Project 2025's plan to make Medicare Advantage the default option would give corporations even more power and strip doctors and patients of the freedom to make decisions about what care enrollees can or cannot receive.
Agency for International Development
mission a minimum percentage of its portfolio that must go to new, underutilized, and local partners. Crucial to the strategy will be increasing the use of open competition that lowers barriers to entry and fixed-amount awards that carry less of a compliance burden along with eliminating cost-plus reimbursement contracts
that favor large companies. Before advancing a new program, the agency should
be required to assess existing local activities to avoid undercutting or duplicating them. At every opportunity, USAID should build on existing local initiatives.
Global Health. The United States is the world’s largest funder of global health initiatives. For more than 60 years, the American people have offered health assistance to the world and saved millions of lives. The USAID Bureau for Global Health (GH), the second largest within USAID, oversees a multibillion-dollar operation to support maternal and child health; voluntary family planning; PEPFAR and the President’s Malaria Initiative (PMI) (both started under President George W. Bush); and other initiatives against other infectious and neglected tropical diseases. Effective use of funds is essential to maximize care for the world’s neediest people.
Countries with strong health institutions and sound public health practices responded quickly to and recovered more rapidly from the COVID-19 pandemic. This demonstrates the importance of “localization,” by which USAID helps governments and the private sector in developing countries to strengthen their own ability to address needed training, services, accountability, and organizational capacity.
Unfortunately, many USAID -funded global health activities remain rooted in patterns that began decades ago and measure improvements in terms of inputs— money spent—instead of outcomes achieved. From the 1950s to 1970s, the major recognized threats to human health were infectious diseases such as polio and smallpox, and USAID funded programs “in” a country, not “with” a country. Maternal and child health, food, water, and sanitation programs were often intermittent. USAID consistently financed population control, contraception, and abortion as essential to “development.” Most programs focused on one disease or condition but had little integration with other global health activities. Chronic diseases were ignored.
Consequently, the next conservative Administration should focus on updating the Global Health Bureau’s portfolio, emphasizing a comprehensive approach to supporting women, children, and families; building host-country institutional capacity; increasing awards to local and faith-based partners (expanding what occurred during the Trump Administration with the NPI); and improving USAID’s ability to coordinate with local partners.
Updating Funding Priorities. The Bureau should identify and eliminate outdated and ineffective concepts and focus on funding innovation. A rigorous review is necessary to ensure that current programs and funding streams avoid wasting taxpayer dollars and prioritize what is needed now and what works.
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