United States Efficiency Audit

United States Efficiency Audit | Zenodo Skip to main Communities My dashboard Log in Sign up Zenodo is currently experiencing slowness and intermittent outages due to heavy automated traffic from bots and AI crawlers. We are aware of the problem, and our team is focused on stabilizing the service. Thank you for your patience. Published May 7, 2026 | Version 1.0 Working paper Open United States Efficiency Audit Authors/Creators Mike P. Sinn 1 Show affiliations 1.

International Campaign to End War and Disease Description Website: https://manual.warondisease.org/knowledge/appendix/us-efficiency-audit.html Abstract: This report applies systems engineering methodology to quantify allocative inefficiency in U.S. governance across four dysfunction categories: direct spending waste, compliance burden on the private sector, policy-induced GDP loss, and system inefficiency. Using Monte Carlo simulation across ten components with OECD benchmarking, we estimate an aggregate efficiency gap of \$4.9 trillion (95% CI: \$3.62 trillion-\$6.5 trillion) annually and recoverable capital of \$2.45 trillion (95% CI: \$1.81 trillion-\$3.25 trillion) if U.S. performance converges toward OECD median efficiency. This categorization distinguishes direct budget waste from broader economic dysfunction, each requiring different solution pathways. We also translate the efficiency gap into QALY and VSL-equivalent welfare terms for interpretability. For global ceiling context, the Optimal Governance Trajectory reaches 56.7x (95% CI: 19.3x-304x) the Earth baseline after 20 years, raises average income to \$1.16 million (95% CI: \$395,118-\$6.22 million) versus \$20,483 on the status-quo path, reaches \$10.7 quadrillion (95% CI: \$3.64 quadrillion-\$57.2 quadrillion) in total output, and recovers roughly \$101 trillion (95% CI: \$83.3 trillion-\$191 trillion)/year in suppressed value ([The Political Dysfunction Tax](https://political-dysfunction-tax.warondisease.org)). Summary: Systems audit estimating an annual U.S. efficiency gap of \$4.9T, with \$2.45T recoverable at OECD-median performance across direct spending waste, compliance burden, policy-induced GDP loss, and system inefficiency. Notes Category: Academic Paper, Public Policy, Economics, Systems Engineering | Genre: Public Finance, Systems Analysis, Policy Analysis, Economics | Target Audience: Researchers, Policy Makers, Economists, Public Finance Analysts Files us-efficiency-audit.pdf Files (6.9 MB) Name Size Download all us-efficiency-audit.pdf md5:8866a2881c9bdbe6f459009f78bed013 6.9 MB Preview Download Additional details Related works Cites 10.5281/zenodo.18161560 (DOI) 10.5281/zenodo.20076511 (DOI) 10.1371/journal.pone.0127242 (DOI) 10.1016/S0140-6736(20)30925-9 (DOI) 10.1093/inthealth/ihz003 (DOI) 10.5281/zenodo.18603840 (DOI) 10.1016/j.drudis.2019.01.009 (DOI) Is supplemented by Software documentation: https://manual.warondisease.org/knowledge/appendix/us-efficiency-audit.html (URL) Software: https://github.com/wishonia/earth-optimization-protocol (URL) References Sinn, Mike P. (2025). The 1\% Treaty: Harnessing Greed to Eradicate Disease. doi:10.5281/zenodo.18161560 Sinn, Mike P. (2025). The 1\% Treaty. doi:10.5281/zenodo.20076511 {Harvard Kennedy School} (2020). 3.5\% participation tipping point. Harvard Kennedy School. https://www.hks.harvard.edu/centers/carr/publications/35-rule-how-small-minority-can-change-world GAO (2025). 95\% of diseases have 0 FDA-approved treatments. GAO. https://www.gao.gov/products/gao-25-106774 ACLED (2024). Active combat deaths annually. ACLED: Global Conflict Surged 2024. https://acleddata.com/2024/12/12/data-shows-global-conflict-surged-in-2024-the-washington-post/ NIH (2015). Antidepressant clinical trial exclusion rates. Zimmerman et al.. https://pubmed.ncbi.nlm.nih.gov/26276679/ ASCE (2025). 2025 Report Card for America's Infrastructure. https://infrastructurereportcard.org/ {U.S. Congress} (2023). H.R.2961 - Audit the Pentagon Act of 2023. https://www.congress.gov/bill/118th-congress/house-bill/2961/text {Biotechnology Innovation Organization (BIO)} (2021). BIO Clinical Development Success Rates 2011-2020. Biotechnology Innovation Organization (BIO). https://go.bio.org/rs/490-EHZ-999/images/ClinicalDevelopmentSuccessRates2011_2020.pdf {U.S. Bureau of Labor Statistics} (2024). CPI Inflation Calculator. https://www.bls.gov/data/inflation_calculator.htm {Center for American Progress} (2021). Ending the War on Drugs: By the Numbers. https://www.americanprogress.org/article/ending-war-drugs-numbers/ {Rep. Ed Case} (2024). Case, Moylan Lead Measures To Relieve Crushing Burden Of Jones Act. https://case.house.gov/news/documentsingle.aspx?DocumentID=3520 {Cato Institute} (2024). Corporate Welfare in the Federal Budget. https://www.cato.org/policy-analysis/corporate-welfare-federal-budget-0 CBO (2025). The Budget and Economic Outlook: 2025 to 2035. https://www.cbo.gov/publication/60870 CBO (2025). Long-Term Implications of the 2025 Future Years Defense Program. https://www.cbo.gov/publication/61017 CBO (2024). The 2024 Long-Term Budget Outlook. https://www.cbo.gov/publication/60039 {Centers for Disease Control and Prevention} (2024). US Life Expectancy 2023. https://www.cdc.gov/nchs/fastats/life-expectancy.htm {US Census Bureau} (2024). US Median Household Income 2023. https://www.census.gov/library/publications/2024/demo/p60-282.html {U.S. Census Bureau} (2024). State and Local Government Finances Summary: 2022. https://www.census.gov/programs-surveys/gov-finances.html {Cato Institute} (). Chance of dying from terrorism statistic. Cato Institute: Terrorism and Immigration Risk Analysis. https://www.cato.org/policy-analysis/terrorism-immigration-risk-analysis {CDC MMWR} (1994). Childhood vaccination economic benefits. CDC MMWR. https://www.cdc.gov/mmwr/volumes/73/wr/mm7331a2.htm CDC (2017). Childhood Vaccination (US) ROI. CDC. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm {Integrated Benefits Institute} (2024). Chronic illness workforce productivity loss. Integrated Benefits Institute 2024. https://www.ibiweb.org/resources/chronic-conditions-in-the-us-workforce-prevalence-trends-and-productivity-impacts {UN News} (2014). Clean Water \& Sanitation (LMICs) ROI. UN News. https://news.un.org/en/story/2014/11/484032 ClearPath (2024). Time to Fix America's Permitting Problems and Let America Build. https://clearpath.org/our-take/time-to-fix-americas-permitting-problems-and-let-america-build/ Williams, Rebecca J and Tse, Tony and DiPiazza, Katelyn and Zarin, Deborah A (2015). Terminated Trials in the ClinicalTrials.gov Results Database: Evaluation of Availability of Primary Outcome Data and Reasons for Termination. PLOS One, 10, e0127242. doi:10.1371/journal.pone.0127242 {ACS CAN} (). Clinical trial patient participation rate. ACS CAN: Barriers to Clinical Trial Enrollment. https://www.fightcancer.org/policy-resources/barriers-patient-enrollment-therapeutic-clinical-trials-cancer PMC (2023). Only ~12\% of human interactome targeted. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10749231/ {ClinicalTrials.gov API v2 direct analysis} (). ClinicalTrials.gov cumulative enrollment data (2025). Direct analysis via ClinicalTrials.gov API v2. https://clinicaltrials.gov/data-api/api {Correlates of War Project} (2017). National Material Capabilities (NMC) Dataset. https://correlatesofwar.org/data-sets/national-material-capabilities/ CRFB (2024). Medicare Advantage Will Be Overpaid by \$1.2 Trillion. https://www.crfb.org/blogs/medicare-advantage-will-be-overpaid-12-trillion {UBS} (2023). Credit Suisse Global Wealth Report 2023. Credit Suisse/UBS. https://www.ubs.com/global/en/family-office-uhnw/reports/global-wealth-report-2023.html {Cybersecurity Ventures} (2016). Cybercrime economy projected to reach \$10.5 trillion. Cybersecurity Ventures: \$10.5T Cybercrime. https://cybersecurityventures.com/hackerpocalypse-cybercrime-report-2016/ GiveWell (). Cost per DALY for Deworming Programs. GiveWell: Cost-Effectiveness in $/DALY for Deworming. https://www.givewell.org/international/technical/programs/deworming/cost-effectiveness WHO (2019). Annual global economic burden of Alzheimer's and other dementias. WHO: Dementia Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/dementia {JAMA Oncology} (2020). Annual global economic burden of cancer. JAMA Oncology: Global Cost 2020-2050. https://jamanetwork.com/journals/jamaoncology/fullarticle/2801798 {Diabetes Care} (). Annual global economic burden of diabetes. Diabetes Care: Global Economic Burden. https://diabetesjournals.org/care/article/41/5/963/36522/Global-Economic-Burden-of-Diabetes-in-Adults Cook, Christopher and Cole, Graham and Asaria, Perviz and Jabbour, Richard and Francis, Darrel P. (2014). Annual global economic burden of heart disease. International Journal of Cardiology. https://www.internationaljournalofcardiology.com/article/S0167-5273(13)02238-9/abstract {Calculated from IHME Global Burden of Disease (2.55B DALYs) and global GDP per capita valuation} (). \$109 trillion annual global disease burden. ScienceDaily (2015). Global prevalence of chronic disease. ScienceDaily: GBD 2015 Study. https://www.sciencedaily.com/releases/2015/06/150608081753.htm {Calculated from Orphanet Journal of Rare Diseases (2024)} (2024). Diseases Getting First Effective Treatment Each Year. Calculated from Orphanet Journal of Rare Diseases (2024). https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03398-1 SIPRI (2016). 36:1 disparity ratio of spending on weapons over cures. SIPRI: Military Spending. https://www.sipri.org/commentary/blog/2016/opportunity-cost-world-military-spending {U.S. DOE} (2024). Pathways to Commercial Liftoff: Clean Energy. https://liftoff.energy.gov/ {U.S. Department of Justice} (2025). The False Claims Act. https://www.justice.gov/civil/false-claims-act DOT (2024). DOT Value of Statistical Life (\$13.6M). DOT: VSL Guidance 2024. https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis {U.S. Department of Transportation} (2024). Departmental Guidance on Valuation of a Statistical Life in Economic Analysis. https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis {Tufts CSDD} (). Cost of drug development. {Nature Medicine} (2024). Drug Repurposing Rate (~30\%). Nature Medicine. https://www.nature.com/articles/s41591-024-03233-x {Nature Reviews Drug Discovery} (2016). Drug trial success rate from Phase I to approval. Nature Reviews Drug Discovery: Clinical Success Rates. https://www.nature.com/articles/nrd.2016.136 {Drug Policy Alliance} (2021). The Drug War by the Numbers. https://drugpolicy.org/drug-war-stats/ EPI (). Education investment economic multiplier (2.1). EPI: Public Investments Outside Core Infrastructure. https://www.epi.org/publication/bp348-public-investments-outside-core-infrastructure/ {Costs of War Project, Brown University Watson Institute} (). Environmental cost of war (\$100B annually). Brown Watson Costs of War: Environmental Cost. https://watson.brown.edu/costsofwar/costs/social/environment {Environmental Working Group} (2024). US Farm Subsidy Database and Analysis. Environmental Working Group. https://farm.ewg.org/ {Environmental Working Group} (2024). Triple dipping: Budget bill raises farm subsidies for wealthy farmers by billions of dollars. https://www.ewg.org/research/triple-dipping-budget-bill-raises-farm-subsidies-wealthy-farmers-billions-dollars GAO (2024). F-35 program lifetime cost: \$1.7 trillion. GAO: F-35 Sustainment Costs. https://www.gao.gov/products/gao-24-106703 FDA (). FDA-approved prescription drug products (20,000+). FDA. https://www.fda.gov/media/143704/download FDA (). FDA GRAS List Count (~570-700). FDA. https://www.fda.gov/food/generally-recognized-safe-gras/gras-notice-inventory {Federal Election Commission} (2023). Statistical Summary of 24-Month Campaign Activity of the 2023-2024 Election Cycle. https://www.fec.gov/updates/statistical-summary-of-24-month-campaign-activity-of-the-2023-2024-election-cycle/ {Forbes} (2024). Forbes World's Billionaires List 2024. https://www.forbes.com/billionaires/ {FracTracker Alliance} (2025). Fossil Fuel Subsidies: The \$760 Billion Lie About 'Free Market' Energy. https://www.fractracker.org/2025/03/fossil-fuel-subsidies-free-market-myth/ FWD.us (2024). Groundbreaking Analysis Finds Incarceration Costs American Families Nearly \$350 Billion Each Year. https://www.fwd.us/news/new-report-groundbreaking-analysis-from-fwd-us-finds-incarceration-costs-american-families-nearly-350-billion-each-year/ GAO (2025). F-35 Joint Strike Fighter: Actions Needed to Address Late Deliveries and Improve Future Development. https://www.gao.gov/products/gao-25-107632 GAO (2024). GAO Reports an Estimated \$162 billion in Improper Payments Across the Federal Government in Fiscal Year 2024. https://www.gao.gov/press-release/gao-reports-estimated-162-billion-improper-payments-across-federal-government-fiscal-year-2024 {GBD 2019 Diseases and Injuries Collaborators} (2020). Global Burden of Disease Study 2019: Disability Weights. The Lancet, 396, 1204--1222. doi:10.1016/S0140-6736(20)30925-9 {Policy Cures Research} (2024). G-FINDER 2024: Neglected Disease Research and Development. https://www.policycuresresearch.org/g-finder GiveWell (). GiveWell Cost per Life Saved for Top Charities (2024). GiveWell: Top Charities. https://www.givewell.org/charities/top-charities {Research and Markets} (2024). Global clinical trials market 2024. Research and Markets. https://www.globenewswire.com/news-release/2024/04/19/2866012/0/en/Global-Clinical-Trials-Market-Research-Report-2024-An-83-16-Billion-Market-by-2030-AI-Machine-Learning-and-Blockchain-will-Transform-the-Clinical-Trials-Landscape.html {Component country budgets} (). Global government medical research spending (\$67.5B, 2023–2024). See component country budgets: NIH Budget. https://www.nih.gov/about-nih/what-we-do/budget {Applied Clinical Trials} (). Global government spending on interventional clinical trials: ~\$3-6 billion/year. Applied Clinical Trials. https://www.appliedclinicaltrialsonline.com/view/sizing-clinical-research-market {United Nations Department of Economic and Social Affairs, Population Division} (2024). World Population Prospects 2024: Summary of Results. https://population.un.org/wpp SIPRI (2025). Global military spending (\$2.72T, 2024). SIPRI. https://www.sipri.org/publications/2025/sipri-fact-sheets/trends-world-military-expenditure-2024 {C\&EN} (2025). Annual number of new drugs approved globally: ~50. C\&EN. https://cen.acs.org/pharmaceuticals/50-new-drugs-received-FDA/103/i2 ICAN (2024). Global nuclear weapon maintenance cost: \$100 billion/year. ICAN: Global Spending \$100B 2024. https://www.icanw.org/global_spending_on_nuclear_weapons_topped_100_billion_in_2024 {Industry reports: IQVIA} (). Global pharmaceutical R\&D spending. UN (2022). Global population reaches 8 billion. UN: World Population 8 Billion Nov 15 2022. https://www.un.org/en/desa/world-population-reach-8-billion-15-november-2022 {IQVIA Report} (). Global trial capacity. IQVIA Report: Clinical Trial Subjects Number Drops Due to Decline in COVID-19 Enrollment. https://gmdpacademy.org/news/iqvia-report-clinical-trial-subjects-number-drops-due-to-decline-in-covid-19-enrollment/ {Our World in Data} (2024). Terror attack deaths (8,300 annually). Our World in Data: Terrorism. https://ourworldindata.org/terrorism Haseltine, William A. (2013). Affordable Excellence: The Singapore Healthcare Story. Brookings Institution Press. https://www.brookings.edu/books/affordable-excellence/ Himmelstein, David U. and Campbell, Terrie and Woolhandler, Steffie (2020). Health Care Administrative Costs in the United States and Canada, 2017. Annals of Internal Medicine. https://pubmed.ncbi.nlm.nih.gov/31905376/ PMC (2022). Healthcare investment economic multiplier (1.8). PMC: California Universal Health Care. https://pmc.ncbi.nlm.nih.gov/articles/PMC5954824/ Greaney, Brian (2023). Housing Constraints and Spatial Misallocation: Comment. American Economic Journal: Macroeconomics. https://www.aeaweb.org/articles?id=10.1257/mac.20230141&from=f Caplan, Bryan (2023). Hsieh-Moretti on Housing Regulation: A Gracious Admission of Error. https://www.econlib.org/a-correction-on-housing-regulation/ Hsieh, Chang-Tai and Moretti, Enrico (2019). Housing Constraints and Spatial Misallocation. American Economic Journal: Macroeconomics. https://www.aeaweb.org/articles?id=10.1257/mac.20170388 NHGRI (2003). Human Genome Project and CRISPR Discovery. NHGRI. https://www.genome.gov/11006929/2003-release-international-consortium-completes-hgp ICRC (1997). International Campaign to Ban Landmines (ICBL) - Ottawa Treaty (1997). ICRC. https://www.icrc.org/en/doc/resources/documents/article/other/57jpjn.htm WHO (2019). ICD-10 Code Count (~14,000). WHO. https://icd.who.int/browse10/2019/en {Institute for Health Metrics and Evaluation (IHME)} (2024). IHME Global Burden of Disease 2021 (2.88B DALYs, 1.13B YLD). Institute for Health Metrics and Evaluation (IHME). https://vizhub.healthdata.org/gbd-results/ {International Monetary Fund} (2023). IMF Fossil Fuel Subsidies Data: 2023 Update. https://www.imf.org/en/Blogs/Articles/2023/08/24/fossil-fuel-subsidies-surged-to-record-7-trillion {International Monetary Fund} (2024). IMF Singapore Government Spending Data. https://www.imf.org/en/Countries/SGP Sinn, Mike P. (2025). Private Industry Clinical Trial Spending Estimate. https://cost-of-change.warondisease.org {Applied Clinical Trials} (). Industry vs. Government Clinical Trial Spending Split (90/10). Applied Clinical Trials. https://www.appliedclinicaltrialsonline.com/view/sizing-clinical-research-market {World Bank} (2022). Infrastructure investment economic multiplier (1.6). World Bank: Infrastructure Investment as Stimulus. https://blogs.worldbank.org/en/ppps/effectiveness-infrastructure-investment-fiscal-stimulus-what-weve-learned {International IDEA} (2026). International IDEA Voter Turnout Database world export. https://www.idea.int/data-tools/export?type=region_only&themeId=293&world=all&loc=home {IQVIA Institute for Human Data Science} (2024). The Global Use of Medicines 2024: Outlook to 2028. IQVIA Institute Report. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/the-global-use-of-medicines-2024-outlook-to-2028 {Market Urbanism} (2019). Why Is Japanese Zoning More Liberal Than US Zoning?. Market Urbanism. https://marketurbanism.com/2019/03/19/why-is-japanese-zoning-more-liberal-than-us-zoning/ {KOF Swiss Economic Institute} (2024). Healthcare expenditure rises to over CHF 100 billion. KOF Swiss Economic Institute, ETH Zurich. https://kof.ethz.ch/en/news-and-events/media/press-releases/2024/11/health-expanditures-forecast.html Lichtenberg, Frank R. (2019). How Many Life-Years Have New Drugs Saved? A Three-Way Fixed-Effects Analysis of 66 Diseases in 27 Countries, 2000-2013. International Health, 11, 403--416. doi:10.1093/inthealth/ihz003 PMC (2012). Contribution of smoking reduction to life expectancy gains. PMC: Benefits Smoking Cessation Longevity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447499/ {Source: US Life Expectancy FDA Budget 1543-2019 CSV} (2019). US life expectancy growth 1880-1960: 3.82 years per decade. https://manual.warondisease.org/knowledge/data/us-life-expectancy-fda-budget-1543-2019.csv OpenSecrets (2024). Lobbying Spend (Defense). OpenSecrets. https://www.opensecrets.org/industries/lobbying?ind=D OpenSecrets (). Lobbyist statistics for Washington D.C.. OpenSecrets: Lobbying in US. https://en.wikipedia.org/wiki/Lobbying_in_the_United_States Wikipedia (). Longevity Escape Velocity (LEV) - Maximum Human Life Extension Potential. Wikipedia: Longevity Escape Velocity. https://en.wikipedia.org/wiki/Longevity_escape_velocity {Think by Numbers} (2021). Lost human capital due to war (\$270B annually). Think by Numbers. https://thinkbynumbers.org/military/war/the-economic-case-for-peace-a-comprehensive-financial-analysis/ Bolt, Jutta and van Zanden, Jan Luiten (2020). Maddison Project Database 2020. https://www.rug.nl/ggdc/historicaldevelopment/maddison/releases/maddison-project-database-2020 Qredible (2024). The Economic Benefits of Legalizing Weed: A Compliance Perspective. https://qredible.com/the-economic-benefits-of-legalizing-weed-a-compliance-perspective/ {MDPI Vaccines} (2024). Measles Vaccination ROI. MDPI Vaccines. https://www.mdpi.com/2076-393X/12/11/1210 ScienceDaily (2020). Medical research lives saved annually (4.2 million). ScienceDaily: Physical Activity Prevents 4M Deaths. https://www.sciencedaily.com/releases/2020/06/200617194510.htm {World Health Organization} (2022). Mental health global burden. World Health Organization. https://www.who.int/news/item/28-09-2001-the-world-health-report-2001-mental-disorders-affect-one-in-four-people Mercatus (). Military spending economic multiplier (0.6). Mercatus: Defense Spending and Economy. https://www.mercatus.org/research/research-papers/defense-spending-and-economy {MIT CEEPR} (2025). Impacts of the Jones Act on U.S. Petroleum Markets. https://ceepr.mit.edu/wp-content/uploads/2025/02/MIT-CEEPR-WP-2025-03.pdf {U.S. Department of Defense} (2024). 5.56mm NATO Ammunition Bulk Procurement Pricing. https://www.bulkcheapammo.com/rifle-ammo/556-ammo Pike, John (2011). U.S. Forces Fire 250,000 Rounds for Every Insurgent Killed. https://jonathanturley.org/2011/01/10/gao-u-s-has-fired-250000-rounds-for-every-insurgent-killed/ NCDAS (2025). NCDAS: Substance Abuse and Addiction Statistics. https://drugabusestatistics.org/ {Daily Signal} (2016). What Happened When New Zealand Got Rid of Government Subsidies for Farmers. Daily Signal. https://www.dailysignal.com/2016/09/22/what-happened-when-new-zealand-got-rid-of-government-subsidies-for-farmers/ {National Institute of Corrections} (2016). The Economic Burden of Incarceration in the U.S.. https://nicic.gov/weblink/economic-burden-incarceration-in-us-2016 NIDA (2025). Trends and Statistics: Drug Use Trends. https://nida.nih.gov/research-topics/trends-statistics NIH (2024). NIH Budget (FY 2025). NIH. https://www.nih.gov/about-nih/organization/budget {Bentley et al.} (2023). NIH spending on clinical trials: ~3.3\%. Bentley et al.. https://pmc.ncbi.nlm.nih.gov/articles/PMC10349341/ {Estimated from major foundation budgets and activities} (). Nonprofit clinical trial funding estimate. {National Priorities Project} (2025). Shut Them Down! Closing Military Bases is Long Overdue. https://www.nationalpriorities.org/blog/2025/02/27/shut-them-down-closing-military-bases-long-overdue/ {National Taxpayers Union} (2025). Taxpayers Will Spend 7.1 Billion Hours and \$464 Billion on Tax Compliance in 2025. https://www.ntu.org/foundation/detail/taxpayers-will-spend-71-billion-hours-464-billion-on-tax-compliance-in-2025 {Xia et al., Nature Food} (2022). Nuclear Winter Famine. Xia et al.. https://www.nature.com/articles/s43016-022-00573-0 {Columbia/NBER} (2012). Odds of a single vote being decisive in a U.S. presidential election. Columbia/NBER: What Is the Probability Your Vote Will Make a Difference?. https://sites.stat.columbia.edu/gelman/research/published/probdecisive2.pdf {OECD} (2024). OECD Government Spending as Percentage of GDP. https://data.oecd.org/gga/general-government-spending.htm {OECD} (2024). OECD Median Household Income Comparison. https://data.oecd.org/hha/household-disposable-income.htm {HHS OIG} (2024). Medicare Advantage: Questionable Use of Health Risk Assessments Continues To Drive Up Payments to Plans by Billions. https://oig.hhs.gov/reports/all/2024/medicare-advantage-questionable-use-of-health-risk-assessments-continues-to-drive-up-payments-to-plans-by-billions/ OpenSecrets (2025). Intuit Inc Lobbying Profile. https://www.opensecrets.org/federal-lobbying/clients/summary?id=D000026667 OpenSecrets (2024). Federal Lobbying Hit Record \$4.4 Billion in 2024. https://www.opensecrets.org/news/2025/02/federal-lobbying-set-new-record-in-2024/ OpenSecrets (2024). Revolving Door: Former Members of Congress. https://www.opensecrets.org/revolving-door OverseasBases.net (2024). The Facts about US Military Bases Overseas. https://www.overseasbases.net/facts.html {Papanicolas, Irene et al.} (2018). Health Care Spending in the United States and Other High-Income Countries. Papanicolas et al.. https://jamanetwork.com/journals/jama/article-abstract/2674671 Trials (). Patient willingness to participate in clinical trials. Trials: Patients' Willingness Survey. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-1105-3 {Responsible Statecraft} (2024). Pentagon can't account for 63\% of nearly \$4 trillion in assets. https://responsiblestatecraft.org/pentagon-audit-2666415734/ {National Priorities Project} (2024). Take 7: The Pentagon Fails Another Audit. https://www.nationalpriorities.org/blog/2024/11/25/take-7-pentagon-fails-another-audit/ {The Commune} (2024). Pentagon audit failures (\$2.46T unaccounted). The Commune. https://thecommunemag.com/the-pentagon-misplaced-2-46-trillion-an-in-depth-look-at-the-financial-audit-failures {Peterson Foundation} (2024). Budget Basics: National Defense. https://www.pgpf.org/article/budget-explainer-national-defense/ {Peterson Foundation} (2024). How Does the U.S. Healthcare System Compare to Other Countries?. https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/ {Value in Health} (). Average lifetime revenue per successful drug. Value in Health: Sales Revenues for New Therapeutic Agents. https://www.sciencedirect.com/science/article/pii/S1098301524027542 {Deloitte} (2025). Pharmaceutical R\&D return on investment (ROI). Deloitte: Measuring Pharmaceutical Innovation 2025. https://www.deloitte.com/ch/en/Industries/life-sciences-health-care/research/measuring-return-from-pharmaceutical-innovation.html {SofproMed} (). Phase 3 cost per trial range. SofproMed. https://www.sofpromed.com/how-much-does-a-clinical-trial-cost Ramsberg, J. and Platt, R. (2018). Pragmatic Trial Cost per Patient (Median \$97). Learning Health Systems. https://pmc.ncbi.nlm.nih.gov/articles/PMC6508852/ WHO (2019). Polio Vaccination ROI. WHO. https://www.who.int/news-room/feature-stories/detail/sustaining-polio-investments-offers-a-high-return Sinn, Mike P. (2025). The Political Dysfunction Tax. doi:10.5281/zenodo.18603840 Kinch, Michael S. and Griesenauer, Robert H. (2019). Lost medicines: a longer view of the pharmaceutical industry with the potential to reinvigorate discovery. Drug Discovery Today, 24, 875-880. doi:10.1016/j.drudis.2019.01.009 {Source: US Life Expectancy FDA Budget 1543-2019 CSV} (2019). Post-1962 slowdown in life expectancy gains. https://manual.warondisease.org/knowledge/data/us-life-expectancy-fda-budget-1543-2019.csv {NIH Common Fund} (2025). NIH Pragmatic Trials: Minimal Funding Despite 30x Cost Advantage. NIH Common Fund: HCS Research Collaboratory. https://commonfund.nih.gov/hcscollaboratory Baily, Martin Neil (1972). Pre-1962 drug development costs (Baily 1972). Baily (1972). https://samizdathealth.org/wp-content/uploads/2020/12/hlthaff.1.2.6.pdf {Think by Numbers} (1962). Pre-1962 drug development costs and timeline (Think by Numbers). Think by Numbers: How Many Lives Does FDA Save?. https://thinkbynumbers.org/health/how-many-net-lives-does-the-fda-save/ {Think by Numbers} (1966). Pre-1962 physician-led clinical trials. Think by Numbers: How Many Lives Does FDA Save?. https://thinkbynumbers.org/health/how-many-net-lives-does-the-fda-save/ {Prison Policy Initiative} (2024). Economics of incarceration. https://www.prisonpolicy.org/research/economics_of_incarceration/ ProPublica (2019). Filing Taxes Could Be Free and Simple. But H\&R Block and Intuit Are Lobbying Against It. https://www.propublica.org/article/filing-taxes-could-be-free-simple-hr-block-intuit-lobbying-against-it PubMed (). Psychological impact of war cost (\$100B annually). PubMed: Economic Burden of PTSD. https://pubmed.ncbi.nlm.nih.gov/35485933/ Gosse, M.E. (2008). Assessing cost-effectiveness in healthcare: history of the \$50,000 per QALY threshold. Sustainability Impact Metrics. https://ecocostsvalue.com/EVR/img/references%20others/Gosse%202008%20QALY%20threshold%20financial.pdf ICER (2024). Value per QALY (standard economic value). ICER. https://icer.org/wp-content/uploads/2024/02/Reference-Case-4.3.25.pdf {Quincy Institute} (2024). Active Denial: A Roadmap to a More Effective, Stabilizing, and Sustainable U.S. Defense Strategy in Asia. https://quincyinst.org/research/active-denial-a-roadmap-to-a-more-effective-stabilizing-and-sustainable-u-s-defense-strategy-in-asia/ {Quincy Institute} (2024). Keys to Developing a More Efficient, Effective Defense at Lower Cost. https://quincyinst.org/research/keys-to-developing-a-more-efficient-effective-defense-at-lower-cost/ {Orphanet Journal of Rare Diseases (2024)} (2024). Rare Disease Treatment Gap. Orphanet Journal of Rare Diseases (2024). https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03398-1 {Oren Cass, Manhattan Institute} (2023). RECOVERY Trial Cost per Patient. Oren Cass. https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs {NHS England; {\'A}guas et al.} (2021). RECOVERY trial global lives saved (~1 million). NHS England: 1 Million Lives Saved. https://www.england.nhs.uk/2021/03/covid-treatment-developed-in-the-nhs-saves-a-million-lives/ {Manhattan Institute} (). RECOVERY trial 82× cost reduction. Manhattan Institute: Slow Costly Trials. https://manhattan.institute/article/slow-costly-clinical-trials-drag-down-biomedical-breakthroughs Rummel, R. J. (1994). Death by Government: Genocide and Mass Murder Since 1900. Transaction Publishers. https://www.hawaii.edu/powerkills/NOTE1.HTM {National September 11 Memorial \& Museum} (2024). September 11 Attack Facts. https://www.911memorial.org/911-faqs {Stockholm International Peace Research Institute} (2025). Trends in World Military Expenditure, 2024. https://www.sipri.org/publications/2025/sipri-fact-sheets/trends-world-military-expenditure-2024 {Stockholm International Peace Research Institute} (2024). Trends in World Military Expenditure, 2023. https://www.sipri.org/publications/2024/sipri-fact-sheets/trends-world-military-expenditure-2023 CSIS (). Smallpox Eradication ROI. CSIS. https://www.csis.org/analysis/smallpox-eradication-model-global-cooperation PMC (1990). Standard Medical Research ROI (\$20k-\$100k/QALY). PMC: Cost-effectiveness Thresholds Used by Study Authors. https://pmc.ncbi.nlm.nih.gov/articles/PMC10114019/ {United States Supreme Court} (2003). State Farm Mutual Automobile Insurance Co. v. Campbell, 538 U.S. 408. https://www.govinfo.gov/app/details/USREPORTS-538/USREPORTS-538-408 {Composite estimate based on Orphanet} (). Average Time to Cure Under Current System. GAO (). Annual cost of U.S. sugar subsidies. GAO: Sugar Program. https://www.gao.gov/products/gao-24-106144 {James Surowiecki} (2004). The Wisdom of Crowds. Surowiecki. https://archive.org/details/wisdomofcrowds0000suro {World Bank} (). Swiss military budget as percentage of GDP. World Bank: Military Expenditure % GDP Switzerland. https://data.worldbank.org/indicator/MS.MIL.XPND.GD.ZS?locations=CH {World Bank} (). Switzerland vs. US GDP per capita comparison. World Bank: Switzerland GDP Per Capita. https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=CH {Tax Foundation} (2024). Tax Compliance Costs the US Economy \$546 Billion Annually. https://taxfoundation.org/data/all/federal/irs-tax-compliance-costs/ Wikipedia (). Thalidomide scandal: worldwide cases and mortality. Wikipedia. https://en.wikipedia.org/wiki/Thalidomide_scandal {PLOS One} (2019). Health and quality of life of Thalidomide survivors as they age. PLOS One. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210222 {U.S. Treasury} (2024). Treasury Forfeiture Fund Accountability Report Fiscal Year 2024. https://home.treasury.gov/system/files/246/TFF-FY-2024-Accountability-Report.pdf {FDA Study via NCBI} (). Trial Costs, FDA Study. FDA Study via NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248200/ UCDP (). State violence deaths annually. UCDP: Uppsala Conflict Data Program. https://ucdp.uu.se/ CGDev (2024). UNHCR average refugee support cost. CGDev. https://www.cgdev.org/blog/costs-hosting-refugees-oecd-countries-and-why-uk-outlier AARP (2023). Unpaid caregiver hours and economic value. AARP 2023. https://www.aarp.org/caregiving/financial-legal/info-2023/unpaid-caregivers-provide-billions-in-care.html {US Census Bureau} (). Historical world population estimates. US Census Bureau. https://www.census.gov/data/tables/time-series/demo/international-programs/historical-est-worldpop.html CDC (). U.S. chronic disease healthcare spending. CDC. https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html CMS (2024). U.S. federal government spending on healthcare. CMS. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet Statista (2024). US military budget as percentage of GDP. Statista. https://www.statista.com/statistics/262742/countries-with-the-highest-military-spending/ Dave Manuel (2025). U.S. Defense Spending History: 100 Years of Military Budgets. DaveManuel.com . https://www.davemanuel.com/us-defense-spending-history-military-budget-data.php {U.S. Senate} (). Treaties. U.S. Senate. https://www.senate.gov/about/powers-procedures/treaties.htm {US Census Bureau} (2024). Number of registered or eligible voters in the U.S.. US Census Bureau. https://www.census.gov/newsroom/press-releases/2025/2024-presidential-election-voting-registration-tables.html USAFacts (2024). US Federal Agricultural Farm Subsidies: How Much Farmers Get By Year. https://usafacts.org/articles/federal-farm-subsidies-what-data-says/ {USC Schaeffer Center} (2024). Estimating Overpayments to MA Plans: MedPAC Critics Get It Wrong. https://schaeffer.usc.edu/research/estimating-overpayments-to-ma-plans-medpac-critics-get-it-wrong/ {Hutchinson and Kirk} (2011). Valley of Death in Drug Development. https://pmc.ncbi.nlm.nih.gov/articles/PMC3324971/ VA (2026). Veteran healthcare cost projections. VA. https://department.va.gov/wp-content/uploads/2025/06/2026-Budget-in-Brief.pdf {PLOS ONE} (2010). Cost per DALY for Vitamin A Supplementation. PLOS ONE: Cost-effectiveness of "Golden Mustard" for Treating Vitamin A Deficiency in India (2010). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0012046 CNBC (2025). Warren Buffett's career average investment return. CNBC. https://www.cnbc.com/2025/05/05/warren-buffetts-return-tally-after-60-years-5502284percent.html PMC (). Cost-effectiveness threshold (\$50,000/QALY). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5193154/ {World Health Organization} (2024). WHO Global Health Estimates 2024. World Health Organization. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates {World Health Organization} (2024). WHO Life Expectancy Data by Country. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy {World Bank} (2024). Expense (\% of GDP) - World. https://data.worldbank.org/indicator/GC.XPN.TOTL.GD.ZS?locations=1W {World Bank} (2024). Gross Savings (\% of GDP). https://data.worldbank.org/indicator/NY.GNS.ICTR.ZS?locations=1W {World Bank} (). World Bank trade disruption cost from conflict. World Bank. https://www.worldbank.org/en/topic/trade/publication/trading-away-from-conflict {Federation of American Scientists} (2024). World Nuclear Forces. Federation of American Scientists. https://fas.org/issues/nuclear-weapons/status-world-nuclear-forces/ {World Bank, Bureau of Economic Analysis} (2024). US GDP 2024 (\$28.78 trillion). World Bank. https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US {World Bank} (2024). Poverty and Shared Prosperity 2024. https://www.worldbank.org/en/publication/poverty-and-shared-prosperity {World Bank} (2024). World Bank Singapore Economic Data. World Bank. https://data.worldbank.org/country/singapore {Yale Budget Lab} (2025). The Fiscal, Economic, and Distributional Effects of All U.S. Tariffs. https://budgetlab.yale.edu/research/where-we-stand-fiscal-economic-and-distributional-effects-all-us-tariffs-enacted-2025-through-april 453 Views 573 Downloads Show more details All versions This version Views Total views 453 96 Downloads Total downloads 573 44 Data volume Total data volume 3.8 GB 312.2 MB More info on how stats are collected.... Versions External resources Indexed in OpenAIRE Communities Keywords and subjects Keywords government-efficiency public-finance resource-allocation systems-analysis federal-spending policy-analysis monte-carlo-simulation efficiency-metrics OECD-benchmarks allocation-inefficiency Details DOI DOI Badge DOI 10.5281/zenodo.20077608 Markdown [](https://doi.org/10.5281/zenodo.20077608) reStructuredText .. image:: https://zenodo.org/badge/DOI/10.5281/zenodo.20077608.svg :target: https://doi.org/10.5281/zenodo.20077608 HTML <a href="https://doi.org/10.5281/zenodo.20077608"><img src="https://zenodo.org/badge/DOI/10.5281/zenodo.20077608.svg" alt="DOI"></a> Image URL https://zenodo.org/badge/DOI/10.5281/zenodo.20077608.svg Target URL https://doi.org/10.5281/zenodo.20077608 Resource type Working paper Publisher Zenodo Languages English Rights License Creative Commons Attribution Non Commercial 4.0 International No further description. Read more Citation Export Technical metadata Created May 8, 2026 Modified May 8, 2026 Jump up About About Policies Infrastructure Principles Projects Roadmap Contact Blog Blog Support Help FAQ Developers REST API OAI-PMH Contribute GitHub Donate Funded by Powered by CERN Data Centre & InvenioRDM Status Privacy policy Cookie policy Terms of Use This site uses cookies. Find out more on how we use cookies Accept all cookies Accept only essential cookies

Related documents

• An Analysis of Audit Risk in Associating with Reserve Information of Oil and Gas Companies#456439
• NIST SP 1800-2: Identity and Access Management for Electric Utilities#2829
• Bank risk and deposit insurance#956384
• 12 U.S.C. § 1784 — Examination of insured credit unions#564329
• 42 U.S.C. § 2996h — Audits#592974