Booting Earth Optimization System
Thank you for your patience. Your civilization is very important to us.
Thank you for your patience. Your civilization is very important to us.
Agency Report Card
Enhance and protect the health and well-being of all Americans
Enhance and protect the health and well-being of all Americans
2000 US is the ONLY developed country without universal healthcare ↗
2003 Medicare Part D — pharma lobbies ban on government negotiating drug prices ↗
2010 ACA signed — individual mandate, no public option. Insurance stocks rally. ↗
2020 COVID-19 — US has highest per-capita death rate of any wealthy nation despite highest spending ↗
Health spending per capita more than tripled ($4,842 in 2000 → $15,474 in 2024) while life expectancy rose only from 76.8 to 79.0 years — barely above its 2014 level of 78.9. The US spends more per person than any country and gets middling outcomes.
| Year | National health expenditure per capita, all payers (CMS NHEA; nominal USD, calendar year) | US life expectancy at birth (NCHS, years) |
|---|---|---|
| 2000 | $4.84K | 76.8 |
| 2002 | $5.68K | 77 |
| 2004 | $6.48K | 77.5 |
| 2006 | $7.27K | 77.8 |
| 2008 | $7.91K | 78.2 |
| 2010 | $8.38K | 78.7 |
| 2012 | $8.86K | 78.8 |
| 2014 | $9.42K | 78.9 |
| 2016 | $10.2K | 78.7 |
| 2018 | $11K | 78.7 |
| 2020 | $12.6K | 77 |
| 2022 | $13.7K | 77.5 |
| 2024 | $15.5K | 79 |
“97% clinical trials, 3% overhead — the exact mirror of your NIH”
Total annual funding for the National Institutes of Health
Share of NIH budget that actually funds clinical trials — ~$1.55B of $47B
Average cost per patient in a traditional randomized controlled trial
Share of researchers' time spent writing grant proposals instead of doing science
“You tripled what you spend on healthcare and your people live about as long as they did a decade ago. Singapore spends a quarter of this and lives six years longer. It is genuinely impressive how wrong you got this.”
Where your $4.5 trillion per year actually goes
$1000B/yr
Billing, coding, prior authorizations, claims processing, credentialing. 25% of all US healthcare spending goes to paperwork. Canada: 10%.
$1 trillion per year on paperwork. That is more than the entire military budget.
$350B/yr
Private health insurance administrative costs, executive compensation, marketing, shareholder returns. None of this heals anyone.
UnitedHealth Group CEO earned $20.9M in 2023. The company denied 32% of claims.
$200B/yr
Americans pay 2-10x more for the same drugs as every other country. Insulin: US $300, Canada $30. Humira: US $80K, UK $15K.
$200B per year in excess drug costs. Congress banned Medicare from negotiating prices until 2022.
$30B/yr
Pharmaceutical companies spend more on marketing ($30B) than on R&D ($28B). The US and New Zealand are the ONLY countries that allow direct-to-consumer drug advertising.
The industry that claims high prices are needed to fund research spends more money convincing you to ask your doctor about their product.
$100B/yr
Doctors order unnecessary tests and procedures to avoid lawsuits. An estimated $55-200B per year wasted on defensive medicine.
The fear of being sued costs more than the lawsuits themselves.
$32B/yr
Millions use the ER for conditions that primary care could handle — because they can't afford a doctor or can't get an appointment.
$32B per year because people don't have a $50 doctor visit.
$1B/yr
Through PDUFA (Prescription Drug User Fee Act), pharmaceutical companies pay $1.1B per year in 'user fees' to the FDA — funding 65% of the drug review budget. The agency that decides if your drug is safe is funded by the company selling the drug.
Imagine if restaurant health inspectors were paid by the restaurants. That is the FDA.
People who didn't have to die
1,645,161/yr
People murdered by the 8.2-year delay in approving drugs already proven safe. The FDA requires efficacy testing AFTER safety is established — treatments sit in a queue while patients die waiting.
34,100 9/11s. 17 Holocausts. More than WWI and WWII combined.
Source: The Invisible Graveyard — Efficacy Lag Deaths 1962-2024 ↗
250,000/yr
Killed by mistakes in hospitals — wrong drugs, wrong doses, hospital-acquired infections, surgical errors. Would be the 3rd leading cause of death if counted as a single category.
A 9/11 every 4.4 days. 685 people killed per day by the healthcare system itself.
45,000/yr
Killed by not having health insurance in the only developed country without universal coverage. They delay care until it's too late.
15 9/11s per year. The US is the ONLY developed nation where this happens.
Source: Harvard Medical School / American Journal of Public Health 2009 ↗
1,205/yr
Killed during pregnancy or childbirth. The US is the ONLY developed country where the maternal death rate is RISING. Black women die at 2.6x the rate of white women.
US: 32.9 per 100K live births. Japan: 3.3. The Netherlands: 3.0. US is 10x worse.
20,000/yr
20,000 infants die per year in the US. The US ranks 33rd among OECD nations. Black infants die at 2.1x the rate of white infants.
US: 5.4 per 1,000. Finland: 1.8. Japan: 1.7. The richest country on earth has 3x the infant death rate of the best.
35,000/yr
Killed by antibiotic-resistant infections in the US (1.27M globally). Overuse of antibiotics in factory farming and overprescription created superbugs that existing drugs can't treat.
1.27M murdered globally per year — more than HIV/AIDS or malaria. By 2050: projected 10M/yr.
107,941/yr
Killed by drug overdoses — primarily fentanyl since 2016. The DEA's budget doubled while deaths increased 600%. Portugal decriminalized all drugs in 2001 and deaths dropped 80%.
A 9/11 every 10 days. 296 people murdered by the drug war's failure every single day.
The system is designed to deny care
32% denied
36,800,000 claims denied out of 115,000,000 processed.
The US spends the most and gets the worst outcomes among wealthy nations
Affordable healthcare for all Americans
Premiums increased 105% in first 7 years. Average family premium: $22,463/yr (2023). Mandated purchase of private insurance instead of creating public option.
Premiums +105%
On a well-run planet, this agency would have been deprecated centuries ago. Here is what replaces it.
Decentralized Institutes of Health — National Institutes of Health + FDA