Unfortunatley Debra, increasing the NIH budget is not about to happen. So, I sadly have to agree with the sentiment that the NIH will need to find ways of defining those who contribute in outsized ways and focus on them. In my opinion, the NIH will lose a lot by doing so, particularly the opportunity for an unusual concept to obtain the support to become tomorrow's next greatest advance.
Hopefully, ways to identify and support creativity will be included in the inevitable pare-down that is coming. But, given the difficulty with the recent attempts to implement 'innovation' as a primary constituent of grant reviews in the US, I think that future creativity is less likely come from the US. Creativity will come as it always has from many different sources. Maybe even businesses will drive some of this innovation, as they have done so aptly with commercially viable products in the computer arena. But that relies on low-cost, mass-market products whereas Pharma seems to be enamoured with high-cost speciality items.
As we move into a period of scientific retrenchment, keep in mind a couple of things: Einstein was a patent clerk who luckily could pursue his passion (although only because he didn't need an expensive laboratory). He chased that pursuit by publishing in German because that's where the predominant support and ideas came from in that era. Long before that were the Greeks, the Romans and many great societieis in between. We're now clearly seeing the decline of support for science what had been but the most recent, fleeting 'Germany' (i.e., the US).
The decline in support for science in the US has been visible for some time now, not just in dollars but in the decline in the American public's willingness to embrace, or even to remotely understand, science. Pseudoscience and fairy tales now reign in the public's conciousness, which is abetted by a popluation so poorly educated in the scientific method that they lack the tools to evaluate often the most ludicrous of claims. It has not helped that there are hucksters out there who have preyed on that ignorance to unduly promote their pseudoscience (and yes, their 'science' too). The public has been promised a lot, seen the lack of results, and has collectively felt conned. That populace will be making decisions for some time. I do not expect the support for science in the US to recover rapidly.
But all is not gloom. There is a whole world out there including some places that will foster science for the next few generations. There will be another Athens. I challenge the cultures of the world to decide which of them will want to become the next great society.