for all the aid dollars that have been spent. But melinda and i had total freedom of how wed spend our money. So the idea with our analytic ability, we happen to be suckered into some indebted program, im saying i dont think so. And heres why. Rose you also point out that the budget for foreign aid is remarkably a small percentage of the budget in most countries. Norway having the largest aid budget is only 3 . Thats right. Theyre exemplary. They as a percentage of the economy are budget they do the most. Were a little bit less than 1 . Amazingly when you get pushed back on foreign aid its because people think amazingly its 10 or 20 . If we were sending that much overseas even i would say wow yes its more effective but then again weve got a lot of problems. The balance that, i wish it was 2 , i have to say. Rose you think a good number would be 2 for america. 2 for america would be fantastic. Rose 41 is health related. Yes. The u. S. Has a very high percentage. Its increased a lot, just over a third. Rose to talk to you over the experience youve had and the places youve been from india to africa to a lot of places in which youve seen things first hand, it becomes more than numbers. It becomes more than 5 . It becomes a dollar makes a difference in a life. All lives have equal value which has been the mantra of the foundation. Yes. If you go and actually meet a mother whose child is dying and you realize, you know, a vaccine that could have been given to that child would have saved their life or some malaria drugs or a bed net. You cant have that experience and not really get dedicated to this cause. Melindas in tanzania with our oldest daughter right now seeing what its like working on a farm. And its that being there that helps you understand okay its going to be hard, you know. How do you get, keep back venes cold, how do you get the farmer education right. If the roads arent there, its hard to get the farm out and sell it at a right price. Its not yeefs easy but you can come back to the wonderful country we live in and not feel like geez, why are they for lack of a little bit of money, why are they having such difficulty. Where even with all their efforts, if that kid doesnt get the nutrition i dont care how hard they try at school, theyre not going to learn. Rose three is that development does not mean overpopulation. She wrote this but make her point. Well this is a myth that i believe so much. Both she and i that the early days of the foundation we werent sure whether to get involved in health. We got involved to fund contraceptive tools. The foundation was quite small compared to how we grew it later. And partly we were hesitating. And it was wonderful. We met the people involved in this contraception availability work. And they educated us about how as you improve health, women voluntarily choose to have less children. And thats why the only places in the world are either bad health and high population growth or good health and low population growth. Rose the point is made that in fact there are many women in certain areas who because theres so much childhood debt, they have a lot more children than they might otherwise have if they knew about either contraception or good health practices. Right. So if your parents want to have at least two children survive and they want to have 90 chance, then theyre going to have to have quite a few kids to get that very high probability. And so only if they see the kids are being healthy, theres a bit of a leg to get a bulge in their population where you cut the death rate down and before the birth rate drops, that budge as it moved up into your working age is call the Demographic Dividend because of the percentage or population earning income is very high. And thats often the time when a country is lifted up into this middle income status. Its quite beneficial. But now we know that the world is going to peak in population. Weve had the most number. Were past what is called peak baby. Weve had the most under five year olds that the world will ever have and its taking that age pyramid and filling out the higher age groups that will take us from the 7 billion to a little up from 10 billion. Rose tell me about james burke and his book about the renaissance and how it influenced you. Well, it was kind of a mind blowing thing to learn that the mind set in ancient days was about decay. That the garden of eden, everything was perfect and pristine and they saw that things were falling apart. And the idea of new knowledge, New Invention just was born. The medical knowledge came from a tusand years before. But then when they started in painting and logic and medicine to find out that those old things they havent come up with these techniques. And they were wrong about anatomy and they, you know, hadnt seen, they hadnt mapped things out. There was this sense of we can discover new things. That mankinds curiosity, that we can build a better world. And that mind set, that forward looking the world will be better in the future than it is now. That helped fuel this sense of okay, lets do science. Rose is that the reason you signal out these benchmark that you talk about in terms of 2035 we can do this and that and in 18 years we can eradicate polio. Yes. I think this negative mind set where people dont see the wonderful progress. Actually its almost like olden days where in fact the American Public when asked about their kids futures or poor countries or a variety of topics show that they are more aware of the problems than the good things that are happening. And i have a concern about that. Certainly in terms of their generosity but in terms of long Term Investments as well. Rose what about public understanding of these kinds of issues. Youre doing what youre doing by writing a letter and capturing my attention and other people. Yeah. I dont know. I hope that we can correct some of this. And i hope people like good news. Good news maybe its not as easy to spread as bad news but it gives you the basis on which you should make new decisions. Rose talk about also choices that you make. For example i think was it peter singer who makes the point maybe we should spend less money in building a new wing of a museum and spend more money in terms of Global Health and blindness. A philosophy i suspect you. I think all philanthropy is great. Blindness. Culture things, it is hard to compare. He creates a construct where he talks about how people want to avoid blindness and how strong that instinct is and is therefore able to create a framework that he tries to have a value system about these things and it comes out the way that i happen to be spending my money. But i wouldnt want to abridge in any way philanthropists ability to spend. I think if they had the confidence that the money against blindness was well spebilityd and spent and wen show them that, a little bit that holes back even personal philanthropy as well as these government aid amounts. Rose i want to talk about Infectious Disease in a moment. When you look at these goals that you have and beyond having a broad sense that its possible, what is it necessary to make it possible other than a mind set. Clearly metrics, accountability, a sense of what works and fueling that rather than what doesnt work. Tell me how you get there. Well you have to fund new science. You have to fund the malaria vaccine which wasnt being done. The center in mexico that improves wheat and corn almost shut down because it didnt have enough funding and yet those better feeds that come out of there has an incredible effect. Who is supposed to fund those crops for people to grow more. Its not clear. The poor countries cant and the rich countries could end a up missing that as an opportunity. So science, innovation is a starting point and systems where youre building up a local capacity. Thats always very difficult. Rose whats the balance between the two, in terms of developing new vaccines or developing cooling systems so you can get vaccines already around to those people who need them. The biggest part ends up being the delivery. The science piece was so under funded that actually we spent about 40 of our money on that new tool discovery piece. And about 60 undelivered. Rose delivery is to get the cooling system. Its to buy the vaccines themselves and then to pay the primary Healthcare Worker who actually goes out and do does that delivery. Or in the case of aids, youd have invent a new vaccine and getting it out there to people as life saving medicine. So the biggest numbers are in delivery but if you dont fund the up stream invention, then youre missing, youll never get rid of malaria. Rose does that have to be a constant ongoing effort to go up stream. Theres never a point in which you stop going up stream and say we found what we need or is there. So now we can simply focus on down stream. Well, we decided our foundation will end 20 years after neither of us is around. Because when you think hopefully thats like 30, 40, 50 years from now. I think the problems of Global Health certainly Infectious Disease can largely be solved during that time frame. Rose lets go to pole oh. Where are we on polio because thats been a particular, and whats interesting about polio is youre getting money from other people now who come on board with gifts of 100 million to say i support this go make it happen. Yes. Mayor bloomberg, carlos slim. So a lot of people have joined. They not only give money, they talked to other people. 2013 was a good year in some ways. And you went now its now the third year. Theyve had no cases. That was very impressive. We had two new outbreaks, one in syria, one in somalia. So weve generally expect about one a year. And so that was a bit disappointing. The ongoing challenge, the big challenge is nigeria and pakistan. Nigeria has about half as many cases. So were rushing to get things really right in nigeria to try and get it done before the unrest around the 2015 election causes a destruction away from all the health activities. So were close on that one. In pakistan, even in the last few days there have been some tragic killings. Rose what are they about . Well, the Polio Program has been demonized as a plot of westerners to do something bad. Sterilize women, know. Almost as though its got a bad intent. And so the truth is on our side, were just trying to help those kids not get paralyzed. But we have to have voices that are trusted, muslim leaders. Other countries that they look to. And so we have the vaccine from last may. Weve got islamic development. A lot of middle east leaders came in to give to the campaign so its not just a campaign from the west. But that lack of trust in the north of packstein, thats a real obstacle. We need a break through there. The president of pakistan committed to help on that, red cross, a lot of people. But weve not made that break through. This weeks news just shows were not there. I hope for it because you know all we have to do is have them know whats true. Rose are you spending more time lobbying foreign leaders and going to washington as you have in the past. The recent budget agreement in d. C. , we suggested that the u. S. Go up from 150 million a year to 200 million a year on polio. We spend over 300 million. And amazingly, in a bipartisan way in a very tough budget agreement, that extra 50 million was included. So it looks like the financial piece will not limit us from having a success. Rose how does the Foundation Work with the government in terms of pilot programs, in terms of being able to prove that somebody is worth doing and worth moving up to scale. Well, the u. S. Government is the biggest foreign aid donors, about 30 billion a year. A bit over 10 billion in areas that we also work in. Aids, malaria. And in the aids treatment area, the program that was created under bush, very bipartisan. Its continued to be funded even in tough budget times. The u. S. Has taken a lead on implementation. We tend to go do measurement, gives them a little bit of advice. We had to work on circumcision to show that actually teenage boys in these affected countries were willing if presented the right way to get circumcision which turns out to cut disease transmission by over half. And so thats been a very good partnership. The u. S. Has been amazing on aids and malaria. Rose chees the change on hiv aids . Africa. Its come down not as much as wed like to see. Its about 20 off the peak infection rate. Its about 25 off the peak death rate. We still need to get the drugs out and get the adherence up a bit. We still need some more tools. The science is really showing us a lot of pathway to get those better tools. The next decade will be exciting but we have to stay the course and keep funding that treatment for a long time. Rose in terms of africa to look at the last five years that seven out of ten the Fastest Growing economies are in africa. What does that portend. The african economy didnt grow for a long time. Even the longevity went up, literacy went up. Charles kinney wrote a whole book Getting Better that talked about that gdp wasnt moving, yet their lives were improving. Now, thats changing. Even countries like ethiopia that were very poor, have increased their gdp a lot. The agricultural policies have helped there quite a bit. Infrastructure helped quite a bit. You have Central African republic, mali, democratic republic. When you have conflict in those land laund nations in Africa Drg Drc is the one with the largest population, about 60 million, thats going to take time. Those are very tough places. The coastal countries is where were seeing the growth. Kenya, tanls tanzania. Rose botswana. They are the wealthest. Rose are you for the change negligent indication. The Asian Countries and the u. S. Continues to grow. The way that they evaluate their teachers, train their teachers. And some cultural intensity around education means that when it comes to being good at math or signs the reading or writing the distance has really opened up. The administration has pushed to have programs, arne duncan with the support of the president has pushed for helping teachers get feedback. And having observation, student surveys, learning measurements, things that can help us say okay the teachers that are doing well, lets really look at best practice and spread those around. But its slow. State by state, you get reversals. Here in new york city, the Charter Movement may continue to get strong support, may not. Some concerning things have been set along those lines. Rose talk about technology for me too because many people think that technologys kind of seen for everything and you have been out front in saying its not. Especially in those areas where youre concerned with in terms of Global Health. Explain that to me. I would say that is equally to education. Just because we have amazing websites like conacademy and good things to motivate the kid, to make it fun, the teacher is still at the center. Were going to count the teacher with which personalized learning technology and they have the kid go off and relearn various things. But the personnel system that improves that teacher and helps them be good is as important as in African Health care that primary Healthcare Worker whose got to show up and be trained and make sure their supplies are in stock. And so amazingly we keep coming back to yes, magic tools are part of the arsenal. But the basic design of the personnel system, the measurement, if you dont get that right, which in places Like Northern nigeria, its not working today. Then anything else you do including new vascular vaccines is not going to have as much impact. Its lessons in our key domain. Rose when you call on a government do they say my god thank you mr. Gates, please come today. Are they anxious to hear from you because youre talking about programs that will affect their own citizens in terms of health and programs that are opportunities to lift them into the middle class. Ive been very impressed with the government leaders willingness to sit down and hear about other countries in similar situations that are doing better than theyre doing. Theyre getting vaccines out or running the primary Healthcare System or farm sectors far more productive. And being able to get their ear and give health and agriculture a little more priority than they receive otherwise, thats beneficial. Ethiopia is a case where mellis, the previous larytd he sort of didnt trust donters for some reason. In a meeting with melinda he said come in and help us redesign how agriculture gets done. He hired the top people from the foundation and created what he called the agricultural transformation agency. We gave him the resources to go do that. That started five years ago and now the pay offs incredible. The new prime ministers carried that on in a great way. So if they feel like theyre going to be with them for the long run, that youre not trying to get a photo op and you have experts who has seen these kinds of problems, then you can get them to may attention. So im very happy with the reception we get. And even on polio where im calling up always saying hey you got to do more you got to call this guy, you got to make sure this happens. They take the call. Rose any push back saying why polio because yes i understand mr. Gates that you want to show that we can do things about polio. And its very important to have the frame of mind that these Infectious Diseases can be conquered but we need dollars for a whole range of diseases having terrible effect on so many lives like cancer. Well, Infectious Disease dominates in these countries in their health picture. Now if they get richer, if they get obesity. Rose but not here as much. In the rich countries, its heart disease, cancer, neurological. You have a few countries that like india where they have both at the same time, that they have middle class people where diabetes is going up. At rates higher than you would expect but they still have huge Infectious Diseases. Theyre the runs rose go ahead. Mexico has moved out, Infectious Disease is very low there. But now they have a obesity level that rivals our own. Rose its very interesting when you thank you about the necessity of bringing out of poverty into the middle class, it brings with it a set of problems. Health issues are one, also Climate Change which affects health too. Right. So i wouldnt say that the Development Agendas the only big problem, i would put it at the top of the list, the equity of everybody being in middle income countries. But boy we better take on these, the Health Problems of affluence and the environmental problems of affluence but theres enough resources you can put a carbon tax and fund the rnd. They dont have to be competitions where you pick no of those three things we can only do one or two. Rose speaking of that we watched this weekend more extreme examples of pollution in china. Whats your take on china, its ability to deal with those kinds of issues that have to do with its own industrialization. Well i think you can saying the u. S. At the level of wealth that chinas at today and say what a horrible polluted place it was. I mean, it was terrible. And we didnt even know the mistakes we were making. China has the benefit of seeing certain chemicals we put out there were a real problem. Now theyve got a lot of work to do. Rose the first to say look you took longer time dont expect us to move as fast as you expect us to. Theyll move faster than we did. This pollution issue really has bothhe government, which in terms of executing on activities is very capable. And the people quite focused on them. So cleaning up the coal emissions, cleaning up the car emissions. Theyre on track now, and i think it will be quite impressive how quickly they can move because theyve seen solutions in other rich countries. Rose with the new leadership of china. In fact he was Vice President before and both he and his wife, we had interacted with quite a bit. Rose shes a singer and a general isnt she. Shes very impressive. I got to know her because she works on the three diseases we work on in china, she works on hiv, she does a little bit on tuberculosis and she does a lot on antitobacco, smoking levels in china are very high. Those are the three diseases that theyre not given their wealth. Theyre not doing as well as youd expect and again they got it in their sight. Rose how do they turn around the economy from an exporting economy to a domestic demand economy. I have quite a positive view of that. You have a range rose ability to turn that ship around. Well theyre doing it, theyre doing a very good job of it. Now growth will drop from the 10 level to as low as maybe five, six percent as youre making that change. You have a credit situation where credits been kind of in the wrong place you control interest rates. But if you got a technocratic issue about how you manage an economy and the structure of the economy. Talking to their government leaders, they looked at countries in the past. Its so well informed and looking at the numbers that theyll do the best. Now every country thats gone from these high growth periods into these areas theyve had blips and growth. Im not sure china has to have that. We certainly had many ourselves that we went through. And if their demand comes down, for china six percent growth is not a disaster. Rose what do you think of the president s speech on the balance between security and privacy . Well, i think you can strike a balance between those things. Rose did he find the right balance in your judgment or not . Well, i do wish people would say that, remind us that when it comes to stopping terrorists from having access to Nuclear Materials to biological weapons of terrorism, were all, we all have an interest in some cases in the government catching those activities before they go too far. And so privacy is absolutely important, but you know, who is the, do we have a balance, do we have an advocate in there who says reducing the chance of severe terrorism is also a very appropriate role and that doesnt fit nicely in the u. S. Versus nonu. S. Type framework. Rose have you changed your opinion of Edward Snowden at all . No. Rose theres been a kind of shift in terms of snowden. Ive always had a negative view of what he did. I cant see that positively. Rose one of the thing the president s looking to is nobody wants to, he doesnt want for the government to house all the metadata and all of that. Hes looking over the next 30 days to get some recommendations. Where should it go . Where should all that be held. Im notn expert on this. I dont think theres any intrinsic reason why you couldnt cept up a Government Agency where you really did trust them to use it in the right way where the records were there, the safeguards were there. I think every solution has some challenges. And he ruled out the Government Holding it which might have been my choice. The idea that when you know somebodys a bad actor that you can see what theyve done to the last 90 days, who theyve called, various data activity theyve engaged in. I think thats just so valuable and you ought to be able to prevent abuses. Rose you dont seem to be worried about the privacy whether they might have been invading the privacy. Or even, i mean the significant change the president did is you cant just go query to get this information. You got to get a court order. Thats one of the changes the president s recommending. You dont seem to be as concerned about or am i misreading you. All of the metadata search as far as i understand always required the court order. The fact that the metadata search has a court order im fine with that. Thats a nice threshold. And you know, at the end of the day, we should be able to have privacy, and still count on our government to be out there looking for bad actors. Rose you think we found the balance . I think technology will continue to challenge us. I mean, you see different policies take cameras and cities. London has lots of cameras and somehow theyve gotten to the point where they trust the police to use those in a way and crime has dropped because of that. It will be interesting to see if the u. S. Adopts a policy where they feel the same way about that. When there was a terrorist attack in london, those film clips were invaluable in figuring out what happened and catching those people. But its all about do you trust that if youre taking all these videos, do you trust theyll be used properly. And you know, can we set up government structures that we will basically trust. In the u. S. , i think we ought to be able to do it. Its not my area of full time work. Rose i want to go to some other things but one more question about that. The healthcare debacle. I mean, if the president called in people not necessarily you but people you know and respect and said help us design this system in a better way, would it have been a lot better off and people you know in the Technology Community have been able to do that or did he have that and screwed it up in another way. The government. The problems are very unfortunate and its easy to second guess how that could have been done better. I dont think thats a fundamental issue. In fact, a person who is retiring from microsoft just a few weeks ago got called in to make sure they do get their act together. The key issue there is, is it attractive given the way that the prices are somewhat rigged against the young. That is, the price when you sell to the young you make a lot of money. When you sell to the healthy you make a lot of money. When you sell to the old or not healthy you lose a lot of money. The big bad and the scary thing here is will that balance happen because thats the only way the pricing works. So people are sort of paying attention to was the website too slow or did the records make sense, fine. But that will be it. But theres a bad in this thing. Rose that the young will sign up and healthy will sign up. You have to price higr because of the mix and more people drop out because you have to price higher. It can fail to work. Now if all the prices had been sort of marketdriven, then youre not a subject to that. But then the prices for the 63 year old, 64 year old, they decided would be too high. I dont know if they did that right. Certainly the healthy versus unhealthy, that is key to the design. Theres no way to get rid of that. You got to get Healthy People signing up. Theres another measure which is how many people are signing up when they didnt have insurance is when will that happen. The cost and the benefit of the things is proportional to that. People didnt like obamacare, the fact that not many people sign up, you know, i guess maybe they feel thats good. I do think one way or another getting coverage is a good thing. And i think theres going to be some fine tuning and why should the atmosphere of someone for recrimination, that may make the seeking out, the right trade offs. Could you even amend the bill, its clear you have to amend the bill. Its tricky for something to be so controversial it has so many experimental elements that the idea that you would get it right from the beginning is quite unlikely. Rose if you could define what the debate ought to be in this country, to advance our progress into the future for the country, tell me what that debate ought to be. We need to look at government expenditure. Not if its all bad or its all good. We need people with defects im immersed in that. I would tell you how i would tune various things but overall i like the u. S. Global Health Spending and i can go to people involved and tell them what i know. But we need that for agricultural spending. The expertise. Ideally not just outside experts but staff in congress and elected representatives in congress. We need Foreign Policy experts not just in their corners. And i worry a little bit that it should be about technical expertise. Given a certain budget, if you want to help the poor, should you have an incomes policy or should we have what we have today where its rent, medicine, fuel, food. All very special policies that you have to apply to a bureaucracy, the criteria might be right or wrong. I would love somebody who was neutral in the sense of not seeing that it should be ten times bigger for it to go away, take what were spending on the poor and go look at it. It cant be right. It accumulated over many years. Its got so much complexity. So the kind of tuning programs and the real discussion of what if people want it to be smaller, what is it they really dont like. How do you get people to state a position really on the specific spending. I know theres rates out there but really get into a discussion. I worry because its become so complex and because youre sort of fighting in your corner politically is what you get elected is this kind of intelligence of okay is it written well. That can go down at a time where complexity demands that we have more understanding. And were kind of in the lead. Other rich countries arent spending what we are in healthcare. Theyre all looking at us and say go figure that out so we can just follow your footsteps. Rose what is that about 18 of our budget. Of our economy. It hasnt grown quite as much in the last two years. People are arguing about why that is. But it can be debilitating if we dont get that cost increase under control. Rose you go to seattle you have three offices as i remember. One is that micro soft, one is at the foundation and one is sort of in between, personal. Right. Rose are you spending more time at microsoft now because of the change that has taken place. Were in a field search so the board is more active right now just making sure that goes well. Once theres a new ceo, then it will be up to that ceo if they want to meet my time. Rose the ceo says i need you on campus you would be willing to be there and spend more time. Not full time. My biggest job is going to be the Foundation Work but i would make trade offs and spend more time. Rose is it productive for you to do that some way you dont want the guy to turn the firm around. Others say yes you do because you want a ceo who is Strong Enough to be his own person to be able to have that. Its up to them. Of course its up to them. Im not going to impose myself. Rose but youre the biggest talk obviously and you have a huge concern about microsofts future. I log emails and it costs very little to send emails. But you know, the tech center is very dynamic and whoever the leader is going to shape the new direction. Rose give me a profile of a leader that you think would fit the deminds demands of microsoft today. Thats not fruitful. Rose why not. The board is working, its a mysterious process. When the smoke comes out emily yes. But i mean when will we see white spoke again. Again a mysterious process. Rose you and i know often executives are admired if they plan well for succession. It doesnt seem like theres been smart planning for succession at microsoft. Well i think Tech Companies are, theyre very challenging to run. The rules of what works in one area that will change. I cant think of a tech company that had some textbook case of succession going on. So i apologize. Rose i was trying to think about hewlettpackard, whether that would work. Oh my god. Rose thats true. Weve seen a lot of people come in at number to at all of these Tech Companies and then they seem to fall by the wayside. Founders do well but only because of the phenomena that 999 out of a thousand finders you never hear their names so the darwinian selection that happens before somebody becomes known because their Company Fails or gets bought. And you know, so those people look like they know what theyre doing but the failure rate of picking them is extreme. Once when you pick a successor youd like to have a higher success rate than picking founders. Rose but you had hathaway, you picked a successor at warren, have they not. Warren consulted with the board about his thinking on that subject and thats very good. Rose all right. One more question. Does microsoft need a young bill gates . Think about it. Microsofts success was always a team of people. And to sort of mythally say i alone did something that oversym simplifies the past. It has wonderful people there. The new leaders going to pick a new direction. And that can either be somebody who draws on the technical strength of the people or themselves. There are multiple models that you could go down. Rose but you believe in your heart he or she has to be grounded in technology. She has to or he has to Love Technology and either be good at orchestrating these or bring them out themselves. Rose finally the Seattle Seahawks are in the sure bowl. Will you come to the game or watch at home. Im very excited about it. The whole town has gone crazy. It will be a special event. Rose paul alan is very proud. He should be. I was with him in detroit when pittsburgh beat us. He was excited to be there. This time he hopes for even more. Rose thank you for coming, great to see you. Bill gates for the hour. Thank you for joining us. See you next time. Captioning sponsored by Rose Communications captioned by Media Access Group at wgbh access. Wgbh. Org and their buns are something i have yet to find anywhere else. cause im not inviting you to my house for dinner. Breaded and fried and gooey and lovely. In the words of arnold schwarzenegger, ill be back youve heard of connoisseur. Im a commonsewer. They knew i had to ward off some vampires or something. Lets talk dess