Contrary to Michael Crow's implications (Nature 471, 569–571; 2011), the annual budget of the US National Institutes of Health (NIH) of US$31 billion is only a small percentage (barely 1%) of yearly US health spending — now $2.5 trillion.

US health care is costly because it is the only wealthy industrialized country without public health insurance. Its citizens give vast sums to insurance companies whose primary function is to bleed money from the system while maximizing profit.

Everyone should benefit when an NIH-funded discovery is made that extends human life. But a shamefully large fraction of the US population does not because they have inadequate health insurance, if any. More politically enlightened nations stand to gain more by providing the best possible health care.