1 oz. Prevention = 1 oz. Cure

In a previous post, I reported on an article in this week’s New England Journal of Medicine that dispells the myth that, ahem, investing in additional preventive care would save money. I titled the post, “An Ounce of Prevention Is Worth … What?” A snarky colleague emailed to say, essentially, “Duh, it’s worth a pound of cure …”

But that’s just the point: an ounce of prevention is not worth a pound of cure. The authors of that article included this graph, which shows that prevention and cure match up fairly evenly when it comes to cost-effectiveness:

Distribution of Cost-Effectiveness Ratios for Preventive Measures and Treatments for Existing Conditions. Data are from the Tufts–New England Medical Center Cost-Effectiveness Registry. QALY denotes quality-adjusted life-year

In other words, it appears that Mr. Franklin over-valued prevention by a factor of 16, and if we want to improve health we would do as well to invest in cure as in prevention.

Bogus Claims of Limitless Executive Power

Cato founder/president/CEO Ed Crane and Board member/senior fellow Bob Levy take on “the president’s bogus claims of limitless executive power” in his battle with Congress over the Terrorist Surveillance Program:

Abiding by the Constitution will not always shield us from bad laws. Nonetheless, even if the Constitution is not a sufficient guidepost, it is certainly a necessary guidepost.

For many years, we were at risk of losing important civil liberties through unchecked transgressions by the executive branch. Maybe we are still at risk. But thanks to the media, the courts and — belatedly — an energized opposition in Congress, the administration has finally resigned itself to a semblance of congressional oversight, even if judicial scrutiny remains inadequate.

The president’s bogus claims of limitless executive power are, for now, on hold. That’s the right constitutional precedent even if it ultimately produces the wrong policy outcomes. Longer term, the precedent is more important than temporal policy judgments. Justice Sandra Day O’Connor’s plurality opinion in the Hamdi case nicely captured the key principle: “Whatever power the U.S. Constitution envisions for the Executive … in time of conflict, it most assuredly envisions a role for all three branches of government when individual civil liberties are at stake.”

Who Are the Real Free Traders in Congress?

Which members of Congress most consistently support the freedom of Americans to trade and invest in the global economy – free of market-distorting subsidies and barriers? A dynamic new Cato web feature, “Free Trade, Free Markets,” allows users to search more than a decade of votes to answer that and other questions about how members have voted on trade.

Regarding Congressional Hearings on Baseball, the Glass Is One-Tenth Full

Andrew Coulson complained on this site yesterday about a House committee investigating steroids in baseball. Andrew sarcastically noted that the country must be in good shape if politicians are holding hearings on matters that have nothing to do with the legitimate functions of the federal government.

His analysis is correct, and politicians certainly deserve the scorn he tosses in their direction. But we should be careful what we wish for. If you watch this clip beginning at 3:50, I explain that there is a bright side to the committee’s ridiculous ploy to get TV coverage. Simply stated, every minute the politicians spend pontificating on baseball and steroids is one minute that they’re not using to create new taxes, increase spending, and add regulations.

Maybe next month, they can waste their time investigating Paris Hilton. Anything that keeps them distracted has to be good for the country.

Congress Ignores Fear-Mongering. World Doesn’t End

The Democratic leadership in the House has called the president’s bluff and stood up for the rule of law. Ryan Singel has the details:

The Protect America Act, a temporary but expansive warrantless spying bill passed by Congress last summer, will likely expire Saturday at midnight, a casualty of a battle between President Bush and House Democrats over amnesty for phone companies that aided his secret, warrantless spying program and how much of that program should be legalized. The House leadership announced there will be no more votes before the long President’s Day legislative break.

The bill’s expiration is largely symbolic, but demonstrates that House Democrats are willing to fight Bush on anti-terrorism policies, where fear-mongering rhetoric had previously cowed their opposition.

One of the most interesting things about the last 24 hours is the subtle shift in rhetoric. The New York Times wrote today that “The lapsing of the deadline would have little practical effect on intelligence gathering” — an accurate statement, but one that most people were missing a few days ago. Even conservative pundits such as David Freddoso started hedging their previously sweeping claims about the dire consequences of letting the PAA expire:

If the president does not sign the bill before Saturday, then we revert to the previous FISA law. The feds will be able to continue certain ongoing terrorist monitoring activities, but they cannot initiate new ones. (It becomes easier to start up a terror cell on Saturday.)

Freddoso is not insinuating, as his colleague did, that all surveillance everywhere in the world will grind to a halt after the PAA expires. But Freddoso’s version is still misleading. The Bush administration can initiate new terrorist monitoring activities after the PAA expires. It just has to get a FISA warrant, the same way it did in 2002, 2003, 2004, 2005, and 2006. Indeed, Bush himself praised the changes Congress made to FISA in the wake of the September 11 attacks, noting that they “will allow surveillance of all communications used by terrorists, including e-mails, the Internet, and cell phones” and makes the intelligences community “able to better meet the technological challenges posed by this proliferation of communications technology.” If we were able to get by with those provisions for nearly six years, surely we’ll be OK living under them again for a couple of weeks.

DHS Promoting Violation of State Law - and Fish Now Smell Good

The Department of Homeland Security is instructing Illinois businesses that they do not have to comply with a law called the Illinois Right to Privacy in the Workplace Act.

The state’s law bars Illinois employers from enrolling in E-Verify or any similar system until the Social Security Administration and DHS can make final determinations on 99 percent of their “tentative nonconfirmation notices” - findings that people aren’t authorized to work under the immigration laws - within three days.

But in a notice that would panic any lawyer advising Illinois clients, the DHS claims that the state “has agreed to not enforce this law” because of its lawsuit against the state. “Illinois has agreed that it will not penalize employers simply for participating in the program, at least until the lawsuit is finished.”

The notice asks people who have been asked to comply with the law to “please contact DHS immediately.” The worry, one supposes, is that a rogue state employee might ask an Illinois business to comply with the state’s laws.

Fascinating. Whatever’s happening here makes the smell of fish downright pleasant.

You’ll be able to learn why Illinois might not want its employers using E-Verify in my forthcoming study, “Electronic Employment Eligibility Verification: Franz Kafka’s Solution to Illegal Immigration.”

Two-Fold Variation in Hospital Care among Privately Insured

Researchers at Dartmouth Medical School have documented that Medicare patients receive dramatically different amounts of medicine in different parts of the country. Doctors in some areas just seem to do lots more stuff to Medicare patients than doctors in other areas, and that additional stuff doesn’t seem to make patients any healthier or happier. But does the same hold for patients under age 65?

According to an article just published by Health Affairs, the answer appears to be yes. The authors – Laurence C. Baker of Stanford University, and Elliott S. Fisher and John E. Wennberg of Dartmouth Medical School – write:

We studied variations across California hospitals in hospital resource use for chronically ill patients covered by Medicare health maintenance organizations (HMOs) and private insurers and found substantial variation in all of the coverage groups studied …

For example, for privately insured PPO or FFS patients, the number of hospital stays in the last two years of life averaged 2.4 at the least-resource-intensive hospital, compared to more than double that rate–a little more than 5.0 stays–at the highest hospital. The average number of days per hospital stay for these patients ranged from a low of 4.5 to a high of 12.5. Sizable differences between the hospitals with the highest and lowest rates of resource use could also be found in the other groups. In most cases, the magnitude of the variation across hospitals was as large for Medicare HMO and privately insured patients as it was for Medicare FFS patients.

The authors did not explicitly consider whether the high-use hospitals delivered better outcomes, though they did argue (consistent with previous studies) that this was unlikely:

For example, in the private PPO population we studied, patients cared for in hospitals with the highest resource-use levels tended to die at younger ages–opposite the view that more resource use might somehow prolong life.

Baker, Fisher, and Wennberg conclude, “Previous estimates of savings if the most resource-intensive hospitals more closely resembled less resource-intensive hospitals, based on just Medicare FFS spending, could underestimate possible savings when other payers are taken into account.”

Supporters of Medicare-for-All claim Medicare is more efficient than private health insurance. On the contrary, it may be that private health insurance is just as inefficient as Medicare.