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The worst thing they could do for their kids, they decided, would be to leave them all their money. Bill had read a 1986 FORTUNE story about the perils of inherited wealth, and it confirmed what he had noticed at his élite private high school in Seattle. "The ones who were the wealthiest weren't the most motivated," he says. He has had long talks on the subject with other rich people, like Buffett and Katharine Graham (who inherited the Washington Post). "Warren has often said that you want to give your kids enough so that they don't have to worry, but not so much that they don't feel the need to work and contribute," says Bill. "It's not clear that's not a paradox, but it's a good thought." The bulk of his $46.5 billion fortune will go to the foundation, but he says he and Melinda have not decided how much to leave their children. "Our thinking will evolve," he says.
Once the Gateses committed to working on global health, the foundation began to grow much faster than anyone anticipated, Stonesifer recalls--just as the U.S. library program had in the years prior. "Bill and Melinda had said, 'Well, how many libraries should we do?' I said, 'Well, what if we did all of them?' And they said, 'Yeah, what if we did all of them?'" she remembers. Today the wall above her desk is covered with a map of all the libraries the foundation has provided with computers, Internet access and librarian training.
Until she quit in 1996, Stonesifer was the highest-ranking female executive at Microsoft, and she got generous stock options to go with it. As a result, she has chosen to forgo a salary at the foundation. But she runs it with the ferocity of a Wall Street titan. When she met with Senator Jesse Helms on Capitol Hill, he called her a spark plug--twice. "None of us knew much about health," she says. "We just kept finding people whom we trusted. And we learned and learned. We used the same skills we'd applied to business prospects." At one point, baffled by the organizational complexities of the U.N., Stonesifer called a man who works there and asked if he had a PowerPoint presentation that would explain how it all works. He did. "So he sent me a PowerPoint presentation, and Bill and Melinda and I went through it!" says Stonesifer.
Very soon, however, they realized that they could never do what they hoped to do because even their money was a drop in the bucket. Instead of downsizing their ambition, they decided they needed force multipliers--or leverage, to use one of Bill's favorite terms from Microsoft. They needed other organizations and countries to step up and make the foundation look puny. According to WHO's Commission for Macroeconomics and Health, it would cost $25 billion annually to save 8 million lives a year. The Gates Foundation will spend, this year, about $1 billion on global health. Bill Gates needed leverage of 25 to 1.
So Bill, Melinda and Patty began to do things they had sworn they would never do. Although as a nonprofit they are forbidden to lobby for legislation, they are allowed to "educate." They opened an office in Washington and began meeting with politicians all over the world, including British Prime Minister Tony Blair, former German Chancellor Gerhard Schröder, French President Jacques Chirac and U.S. Secretary of State Condoleezza Rice.