Optimocracy: Causal Inference on Cross-Jurisdictional Policy Data to Maximize Median Health and Wealth
Description
Website: https://manual.warondisease.org/knowledge/appendix/optimocracy-paper.html
Abstract: Thousands of jurisdictions (municipal, state, federal, international) have exposed populations to different policies over decades. This cross-jurisdictional variation is a natural experiment. Optimocracy: (1) Apply causal inference to this historical policy data, (2) Identify which policies predict above-average median income and healthy life years, (3) Publish recommendations for every major vote, (4) Track politician alignment with evidence, (5) Algorithmically fund the campaigns of the most aligned policymakers via SuperPAC. Politicians still decide; the algorithm just makes ignoring evidence expensive. At system scale, the Optimal Governance Trajectory reaches 56.7x (95% CI: 19.3x-304x) the Earth baseline after 20 years, raises average income to \$1.16M (95% CI: \$395K-\$6.22M) versus \$20.5K on the status-quo path, reaches \$10.7 quadrillion (95% CI: \$3.64 quadrillion-\$57.2 quadrillion) in total output, and recovers roughly \$101T (95% CI: \$83.3T-\$191T)/year in suppressed value ([The Political Dysfunction Tax](https://political-dysfunction-tax.warondisease.org)).
Summary: Thousands of jurisdictions have made different policy and budget choices over decades, creating a natural experiment. Optimocracy applies causal inference to this cross-jurisdictional time-series data to identify which policies predict above-average median income and healthy life years. It then publishes evidence-based recommendations for every major vote, tracks politician alignment, and funds aligned candidates via SuperPAC, making suboptimal policy politically expensive while preserving democratic structures.
Notes
Files
optimocracy-paper.pdf
Files
(12.8 MB)
| Name | Size | Download all |
|---|---|---|
|
md5:7f6ff311b8e60e21e05a17de9805f027
|
12.8 MB | Preview Download |
Additional details
References
- Sinn, Mike P. (2025). The 1\% Treaty: Harnessing Greed to Eradicate Disease. doi:10.5281/zenodo.18161560
- {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/
- Arrow, Kenneth J. (1951). Social Choice and Individual Values. Kenneth J. Arrow. https://www.amazon.com/Social-Choice-Individual-Values-Monograph/dp/0300013647
- {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
- 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
- {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
- 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
- Coase, Ronald H. (1960). The Problem of Social Cost. Ronald H. Coase, 3, 1-44. https://www.jstor.org/stable/724810
- Coffey, Bentley and McLaughlin, Patrick A. and Peretto, Pietro F. (2020). The Cumulative Cost of Regulations. Review of Economic Dynamics, 38, 1-21. https://www.sciencedirect.com/science/article/abs/pii/S1094202520300223
- Sinn, Mike P. (2025). The Price of Political Change: A Cost-Benefit Framework for Policy Incentivization. doi:10.5281/zenodo.18356215
- Costinot, Arnaud and Rodriguez-Clare, Andres (2015). Trade Theory with Numbers: Quantifying the Consequences of Globalization. Handbook of International Economics, 4, 197-261. https://economics.mit.edu/sites/default/files/publications/Trade-Theory-with-Numbers-Quantifying.pdf
- {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/
- Dawson, John W. and Seater, John J. (2013). Federal Regulation and Aggregate Economic Growth. Journal of Economic Growth, 18, 137-177. https://link.springer.com/article/10.1007/s10887-013-9088-y
- Del Rosal, Ignacio (2011). The Empirical Measurement of Rent-Seeking Costs. Journal of Economic Surveys. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-6419.2009.00621.x
- 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
- 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/
- Drutman, Lee (2015). The Business of America is Lobbying. Oxford University Press. doi:10.1093/acprof:oso/9780190215514.001.0001
- 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/
- 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/
- {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
- Gibbard, Allan (1973). Manipulation of Voting Schemes: A General Result. Econometrica, 41, 587-601. doi:10.2307/1914083
- Gilens, Martin and Page, Benjamin I. (2014). Testing Theories of American Politics: Elites, Interest Groups, and Average Citizens. Perspectives on Politics, 12, 564-581. doi:10.1017/S1537592714001595
- 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
- {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/
- Goodhart, Charles A. E. (1984). Problems of Monetary Management: The UK Experience. Monetary Theory and Practice, 91-121.
- {Our World in Data} (2024). Terror attack deaths (8,300 annually). Our World in Data: Terrorism. https://ourworldindata.org/terrorism
- Hayek, Friedrich A. (1945). The Use of Knowledge in Society. American Economic Review, 35, 519-530. https://www.econlib.org/library/Essays/hykKnw.html
- PMC (2022). Healthcare investment economic multiplier (1.8). PMC: California Universal Health Care. https://pmc.ncbi.nlm.nih.gov/articles/PMC5954824/
- 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
- Sinn, Mike P. (2025). Incentive Alignment Bonds: Making Public Goods Financially and Politically Profitable. doi:10.5281/zenodo.18203221
- 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
- {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
- Kleiner, Morris M. and Krueger, Alan B. (2013). Analyzing the Extent and Influence of Occupational Licensing on the Labor Market. Journal of Labor Economics, 31, S173-S202. https://www.journals.uchicago.edu/doi/abs/10.1086/669060
- 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/
- Maskin, Eric (1999). Nash Equilibrium and Welfare Optimality. Review of Economic Studies, 66, 23-38.
- {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
- Mulcahy, Andrew W. and Schwam, Daniel and Edenfield, Nathaniel (2021). International Prescription Drug Price Comparisons. https://www.rand.org/pubs/research_reports/RR2956.html
- Myerson, Roger B. (1981). Optimal Auction Design. Mathematics of Operations Research, 6, 58-73. doi:10.1287/moor.6.1.58
- 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.
- Sinn, Mike P. (2025). The Optimal Budget Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Goods Funding. doi:10.5281/zenodo.18356209
- {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
- Olson, Mancur (1996). Big Bills Left on the Sidewalk: Why Some Nations are Rich, and Others Poor. Journal of Economic Perspectives, 10, 3-24. https://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.10.2.3
- 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
- Sinn, Mike P. (2025). The Optimal Policy Generator: A Causal Inference Protocol for Maximizing Median Health and Wealth Through Public Policy. doi:10.5281/zenodo.18603834
- {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
- {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
- Philipson, Tomas and Berndt, Ernst R. and Gottschalk, Adrian H. and Sun, Eric (2008). Cost-benefit Analysis of the FDA: The Case of the Prescription Drug User Fee Acts. Journal of Public Economics, 92, 1306-1325. https://www.sciencedirect.com/science/article/abs/pii/S0047272708000054
- 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/
- 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
- {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
- {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
- {S\&P Dow Jones Indices} (2023). SPIVA U.S. Scorecard Year-End 2023. https://www.spglobal.com/spdji/en/research-insights/spiva/
- 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/
- {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
- {The Nation} (2021). The Pentagon's Revolving Door Keeps Spinning. The Nation. https://www.pogo.org/analyses/the-pentagons-revolving-door-keeps-spinning-2021-in-review
- {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/
- {United Nations} (2018). Corruption Costs Global Economy \$2.6 Trillion Annually. https://www.unodc.org/unodc/en/frontpage/2018/December/corruption-costs-the-global-economy-us-2_6-trillion-annually-says-un-anti-corruption-day.html
- 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
- Sinn, Mike P. (2025). United States Efficiency Audit. doi:10.5281/zenodo.18447476
- 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
- {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). 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
- {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). 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