The Sept. 11, 2001, attacks and subsequent wars in Iraq and Afghanistan prompted U.S. leaders to increase U.S. aid in the belief that improved global stability ultimately undergirds U.S. security. Secretary of State Hillary Clinton and Defense Secretary Robert Gates are now among those calling for elevating international development assistance and diplomacy to the same status as defense. But budget debates on Capitol Hill could block aid-reform efforts. The Republican-led House calls for drastically reducing international affairs funding, but the Democratic-led Senate and the Obama administration are resisting. Complicating the arguments are questions about the efficiency of America's aid bureaucracy and, ultimately, the effectiveness of the aid itself. While aid supporters point to improved accountability, it's unclear whether future aid requests can withstand the pressure of budget cutters.

Nellie Bristol is a veteran Capitol Hill reporter who has covered health policy in Washington for more than 20 years. She now writes for The Lancet, Health Affairs and Global Health Magazine. She graduated in American studies from The George Washington University, where she recently earned a master's degree in public health/global health.