At the Cleveland church he went to, significant portions of his time spent there was to write checks to parishioners.
I'd say it takes roughly the same amount of effort to spend money as it does to make it. You still need an organization, you still need to make really hard decisions day in and day out. It seems that there's something fundamental about philanthropy that doesn't scale.
Personally, I think the work a person does to earn that kind of money, assuming of course it's from legitimate commercial activity, is plenty enough, one shouldn't feel morally compelled to donate it back. But like you said, what else are you going to do with it? Doesn't make a lot of sense anymore to leave billions to heirs.