Policy Rankings

Redirect research funding to pragmatic real-world trials. UK NIHR produces actionable evidence at 1/10th the cost.

Current: NIH: $48B/yr, <10% on pragmatic trials, 85% of findings fail to replicate → Target: Mandate 30%+ of research budget for pragmatic trials with open data requirements

Decriminalize personal drug use, redirect enforcement budget to treatment. Based on Portugal (2001).

Current: US spends $40B/yr on enforcement; 1.5M arrests/yr; overdose deaths at record highs → Target: Decriminalize personal use, redirect enforcement budget to treatment

Guarantee every patient the right to join a pragmatic trial of any treatment that passed safety testing, and upgrade the FDA to publish real-time outcome labels from all treatment data.

Current: Draft legislation; most patients ineligible for conventional trials; 6,650 diseases with zero FDA-approved treatments → Target: Enact patient trial-access rights plus a real-time FDA outcome-label platform (dFDA)

Federally funded universal pre-K. Perry Preschool RCT shows $7-12 ROI per dollar over 40 years.

Current: Only 34% of US 3-year-olds enrolled; varies wildly by state → Target: Federal funding for universal enrollment by age 3

Reduce military spending to the cheapest high-performer floor. Switzerland achieves Life Expectancy 83.37 at $389/cap; United States gets 76.93 at $2052/cap.

Current: United States spends $2052/cap on military spending, ranks 27/28. 5.3x overspend. → Target: Switzerland model ($389/cap floor). $564B/yr savings → Optimization Dividend.

Reduce total health spending (public and private) to the cheapest high-performer floor. South Korea achieves Life Expectancy 83.57 at $3588/cap; United States gets 76.93 at $10333/cap.

Current: United States spends $10333/cap on total health spending (public and private), ranks 28/28. 2.9x overspend. → Target: South Korea model ($3588/cap floor). $2287B/yr savings → Optimization Dividend.

Remove restrictive zoning that constrains housing supply. Tokyo, Minneapolis, Oregon show reduced housing cost growth.

Current: 75% of US residential land zoned single-family only → Target: Condition federal grants on local zoning reform

Reduce government education spending (all levels) to the cheapest high-performer floor. Japan achieves PISA Math Score 536 at $1288/cap; United States gets 465 at $2996/cap.

Current: United States spends $2996/cap on government education spending (all levels), ranks 8/8. 2.3x overspend. → Target: Japan model ($1288/cap floor). $579B/yr savings → Optimization Dividend.