Target Ineffective Programs, Not People, to Save Money

April 25, 2025

Opinion; By Diana Fishbein & Neil Wollman

This opinion piece can also be found at: https://medium.com/@dianafishbein/target-ineffective-programs-not-people-to-save-money-155ee655de1a

An army of researchers, service providers, physicians, community workers, prevention practitioners, and countless others who serve the American public on a daily basis have been either fired or otherwise rendered unable to perform their duties.

The common thread is that this federally-funded work has been abruptly terminated by Elon Musk and DOGE. And now, RFK Jr, at the behest of the administration, has cut 10,000 jobs across Health and Human Services—a sprawling Department charged with everything from providing health insurance to 137 million Americans, to protecting us from disease epidemics and preventing mental health problems. And more cuts are imminent.

They say these actions will eliminate fraud, waste, and abuse and, in the process, improve efficiency. However, the rapid-fire succession of these actions has not allowed for a thorough analysis of the value-added of programs and services being terminated.

In reality, the effectiveness of government operations is being sacrificed for these strictly cost-cutting measures. Effective governance is essential for achieving true efficiency as it ensures that the government's mandate can be carried out successfully.

Compromising effectiveness will prove devastating to the many Americans already facing challenges, such as the need for safe environments, childcare, special education, and physical and mental health care. The reductions we are seeing in human services will impair the nation's ability to meet these needs. And worse, this strategy could wreak havoc on the public’s health. Slashing funds for effective programs in other countries that prevent the spread of highly transmissible diseases, for example, mean they are now more likely to reach our shores.

A smarter way to cut waste and preserve effectiveness is to invest in an "evidence-based” approach to government. Decades of careful research have identified numerous programs that work and many that don’t. Cutting ineffective programs and providing employees with opportunities to deliver evidence-based services saves money and makes our country stronger. Strategies funded by NIH alone have been found to generate $2.5 for every $1 invested.

So yes, let’s cut that waste. But let’s not throw the baby out with the bathwater.

The evidence used to guide cost-effective decision-making also underscores the importance of preventing problems rather than reacting to them after they’ve become entrenched. Take, for example, substance abuse. We can wait until teens begin to use drugs, with some eventually becoming addicted, before we intervene. Or we can prevent drug use altogether with proven programs.  

Although solving existing problems is of course necessary, prevention is far less costly in both human and financial terms than allowing problems to fester before we act. Concerns such as academic failure, bullying, child maltreatment, mental health issues, and medical conditions associated with an unhealthy lifestyle can be addressed by investing in evidence-based prevention strategies. Indeed, “An ounce of prevention is worth a pound of cure” (Benjamin Franklin).

The good news is that databases populated with programs shown to prevent a wide array of problems are already available. There are also many other issue areas that have been evaluated but where data are not yet neatly packaged into a ready-to-use registry, such as foreign aid, climate change, and entitlement programs. And several US-based research shops—including the Rand Corporation, Center for Naval Analyses, Center for a New American Security, and National Science Foundation—collect and organize data on best practices in national security.

Using artificial intelligence (AI), this information can be readily assembled into platforms used by existing registries for a more evidence-based approach to policymaking (see the framework outlined by the National Prevention Science Coalition to Improve Lives). And while further research is needed on programs yet to be evaluated, AI can make the data available on a timely and cost-efficient basis. Ultimately, benefits to the public will translate to reduced demands on governmental systems.

A prime example of how evidence-based policymaking might have been more beneficial and less harmful has to do with the decision to decimate USAID. Many independent evaluation studies have been carried out on the work of USAID, and the agency itself provides grants to innovators and researchers to test new ideas, take strategic risks, build evidence of what works, and advance the best solutions. Reviewing those data to determine where best to cut could have avoided the adverse impacts we are already seeing on global health and national security.

Similarly, DOGE just ordered AmeriCorps to cancel $400 million in grants. Instead of arbitrarily cutting AmeriCorps programs to ostensibly save money, determining first whether the community services these programs offer have been effective would have been wiser. And indeed, analyses by an external independent agency found they have been highly cost-beneficial, actually saving the government money.

Using existing data and further populating registries with rigorously tested programs will ensure that our investments benefit Americans, in accordance with the Evidence-Based Policymaking Act signed into law by President Trump in 2018.

Evidence-based, prevention-minded policymaking is likely to resonate on both sides of the aisle and has the potential to coalesce the public around what can be done for the greater good. Imagine a future where the US government is celebrated rather than denigrated. It's time we embrace evidence-based policies to reduce waste while preserving effectiveness and investing in prevention for a more resilient, healthier nation.

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Diana Fishbein, Ph.D. is a Nova Scholar and president of the National Prevention Science Coalition to Improve Lives, senior scientist in the Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, and part-time research faculty at Penn State University. dfishbein@unc.edu: 301–717–1641

Neil Wollman, Ph.D. is a retired senior fellow at Manchester and Bentley Universities and former co-director of the National Prevention Science Coalition to Improve Lives. neiljwollman@gmail.com