When nations face a fiscal emergency they turn to the International Monetary Fund (IMF). When they need capital to build roads, energy grids, or water sanitation, they go to the World Bank.

Both institutions play essential roles in the international financial system. But Treasury Secretary Scott Bessent believes “mission creep has knocked these institutions off course.”

Earlier this year, Bessent warned that the IMF and World Bank have drifted from their mandates by devoting time and resources to work on climate change, gender, and social issues. On Wednesday, he acknowledged recent course corrections and urged both institutions to continue refocusing on their original mandates.

“At a time when countries around the world are tightening their belts, we should expect the same from public institutions that have been built with and supported by taxpayer money from around the world,” Bessent said this week ahead of both the IMF and World Bank’s annual meetings.

He criticized the board’s “ballooning salaries” and expanding administrative overhead, urging the institutions to impose financial discipline. “Resources must not be siphoned away from the core missions,” he added.

Part of that mission involves refocusing the IMF and World Bank’s relationship with China.

Last week, China sent a letter announcing large-scale export controls taking effect on November 1. President Donald Trump said the export controls would be on “virtually every product they make“ and “affect all countries.” He condemned the policy as a “moral disgrace” and responded with a threat to raise tariffs to 100% on all Chinese imports.

Bessent, echoing Trump’s concerns, urged the IMF and the World Bank to take another look at China.

“The IMF is uniquely positioned to provide bilateral and multilateral economic surveillance that identifies imbalances and risks, facilitates the balanced growth of international trade, and discourages harmful policies.”

Bessent called the IMF to examine China’s policies, focusing their surveillance “on macroeconomic and financial stability” rather than “climate and gender.”

Addressing the World Bank, Bessent pushed for implementing a graduation policy “supporting countries along the way to self-reliance and enabling the bank to concentrate its resources on poorer, less creditworthy countries where its support is most needed and most impactful.”

Bessent specifically named China as a country that should no longer be receiving World Bank assistance, saying it’s time for the institution to “graduate” China and focus its limited resources where support is truly needed.

Bessent’s stance matters. The United States is the largest financial contributor to both institutions, giving it considerable influence over policy direction and voting power.

The Treasury Secretary’s remarks also mark a sharp change in policy from his predecessor. At the 2024 Annual Meetings of the International Monetary Fund and World Bank, Biden Treasury Secretary Janet Yellen praised the “record high of nearly $75 billion in climate finance to low- and middle-income countries in 2023, a 45 percent increase from 2021.”

“Confronting climate change, of course, remains at the top of our agenda,” she announced. She also supported an expansion of IMF funding through increased quotas.

A Colorado woman bled on the emergency room floor while waiting 12 hours for care. A New York man who feared he had appendicitis waited eight hours while repeatedly vomiting and passing out. A cancer survivor in San Francisco waited 28 hours for a doctor to examine her injured leg. By the time she saw a doctor, she was paralyzed.

ER wait times have been steadily increasing since 2012, spiking during the coronavirus pandemic. Today, they’re higher than ever.

What is happening in America’s emergency rooms?

A new study published in the journal Health Affairs looked at data from 46 million emergency visits across all 50 states since 2017. Researchers found a national increase in wait times, with the average wait time exceeding four hours. Additionally, 5% of patients waited more than 24 hours to get assistance.

Notably, the study did not factor people leaving the ER before they received care, which is typically referred to as ER “abandonment.”

Staffing shortages are certainly a factor, but they alone can’t explain increased wait times.

According to Niklas Kleinworth, a policy analyst at the Paragon Health Institute, the problem is largely due to the lack of financial incentives in the American healthcare system.

“I think that the increased ER wait times are actually one of the big broken promises of Obamacare,” Kleinworth told The Daily Wire on Thursday. “When that law was passed, we were promised that if you gave people more healthcare coverage, they would see their primary care physician instead of going to the ER. They would have more access. But we’ve actually seen the opposite.”

“We’ve seen that a lot of the financial incentives for people to take care of themselves and go see their regular physician haven’t come to fruition,” he explained. “And so now people are going to the emergency room to get routine care instead.”

Kleinworth said expanding telehealth services could help solve this problem. In Montana, for example, after Gov. Greg Gianforte (R) signed a bill in 2021 to increase telehealth access and eliminate certain restrictions, emergency department visits decreased with Medicaid enrollees. Mental health services were also more accessible and cost-effective for residents in rural communities and the Native population.

Another problem is the increased rate of rural hospital closures. With fewer rural hospitals, Americans from these areas are forced to travel longer distances to city hospitals, adding to already congested ERs.

Kleinworth explained that federal programs like the 340B Drug Pricing Program actually “encourage consolidation.” As a result, we’re seeing large urban hospitals buy up small rural hospitals to capitalize incentives meant for rural areas.

Larger city hospitals “benefit from a lot of the programs that were designed for those [rural] hospitals, like 340B Drug Pricing Program,” he said. “And then they’ll reduce access to services in those areas and redirect them to more wealthy areas where the margins are higher.”

He also highlighted some other “pretty basic solutions,” like making sure government programs designed to help rural facilities actually help rural facilities.

Kleinworth also noted that a little deregulation could go a long way to increase health care access.

“For example, in the state of Idaho, they allow non-physicians like pharmacists to be able to practice at the top of their license. And a lot of people receive their primary care through their pharmacists now,” Kleinworth said.

White House Press Secretary Karoline Leavitt said this month that illegal immigrants are driving up ER wait times and healthcare costs alike. Democrats say that giving illegals full access to the American healthcare marketplace will help alleviate stress on emergency rooms.

Kleinworth isn’t so sure.

“Unfortunately, no, that’s not the solution,” Kleinworth told The Daily Wire. “Take California, for example. California is one of those states where they’ve offered healthcare benefits to illegals for years now. The promise was that it was going to allow them to access their primary care and they won’t have to go to the emergency rooms anymore. But we find that California actually has some of the highest ER wait times in the country. They also have some of the highest abandonment rates in the country.”

Ultimately, Kleinworth says, we need to seriously overhaul Medicaid.

“The problem here is that the way the system is designed, it prioritizes able-bodied working-age adults over pregnant women, the disabled, elderly, and children,” he said. “And what we saw with Medicaid expansion, a lot of those people were less likely to be able to access their specialists, their primary care physician, so it also increased the ER wait times.”

“Refocusing the program on the truly needy, instead of able-bodied working-age adults would help,” Kleinworth said, noting that President Donald Trump’s big, beautiful bill “made a lot of progress toward that.”