In this Lancet opinion piece, Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, examines a number of social, political, and financial issues at play ahead of the November 6 U.S. presidential election and their implications for domestic and global health programs. “Fundamentally, the 2012 election reflects a Grand Canyon scale rift through the national psyche over the importance of government, provision of tax-supported public goods, including health care, and who is responsible for the 2008 financial crisis and ongoing economic doldrums,” she writes. “But the biggest concern for America’s future is the budget,” she continues. Garrett discusses how sequestration might affect foreign assistance and global health programs and states, “U.S. commitment to foreign assistance and such international ventures as the President’s Emergency Program for AIDS Relief (PEPFAR) and Obama’s signature Global Health Initiative are also likely to rise, or fall with the elections” (9/1).