Summary

Seven years after the creation of the U.S. Digital Service (USDS) and 18F, the Federal Government still struggles to buy, build, and operate technology in a modern, scalable way. While there have been small success stories, most government technology and delivery practices remain antiquated and ineffective. Critical systems underperforming during the COVID-19 crisis is the latest example of technology and delivery failing to meet the needs of Americans. The federal government will spend $90.9 billion on information technology (IT) projects in fiscal year (FY) 21, an increase of $15.3 billion since it began to embrace the digital-services movement in earnest in FY14 in response the high failure rate of federal IT projects. Yet the public is not receiving the value expected from this substantial investment in technology. Between 2003 and 2012, only 6.4% of IT projects with a budget of over $10 million were considered successful. 41% were complete failures that had to be scrapped and started again. There is no evidence that performance has improved on a large scale since FY12.

In spite of efforts to implement transformative technological practices, most government systems still fail to meet modern standards or expectations. The next administration should undertake a series of actions outlined in this memo to scale proven IT modernization strategies across the Federal Government to improve its structure and culture, and buy, build, and deliver technology that meets the needs of Americans today and into the future.

Summary

A national regenerative agriculture initiative launched by the federal government could transform how American farmers provide food, fiber, and land stewardship. This initiative would commit to matching what farmers earn growing food and fiber with an equal investment in farmers’ work to rebuild the country’s natural capital.

Regenerative agriculture produces a safe and abundant food supply while building soil health and regenerating natural resources. This approach recognizes the key roles farmers and ranchers have in providing clean air, clean water, and ecosystem services that benefit all society.

A national regenerative agriculture initiative would provide needed investment in rural economies while simultaneously empowering current and future farmers to grow food in ways that improve soil health, ecosystem services, and natural resources. This strategic initiative would support the return of farming as a more widely valued job in America.

To achieve truly regenerative agricultural systems nationwide, the federal government should catalyze new markets and focus federal funding for regenerative agriculture programs, research, and development. Key steps towards this goal include creating a Regenerative Agriculture Advisory Task Force, mobilizing substantial investments to upgrade the agricultural sector, and prioritizing regenerative agriculture as a major theme in agricultural innovation.

Summary

The next administration should support legislation to fund the National Climate Bank, a non- profit that will create millions of jobs through public-private investment in clean energy and climate-related technologies. Built on the successful “green bank” model, the Climate Bank will spur $500 billion of private and public investment, create 5.4 million jobs, and reduce greenhouse-gas emissions while driving capital into frontline and environmental-justice communities. Legislation to support this policy passed the House of Representatives with billions of dollars in funding in July. The administration can enact this policy by including funding for the National Climate Bank in its climate and infrastructure-oriented stimulus proposals to Congress.

Summary

The COVID-19 pandemic has pushed science to the forefront of public attention. For many Americans, following daily reports about the novel coronavirus represents the first time they are seeing science and scientists operate in “real time”. This experience is new for scientists too. Scientists are not trained to engage the public, despite the fact that scientific research is put to work daily to help improve lives, address the needs of diverse communities, and solve problems at a national and global scale.

This proposal offers a set of actions to give federally-funded Ph.D. students in science, technology, engineering, and math (STEM), specific training to enable them to engage effectively with the public. In turn, this will increase trust in and support for the scientific enterprise, drive stronger interest in STEM careers, set the stage for faster response to threats, and build a stronger, science-driven U.S. economy. Lastly, at a local level, taxpayers will benefit directly as more scientists are trained to engage regularly and meaningfully with schools, community institutions, and local governments.

Summary

Wildfires, damages, and deaths are increasing because of unnatural accumulations of wood from outdated forest policies and intensifying heat from human-caused climate change. Preventing catastrophic wildfires requires improved, science-based policies that will shift the government from after-the-fact firefighting to proactive controlled burning. This would improve the lives of Americans and the health of our ecosystems by reducing deaths and damage due to wildfire, restoring damaged forests that naturally require fire, and decreasing the carbon emissions that cause climate change.

This memorandum outlines a policy approach to achieve these outcomes. Executive action will establish a national strategy for proactive fire management. Legislation will ensure revenue neutral implementation by reallocating funds currently used for firefighting to less expensive and more effective fire prevention. Finally, fire managers will increase prescribed burning and use of natural fires, relying on scientific analyses to target areas at greatest risk under climate change.

Summary

The next administration should institute a national White House Youth Innovation Showcase similar to the discontinued White House Science Fair to promote and provide new opportunities for increased K–12 participation in science, technology, engineering, and math (STEM). As a national platform to amplify and inspire scientific accomplishments by students of all backgrounds, the Showcase will help the next administration strengthen the U.S. STEM talent pipeline and pave the way for future growth in American science and technology industries. The Showcase will also provide an opportunity for the White House Office of Science and Technology Policy (OSTP) to facilitate public-private collaborations that provide resources for participating students and support regional initiatives to increase diversity in STEM fields. The next administration can use the announcement of the Showcase to reveal its STEM agenda, outlining its policies to support STEM education and a diverse STEM workforce while articulating how its STEM goals will support emerging technology industries and overall economic development.

Summary

With about $130 billion USD, the United States leads the world in federal research and development spending. Most of this spending is distributed by science and technology (S&T) agencies that use internal reviews to identify the best proposals submitted in response to competitive funding opportunities. As stewards of quality scientific research, part of each funding agency’s mission is to ensure fairness, transparency, and integrity in the proposal-review process. Manual proposal review is time-consuming and expensive, costing an estimated $300 million annually at the National Science Foundation alone. Yet at current proposal-success rates (between 5% and 20% for most funding opportunities), a substantial fraction of proposals reviewed are simply not competitive.

The next administration should initiate and execute a plan to advance machine learning to triage scientific proposals. This proposal presents a set of actions and a vision to diffuse machine-learning across science and technology agencies to ultimately become a standard component of proposal review, while improving the efficiency of the funding process without compromising the quality of funded research.

Summary

Breastfeeding can provide important health and financial benefits for new families. But insufficient healthcare coverage, underlying medical conditions, and economic obstacles can make breastfeeding difficult or impossible for many parents. In this memo, a three-pronged approach is proposed—facilitated by an interagency collaboration through the National Advisory Council on Maternal, Infant, and Fetal Nutrition—to transform infant nutrition. First, to increase breastfeeding rates in the United States, the Centers for Medicare & Medicaid Services (CMS) should alter reimbursement policy by reimbursing tele-lactation and nutrition support for all babies covered under Medicaid. Second, the government should partner with the private sector to launch a “Synthesizing Human Milk Grand Innovation Challenge” to catalyze new extramural R&D and innovation efforts to accelerate commercialization of breast-milk alternatives for those that cannot breastfeed. And finally, the government should enact paid parental leave policies to give parents financial flexibility and dedicated time after birth to breastfeed.

Summary

With 1,255 VA medical facilities serving over 9 million veterans each year, the VA — through its Veterans Health Administration — maintains the largest integrated healthcare system in the United States. The VA is a national leader in delivering quality health services and driving innovation in high-priority healthcare issues such as telehealth, precision medicine, suicide prevention, and opioid safety. Yet the VA remains an under-appreciated and underutilized health policy stakeholder, involved in minimal interactions with other federal health agencies and exerting limited influence on the private healthcare system. This is a mistake. The VA is a robust healthcare provider with innovative clinical and operational practices that should be firmly entrenched in the national health policy conversation.

As a remedy, we propose strategically coordinating and consolidating the healthcare innovation, demonstration, and implementation capacities of the VA and HHS in order to ensure care of the highest possible quality across urgent issues. Elevating the VA as a major healthcare policy stakeholder will demonstrate the value of government-run healthcare, promote best practices for building an effective and forward-thinking healthcare system, and advance the VA’s “fourth mission” of supporting national preparedness.

Summary

Pending bipartisan “Cures 2.0” legislation is intended to safely and efficiently modernize healthcare delivery in the wake of the novel coronavirus (COVID-19) pandemic. Such modernization is contingent on access to high-quality data to power innovation and guided decision-making. Yet over 80% of Americans feel that the potential risks of companies collecting their data outweigh the benefits. To ensure the success of Cures 2.0, provisions must be added that bolster public trust in how health data are used.

Addressing the largely unregulated activities of data brokers — businesses that collect, sell, and/or license brokered personal information — offers a budget-neutral solution to the public’s crisis of faith in privacy. Building a well-governed health-data ecosystem that the public can trust is essential to improving healthcare in the United States.