for departmental decision making, including the Centers for Medicare and Medicaid (CMS) reimbursement policy.

  1. Congress should allocate sufficient, predictable funding for NIH, CDC, FDA, and the Agency for Healthcare Research and Quality (AHRQ) in order to preserve and enhance these agencies’ scientific missions. Congress should also establish a specific budget line for AHRQ that is independent of appropriations to other HHS agencies.

  2. To address the growing threat of food-borne illnesses, Congress should unify the U.S. Department of Agriculture’s (USDA’s) Food Safety and Inspection Service and the food safety activities of FDA within HHS and ensure provision of adequate resources for high-quality inspection, enforcement, and research.


As the organization charged with primary responsibility for ensuring the health and well-being of Americans, HHS must keep pace with rapid advances in many fields—biomedical sciences, health care technologies, the organization of health care, information technologies, health and social services research, and quality improvement. It also must keep abreast of emerging global threats to health, rising consumer expectations, and pressure for cost control and greater efficiency.

As Chapter 2 shows, substantial evidence indicates problems in HHS’s structure and alignment. However, even with an optimal structure and admirable alignment across its many units, HHS would face an array of challenges that were unimaginable when the department was created in 1953. First, like any large American organization, it must adapt to new and overarching trends, including many described by the former comptroller general:

  • the need to respond to terrorism and other threats to security,

  • a population marked by increasing diversity and older age,

  • an accelerating pace of advances in science and technology,

  • rapid evolution of information and communications technology,

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