Why would you choose to save lives and reduce suffering in a far off land when you could save lives and reduce suffering for your own country? That is what I have never understood about foreign aid charities.
Maybe because issues in poor nations are straightforward to solve: if you resolve the issue with clean water for a village, that improves lives of hundreds. Issues that plague 'The west' don't have a known solution.
Maybe because of most issues in poorest nations is lack of funs / tech, which he can provide, but cause of suffering in western world is usually political or mismanagement, which he cannot 'provide'
Maybe because for the same resources deployed the choice is between saving 100 kids from disease in Africa vs helping social mobility of 1 kids in US
Maybe you do not believe that from Alaska to Hawaii is 5,000 miles of "we", but 500 miles South from Texas it's "they". Nation-centric worldview is a relatively new idea that only existed for a couple hundred years, even today many people associate by faith, by town/province, by ethnicity or other things over nationality
Because there are more lives to save and suffering to reduce in that far off land than in your own country, perhaps?
Are you, say, a man? Then why would you give anything to a charity that helps women? (Or vice versa.) Or are you perhaps white? Then why would you give anything to a charity that helps people of colour? (Or vice versa.) Etc, etc... Get the point yet? If not, I'll spell it out for you: "Charity" that only benefits copies of yourself isn't really charity.
Simple: The US is the wealthiest country in the history of the world and we don't have a lot of low hanging fruit in terms of easily preventable/treatable diseases.
Most fundamentally, a lot of us are humanists, not nationalists.
But more narrowly: Gates Foundation focuses on straightforwardly preventable diseases. These are diseases of extreme poverty that are nearly or entirely absent in the US. The US's problems are of a different nature, largely stemming from inequality in access to healthcare which is a political problem.
It seems rather ghoulish to look at one of the most effective charities in the world, that has no doubt had an impact on millions of people, and say "I want those $$ to stay in the US instead" when we are the most wealthy and powerful nation in history. We need to fix our own political issues, not shame Gates for doing truly good things elsewhere. You want to help the US? Vote for people who want to help the most vulnerable among us vs the most powerful. Our government and society has the resources, they are simply being directed with deliberate inequities.
Maybe because issues in poor nations are straightforward to solve: if you resolve the issue with clean water for a village, that improves lives of hundreds. Issues that plague 'The west' don't have a known solution.
Maybe because of most issues in poorest nations is lack of funs / tech, which he can provide, but cause of suffering in western world is usually political or mismanagement, which he cannot 'provide'
Maybe because for the same resources deployed the choice is between saving 100 kids from disease in Africa vs helping social mobility of 1 kids in US
Maybe you do not believe that from Alaska to Hawaii is 5,000 miles of "we", but 500 miles South from Texas it's "they". Nation-centric worldview is a relatively new idea that only existed for a couple hundred years, even today many people associate by faith, by town/province, by ethnicity or other things over nationality