> They don't really exist to "fix" problems, they are mostly a band-aid over the structural issues that lead to social problems. The long-term solutions to most of these problems involve policy changes rather than "spot fixes"

Non-profits are 12% of GDP, over $3.5 trillion. Excluding hospitals, universities, and churches, leaves over $2 trillion in non-profit expenditures. Of that, about $300 billion comes from the government. That is more than enough money to solve structural issues.

My dad spent his career in non-profits working on public health in third world countries. These NGOs were able to work with highly dysfunctional foreign governments to achieve real and measurable improvements in some of the poorest countries in the world. Which is why it blows my mind that non-profits spending vastly more money domestically can’t work with e.g. the government of Baltimore to deliver meaningful improvements to the abysmal literacy rates in that city, or work in infant morality in inner cities.

The key difference it seems to me is the lack of accountability in domestic non-profits. The U.S., EU, Japan, etc., care how their foreign aid dollars are used. Every project is evaluated for effectiveness in quantitative terms. That culture of measured accountability seems entirely absent in domestic non-profits.

It doesn't surprise men to find we spend trillions on nonprofits and get little in return. There is an enormous amount of corruption. More than forty years ago I knew a woman who was cold calling people to raise money for research into a canine disease.

If you donated a dollar, she got fifty cents. Her boss got twenty five cents, the company got their cut, the university took a little, so did the department and the professor. By the time it came down to some poor grad student looking at slides there was only a penny or two going to pay him/her. This kind of thing combines the worst of both government and private business.

> 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.

depends on your lawyers.. the reporting requirements in the USA are real. What the report says, who is named.. a much broader topic.