United States
#13 of 18 by healthy life years
Current employee: Donald Trump
Official government site โFor every $1 spent finding out which medicines work, United States spends $1,094 on military.
๐ฎ Game Metrics
๐ฃ Military vs ๐งช Medicine
Scaled to the same axis as military โ the bar is 0.09% of military spending
๐ Spending Profile
๐ Body Count
๐ฅ Countries Bombed
Korea, Vietnam, Laos, Cambodia, Libya, Iraq, Afghanistan, Syria, Yemen, Somalia, Pakistan, Sudan, Serbia, Panama, Grenada, Lebanon, Iran, Guatemala, Dominican Republic, Cuba, Nicaragua, El Salvador, Honduras, Chad, Bosnia, Colombia, Philippines, Uganda, Niger, Burkina Faso
๐ Death Ledger
Sourced regime and conflict entries summed into the body-count total.
โ๏ธ Justice & Domestic
๐๏ธ Agency Report Cards
Spending over time vs. outcomes over time. If the lines diverge โ spending up, outcomes flat or worse โ the agency is failing its mission. Letter grade is computed from trend analysis.
๐ Drug Enforcement Administration
Enforce controlled substance laws and reduce drug availability
Total drug war spending grew from $18.5B to $47B/yr while overdose deaths went from 17,415 (2000) to 107,941 (2022) โ a 520% increase. Since the DEA was created in 1973, deaths went from ~5,000 to 108,000 โ roughly 20x worse.
๐ฌ National Institutes of Health
Seek fundamental knowledge and apply it to enhance health
2003 Doubling complete ($27.2B) โ then budget flatlines for a decade โ
2013 Sequestration cuts $1.7B from NIH โ 640 fewer grants funded โ
2020 $4.9B emergency COVID supplemental โ suddenly money is available when Congress is scared โ
Budget increased 164% while drug approvals remained volatile and flat on trend. Only 3.3% of the budget reaches actual clinical trials.
๐ฅ Food and Drug Administration
Protect public health by ensuring safety and efficacy of drugs and food
2004 Vioxx withdrawn โ FDA knew about cardiac risks for years, approved anyway โ
2003 Medicare Part D signed โ pharma lobbies a BAN on government negotiating drug prices โ
2024 Same drug: Insulin US $300, Canada $30. Humira US $80K, UK $15K. โ
FDA budget increased 454% while the cost to develop a new drug increased 287%. The agency meant to make drugs accessible made them more expensive.
๐ Department of Education
Promote student achievement and preparation for global competitiveness
2002 No Child Left Behind signed โ standardized testing becomes the curriculum โ
2009 Race to the Top โ $4.35B in competitive grants, schools teach to the test โ
2015 Every Student Succeeds Act replaces NCLB โ test scores still flat โ
Budget increased 124% while math scores for 17-year-olds declined. Scores are now lower than in 1990.
๐ Department of Defense
Provide military forces needed to deter war and protect security
2010 Leaked video shows Apache helicopter killing Reuters journalists and children in Baghdad โ
2013 NSA mass surveillance revealed โ warrantless wiretapping of US citizens funded by DoD budget โ
2021 Afghanistan withdrawal โ 20 years, $2.3T, 176K murdered. Taliban retakes country in 11 days. โ
Spending tripled since 2000 while causing over one million deaths in the 'War on Terror.' The department meant to deter war started several.
๐ฉบ Healthcare System (HHS/CMS)
Enhance and protect the health and well-being of all Americans
2003 Medicare Part D โ pharma lobbies ban on government negotiating drug prices โ
2010 ACA signed โ individual mandate, no public option. Insurance stocks rally. โ
2020 COVID-19 โ US has highest per-capita death rate of any wealthy nation despite highest spending โ
2000 US is the ONLY developed country without universal healthcare โ
Health spending per capita tripled ($4,845 โ $14,570) while life expectancy is LOWER than in 2014. The US spends more per person than any country and gets middling outcomes.
๐ง Immigration & Customs Enforcement + CBP
Protect national security and public safety through immigration enforcement
2003 DHS created โ largest government reorganization since 1947. 22 agencies merged. โ
2006 Secure Fence Act โ $2.3B for 700 miles of border fencing โ
2017 Family separation policy ('zero tolerance') โ 5,500+ children separated from parents โ
2019 Remain in Mexico policy โ asylum seekers forced to wait in dangerous border cities โ
Budget tripled from $10B to $29B while border encounters increased 166%. More money, more crossings.
โ๏ธ Bureau of Prisons (DOJ)
Protect public safety through correctional management
2010 Fair Sentencing Act โ reduces crack/powder disparity from 100:1 to 18:1 (not eliminated) โ
2018 First Step Act โ first federal sentencing reform in decades. Population begins declining. โ
2008 US has 5% of world population, 25% of world prisoners. Incarceration rate 5x the OECD average. โ
Budget increased 136% while prison population grew then declined. Recidivism remains at ~67% regardless of spending level.
๐ฑ Environmental Protection Agency
Protect human health and the environment
Unhealthy air days dropped 69% with moderate budget increases. One of the few agencies that demonstrably improves its target metric.
๐ Federal Bureau of Investigation
Protect the American people and uphold the Constitution
2004 9/11 Commission finds FBI missed 10+ pre-attack warnings due to bureaucratic failures โ
2013 Boston Marathon bombing โ FBI had been warned about Tsarnaevs by Russia, didn't follow up โ
2016 FBI director reopens presidential candidate email probe 11 days before election โ
Budget tripled ($3.4B โ $11.3B) while murder clearance rate dropped from 63% to 52%. Nearly half of all murders go unsolved despite record funding.
๐ก๏ธ Cybercrime Enforcement (FBI IC3 + CISA)
Protect the nation from cyber-based threats
2017 Equifax breach โ 147M Americans' data stolen. $700M settlement, no one jailed. โ
2018 CISA established within DHS โ
2020 SolarWinds hack โ Russian intelligence inside US government networks for 9 months undetected โ
2021 Colonial Pipeline ransomware โ gas shortages across East Coast. $4.4M ransom paid. โ
Cybercrime budget grew 173% while reported losses exploded 1,409% ($1.1B โ $16.6B). Complaints tripled. The threat is growing 8x faster than the defense.
๐๏ธ Department of Veterans Affairs
Fulfill Lincoln's promise โ to care for those who have served
2007 Walter Reed neglect scandal โ moldy walls, cockroaches in wounded warrior housing โ
2017 VA still can't deploy a working electronic health records system after $16B spent โ
2022 PACT Act signed โ toxic exposure benefits for 3.5M veterans. Budget surges to $325B. โ
Budget increased 622% ($45B โ $325B) while veteran suicides remained flat at ~6,200-6,400/year. The money grew but the deaths didn't shrink.
โ๏ธ Transportation Security Administration
Protect the nation's transportation systems
2006 Liquid bomb plot (UK) โ TSA bans liquids >3.4oz. Still banned 18 years later. โ
2015 DHS Red Team gets 67 of 70 weapons through TSA checkpoints undetected (95% failure rate) โ
Zero major aviation attacks since creation, but attacks on transportation were near-zero before TSA too. GAO tests show 70-95% failure rate detecting test weapons. $11B/yr for security theater.
๐พ USDA (Farm Subsidies)
Provide leadership on food, agriculture, and natural resources
Hundreds of billions in subsidies over decades while number of farms declined 12% and food prices rose 83%. Subsidies flow to megafarms while small farms die.
๐ Department of Housing and Urban Development
Create strong, sustainable, inclusive communities
2008 Subprime collapse โ 10M foreclosures. HUD had promoted the lending policies that caused it. โ
2017 HUD Secretary appointed with zero housing policy experience โ
Budget increased 137% ($30.8B โ $73B) while homelessness decreased only 10% then reversed. 2023 count (653K) is the highest ever recorded.
๐ State Department (Sanctions Regime)
Lead America's foreign policy through diplomacy and sanctions
2003 Libya sanctions lifted after Gaddafi denuclearizes โ NATO bombs him 8 years later anyway โ
2012 Iran nuclear sanctions โ medicine shortages kill unknown thousands of Iranian civilians โ
2022 Russia sanctions (Ukraine) โ most sanctioned country in history. Ruble recovers within months. โ
Sanctioned countries quadrupled (9โ36) with no evidence of regime change. Estimated 700K+ civilian deaths from sanctions, primarily children. Sanctions punish populations, not leaders.
๐ฆบ Occupational Safety and Health Administration
Ensure safe and healthful working conditions
2010 Deepwater Horizon โ 11 workers killed. OSHA had no jurisdiction (offshore = different agency). โ
Workplace fatality rate declined from 4.3 to 3.5 per 100K (19% drop) with modest budget increases. However, the rate was already declining at the same pace before OSHA existed (from 61 per 100K in 1900 to 18 in 1970).
๐ธ Internal Revenue Service
Provide America's taxpayers top quality service by helping them understand and meet their tax responsibilities
2013 IRS targeting scandal โ Congress retaliates by cutting budget 20% over next 5 years โ
2017 Audit rate for millionaires drops to 1.4% โ lower than for EITC recipients making <$25K โ
2022 Inflation Reduction Act โ $80B IRS funding approved โ
2023 $20B of IRA funding rescinded in debt ceiling deal โ before agents are even hired โ
Budget was effectively flat/cut for a decade while the tax gap doubled to $700B. Audit rate collapsed from 1.1% to 0.25%. The IRA funding in 2022 is slowly reversing the damage.
๐ฆ Federal Reserve System
Promote maximum employment, stable prices, and moderate long-term interest rates
The dollar has lost 97% of its purchasing power since the Fed was created. The economy grew faster without it (3.8% vs 2.7%). Canada had zero bank failures during the Great Depression without a central bank. The Fed's balance sheet went from $900B to $8.9T โ printing money that went to the top 1%.
๐ Before vs After: Did the Agency Change the Trend?
The red dashed line shows when each agency was created. If the trend was already improving before the agency existed and didn't accelerate after โ the agency didn't help.
Department of Education
Did creating a federal Department of Education improve student achievement?
NAEP reading scores for 17-year-olds were 285 in 1971 (before DoEd) and 287 in 2020 (40 years after DoEd) โ a statistically insignificant 2-point gain. Meanwhile, inflation-adjusted per-pupil spending increased 280% since 1960. SAT verbal scores dropped from 466 in 1967 to 424 in 1980 and never recovered to pre-DoEd levels. The US ranked 11th out of 12 countries in the 1964 international math test โ it has never been at the top.
FDA (Kefauver-Harris Efficacy Amendment)
Did requiring efficacy proof (in addition to safety) speed up or slow down drug access?
New drug introductions dropped from ~43/year (pre-1962) to ~16/year (post-1962). Drug development time went from ~7 months to over 10 years. Cost per new drug rose from $179M (1970s) to $2.6B (2010s) in constant dollars. An estimated 21,000-120,000 lives lost per decade from delayed access. Countries with faster approval (UK, France) had similar drug safety withdrawal rates (~3-4%), suggesting no safety benefit from the delay.
Drug Enforcement Administration
Did creating the DEA reduce drug use, drug deaths, or drug availability?
Drug overdose deaths went from 2.5 per 100,000 in 1968 to 32.6 per 100,000 in 2022 โ a 13x increase. The rate was stable or slightly declining in the 1970s (when the DEA was new), then began an exponential increase that continues to this day. Over 1.1 million Americans died from drug overdoses between 1968 and 2020, with 85% of those deaths occurring after 1999. The DEA budget went from ~$75M in 1973 to $3.5B in 2024 โ a 47x increase โ while the problem got 13x worse.
Occupational Safety and Health Administration
Did OSHA change the already-declining trajectory of workplace fatalities?
Workplace fatalities were ALREADY declining steeply before OSHA. Manufacturing injury rates dropped from 24.2 per million man-hours in 1926 to 15.2 in 1970 โ a 37% decline BEFORE OSHA existed. Workplace deaths went from ~14,000/year in 1970 to ~5,283/year in 2023, but the pre-OSHA trend (driven by mechanization, safety engineering, and liability law) was already achieving similar rates of decline. Coal mining injury rates fell from 89.9 in 1931 to 42.6 in 1970 โ a 53% reduction without OSHA.
Department of Defense / US Military
How has military spending evolved and what has it produced in terms of lives lost?
Defense spending consumed 1-2% of GDP from 1900-1916, spiked to 22% in WWI, 41% in WWII, 14.6% at the Korean War peak, and has been declining from ~10% (Cold War) to ~3.5% today. US wars have killed ~623,000+ US military personnel and millions of foreign combatants and civilians. The post-9/11 wars cost over $8 trillion and killed an estimated 900,000+ people (Brown University Costs of War Project).
Federal Reserve System
Has the Federal Reserve preserved the dollar's purchasing power as mandated?
From 1774 to 1900 (126 years, no Fed), there was only 4.09% total inflation. From 1900 to 2025 (125 years, with Fed from 1913), there was 3,858% inflation. The dollar lost 97% of its purchasing power since the Fed was created. The CPI was essentially stable from 1800 to 1913 (fluctuating between CPI 25 and 51) but exploded from 29.7 in 1913 to 967.5 in 2025. The acceleration after 1971 (end of gold standard) was particularly dramatic: CPI 40.5 in 1971 to 967.5 in 2025 โ a 24x increase in 54 years.
HHS/CMS (Medicare & Medicaid)
Did Medicare/Medicaid improve life expectancy outcomes relative to spending growth?
Life expectancy was increasing FASTER before Medicare/Medicaid. From 1900-1965: gain of 23 years (47.3 to 70.2). From 1965-2024: gain of only ~7 years (70.2 to 77.6), and it actually DECLINED after 2014. Meanwhile, per-capita healthcare spending went from $146 (1960) to $15,474 (2024) โ a 106x increase. The US now spends more per capita than any other country and ranks ~40th in life expectancy. Singapore spends about a quarter of what the US spends and its citizens live 6 years longer.
Immigration & Customs Enforcement / CBP
Did creating DHS/ICE/CBP reduce unauthorized border crossings?
Border apprehensions peaked at 1.6M in 2000 and were already declining before DHS existed. They dropped to 340K by 2011, then surged to 2.5M by 2023 โ despite the budget tripling.
Bureau of Prisons / Mass Incarceration
Did mass incarceration reduce crime?
US incarceration rate was flat at ~100 per 100K from 1925-1972. After mandatory minimums, it exploded to 531 per 100K โ the highest in the world. Violent crime dropped at the same rate in states that did NOT increase incarceration.
Environmental Protection Agency
Did EPA accelerate the improvement in air quality?
Air quality was already improving from the Clean Air Act of 1963 and 1967 โ both passed 3-7 years BEFORE EPA existed. The trend continued at a similar pace after EPA was created. EPA's main contribution was enforcement capacity, not the original legislation.
Federal Bureau of Investigation
Did the FBI's counterterrorism pivot improve crime-solving or prevent terrorism?
Murder clearance rate was 93% in 1965. It has been declining for 60 years and accelerated after the 2001 CT pivot, reaching 52% by 2022. Nearly half of all murders in America go unsolved.
Department of Veterans Affairs
Did expanding the VA budget reduce veteran suicides?
VA budget increased 622% ($45B to $325B) while veteran suicides remained flat at ~6,200-6,400 per year. In 2014, the VA wait-time scandal revealed veterans were dying while waiting for appointments โ and officials falsified records to hide it.
Transportation Security Administration
Were terrorist attacks on US soil declining before TSA was created?
Domestic terrorism incidents were already declining through the 1980s and 1990s. The major pre-TSA attacks (1993 WTC, 1995 OKC) were NOT prevented by the security that existed at the time. Post-TSA, GAO red teams got 67 of 70 test weapons through checkpoints (95% failure rate).
๐ณ๏ธ United States Politician Alignment
Every politician's votes scored against what citizens actually want via pairwise comparison. The gap between what they vote for and what you'd vote for, expressed as a single number.
See Politician Scores๐ฏ Fix United States's Score
United States spends $886B/yr on military and $810M/yr testing which medicines work. The 1% Treaty redirects 1% of the first number to the second. The deposit funds the campaign to make it happen.