A Tale of Three Cities: Davos, Washington DC, San Francisco. And Three Different Visions for People: Two Positive, One Negative.

"Vaccines are a miracle." So says Melinda Gates, wife of Bill Gates and his partner in one of the great philanthropic projects of all time, The Bill & Melinda Gates Foundation. "With just a few doses, [vaccines] can prevent deadly diseases for a lifetime," Mrs. Gates adds, according to Science Daily, one of many sources reporting from the World Economic Forum in Davos, Switzerland. Yes, vaccines are, indeed a "miracle." So why don't we have more of them? How could it be that the Gates Foundation wishes to expand health and medicine for the world, while the US government seeks to restrict and constrict health and medicine here at home?

The Gates Foundation has just announced that it will donate $10 billion to the cause of vaccine research. In the words of Margaret Chan, head of the World Health Organization, "An additional 2 million deaths in children under five could be prevented by 2015 through widespread use of new vaccines and a 10 percent increase in global vaccination coverage." Well put!

But now we might note a strange dichotomy, a vast chasm between the warm outpouring of humanitarianism that we see in Davos and the chilly "austeritarianism" that's crunching DC. Over in Switzerland, Bill and Melinda Gates are seeking to "bend the curve" on healthcare costs in the best possible way--by eliminating disease, including AIDS, malaria, and tuberculosis. So it should be pointed out that in addition to the profound compassion driving the Gates' efforts, what they are doing, by promoting vaccines, will actually save the world money. Children who grow up to be productive adults are, to be utilitarian about it, good investments. Now I don't think that utilitarianism is the motivation of Mr. and Mrs. Gates; such economic abundance-making is merely a happy byproduct--good begetting good. If economic activity is ultimately a function of "animal spirits," then the higher the spirits, the more healthy the energy, the better for the world economy.

Meanwhile, what's the discussion in Washington DC, as led by Barack Obama and the majority in Congress? It's over "health insurance policy" and various schemes to ration care, all in the name of reducing costs. These "less is more" ideas were never all that popular, and they grew less popular as a) the economy worsened, and b) people learned new details of the Obamacare plan. Indeed, it now appears that Obamacare is doomed; even its best friends say it is on "life support." One might think, especially after the Clintoncare debacle, that the liberal-left would rethink its approach, and maybe now, after two huge defeats, it will. Maybe the liberal-left will embrace the "more is more" approach of the Gates Foundation.

A few days ago, here at Serious Medicine Strategy, I drew the contrast between Obama and Steve Jobs, both of whom made big announcements on Wednesday. But Jobs' announcement, launching the iPad, was greeted mostly with applause, while Obama's announcement, that he still wanted a healthcare bill, was greeted mostly with skepticism, even derision.

So now, in one of life's ironies, Jobs' great rival over the last 30 years, Bill Gates, has stepped forward with a vision that is also radically at odds with Obama's. That is, Gates and Jobs are on the same side of the optimism vs. pessimism divide; the two historic rivals are now united in their faith in a better future. Jobs seeks transformation through high-tech. Gates seeks transformation through cures. Those two visions, Jobs' and Gates', are both popular and admirable in their own ways. Meanwhile, Obama seeks only to build a bigger bureaucracy; his healthcare plan is mundane transactionalism, oblivious to the transformational power of technology, and also to the transformational power of prevention and cures.

So, come to think of it, it's a tale of three cities: Davos, Washington, and San Francisco. Optimism in Davos and San Francisco, pessimism in DC.

But wasn't Obama supposed to be the candidate of "Hope"? Indeed he was, back in 2008. But all the techno-progressivism of his campaign seems to have been leached out of him by the bloodless bean-counters he surrounded himself with when entering the White House. So yes, historians will marvel at these strange choices made by Obama. The 44th President is, after all, younger than either Gates or Jobs--and as an elected official, he is the figure most directly dependent on the affection and good will of the American people. It's Obama who will likely go before the voters again in less than three years; one would think that he would seek to propose something popular, such as a Cure Strategy, as opposed to the same old bureaucracy. Or at least that he would want to clamber onto the Gates bandwagon, or the Jobs bandwagon, or both.

So far, of course, Obama shows no such interest. But as his 2012 re-election campaign looms closer, perhaps the President will rediscover the value of Hope.