OPINION:
In April 1945, President Franklin Delano Roosevelt died of a hemorrhagic stroke after years of uncontrolled hypertension, an illness many doctors treated as an inevitable fact of aging. At the time, half of American deaths were from cardiovascular issues. FDR’s death galvanized Washington to ask not just how to treat heart disease, but how to prevent it. Congress funded the Framingham Heart Study, which is still-ongoing today with its third generation of participants. The Framingham Study revolutionized the modern understanding of heart disease, helping save millions of lives and catalyzing a 70% decline in cardiovascular mortality.
That kind of sustained public investment was the foundation for decades of American biomedical dominance. Funding from the National Institutes of Health underwrote foundational discoveries not only in cardiovascular disease, but in cancer biology, immunology, virology, and more. This work unlocked cholesterol-lowering drugs, targeted cancer therapies, organ transplantation, and modern vaccines. These investments did more than advance science: they reshaped clinical practice, extended life expectancy, and anchored America’s leadership in the global life sciences economy.
But that leadership position is now fading. Over the past decade, China has translated scale into genuine leadership in several major areas of health science. Chinese institutions now publish more scientific research papers annually than the United States, and their share of highly-cited medical research has risen rapidly. Chinese scientists are now global leaders in areas like single-cell biology, CRISPR screening, AI-enabled drug discovery, and large-scale population genomics. The difference is not ambition or intelligence, it’s that China has built a health science system that prioritizes speed and scale while the United States burdens scientists with fragmentation, short funding cycles, and defensive bureaucracy.
American researchers are still largely organized around short-cycle, project-specific grants. The current NIH funding process prioritizes paperwork compliance and short-term accountability, rewarding predictability over boldness and incremental progress over breakthroughs. Neverending political fights are partly to blame. But over the last year, the challenges mounted as the Trump administration disrupted universities, restricted scientific visas-and paused research trials.
We have to fix what the Trump administration broke, but American science lost ground even before President Donald Trump came into office. We must think more seriously about reform and how to get better value and more innovation regardless of overall funding levels. One useful example comes from funding models that have been proven successful by philanthropic donors. Research organizations like the Arc Institute and Howard Hughes Medical Institute fund investigators with long horizons and flexible budgets and often require collaboration when it makes scientific sense.
Both Arc and HHMI fund people, not projects. They pick extraordinary scientists, support them for seven to ten years, and allow research agendas to evolve as results emerge rather than locking investigators into fixed-grant deliverables. This structure mirrors how scientific breakthroughs actually occur, and decades of retrospective analysis show that investigator-centered funding produces a disproportionate share of highly cited work and transformative discoveries.
Reform will strengthen public accountability by measuring long-term scientific progress rather than short-term grant compliance. The NIH needs a new grant mechanism to bring these private sector successes in-house to fund projects with longer horizons, fewer interim milestones, greater budget flexibility, and evaluation based on scientific trajectories rather than narrowly defined project outcomes.
Unlike so many other fights over science right now, this is a bipartisan effort. A new bill I co-authored with Rep. Jay Obernolte, R-Calif., would allow the NIH to fund high-risk, high-reward scientific exploration, and the National Science Foundation has already begun moving in the same direction. Just last week, NIH Director Dr. Jay Bhattacharya voiced new support for establishing this kind of initiative. This should be just the beginning of rethinking how to put innovative, high-return science at the center of the NIH.
This is not an abstract competition among scientists or a zero-sum race for prestige. The structure of American biomedical research determines how quickly new treatments reach patients, how prepared our country is for the next pandemic, and whether the United States remains the place where the most ambitious ideas in medicine are pursued rather than postponed.
America built our postwar leadership by recognizing that discovery under uncertainty requires trust in people, long horizons, and tolerance for failure. The Framingham Heart Study was not safe or incremental; it was a bet that knowledge could change the course of heart disease. If the United States wants to remain a biomedical superpower, we cannot rely on past institutions running on outdated incentives. Reforming how American science funds discovery is not about spending more. It’s about deciding whether America still intends to lead.
• Rep. Josh Harder represents California’s 9th Congressional District. He’s a member of the powerful House Appropriations Committee, where he serves on the subcommittees on Labor, Health and Human Services, and Education and Interior, Environment, and Related Agencies.
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