[jasonwatkinspdx]

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.