Christopher Weaver of Kaiser Health News has an excellent article in today's Washington Post on the various government agencies that will now be deciding what health insurance coverage you must purchase, and how many of those decisions will ultimately fall to lobbyists and politicians:
For years, an obscure federal task force sifted through medical literature on colonoscopies, prostate-cancer screening and fluoride treatments, ferreting out the best evidence for doctors to use in caring for their patients. But now its recommendations have financial implications, raising the stakes for patients, doctors and others in the health-care industry.
Under the new health-care overhaul law, health insurers will be required to pay fully for services that get an A or B recommendation from the U.S. Preventive Services Task Force...[which] puts the group in the cross hairs of lobbyists and disease advocates eager to see their top priorities -- routine screening for Alzheimer's disease, diabetes or HIV, for example -- become covered services.
And it's not just the USPSTF that will be deciding what coverage you must purchase:
[P]lans must also cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices, as well as screening practices for children that have been developed by the Health Resources and Services Administration in conjunction the American Academy of Pediatrics. Health plans will also be required to cover additional preventative care for women recommended under new guidelines that the Department of Health and Human Services is expected to issue by August 2011.
The chairman of the USPSTF says the task force will try "to stay true to the methods and the evidence... the science needs to come first." A noble sentiment, but as my colleague Peter Van Doren likes to say, "When politics and science conflict, politics wins." Witness how industry lobbyists have killed or neutered every single government agency that has ever dared to produce useful comparative-effectiveness research. (You're next, Patient-Centered Outcomes Research Institute!)
When government agencies are making non-scientific value judgments--e.g., are these studies reliable enough to merit an A or B recommendation? what should be the thresholds for an A or B recommendation? will the benefits of mandating this coverage outweigh the costs?--politics does even better. Witness Sen. Barbara Mikulski (D-Md) overruling a USPSTF recommendation when she "inserted an amendment in the [new] health-care law to explicitly cover regular mammograms for women between 40 and 50. "
Speaking of value judgments, the one flaw in Weaver's article is that it inadvertently conveys a value judgment as if it were fact. He writes that the mandate to purchase coverage for preventive services is "good news for patients" and that 88 million Americans "will benefit." Whether the mandate is good news for patients depends on whether patients value the added coverage more than the additional premiums they must pay. (The administration estimates that premiums for affected consumers will rise an average of 1.5 percent. One insurer puts the average cost at 3-4 percent of premiums. Naturally, some consumers will face above-average costs.) Whether the benefits outweigh the costs is ultimately a subjective determination. (The best way to find out, as it happens, is to let consumers make the decision themselves.)
I was never a fan of Dick Cheney's one percent doctrine.
According to Ron Suskind, after 9/11 Cheney explained to law enforcement and intelligence officials that they should treat even the one percent chance of a terrorist attack as a mathematical certainty. The particular case was of a Pakistani nuclear scientist helping al-Qaeda to acquire a nuclear bomb, but the standard became a shorthand for U.S. counterterror efforts generally. No scale of effort would be too great. Better to chase down 100 leads, 99 of which turn out to be bogus, because finding just that one nugget would have been worth the level of effort.
Now we have evidence that the federal government is chasing down far more than 99 blind alleys for just one lead. From today's front-page story in the New York Times, Eric Schmitt explains how the FBI has adapted and evolved since 9/11:
The bureau now ranks fighting terrorism as its No. 1 priority. It has doubled the number of agents assigned to counterterrorism duties to roughly 5,000 people, and has created new squads across the country that focus more on deterring and disrupting terrorism than on solving crimes.
But the manpower costs of this focus are steep, and the benefits not always clear. Of the 5,500 leads that the squad has pursued since it was formed five years ago, only 5 percent have been found credible enough to be sent to permanent F.B.I. squads for longer-term investigations, said Supervisory Special Agent Kristen von KleinSmid, head of the squad. Only a handful of those cases have resulted in criminal prosecutions or other law enforcement action, and none have foiled a specific terrorist plot, the authorities acknowledge. (Emphasis mine.)
So, just to review:
- 5,500 leads over 5 years
- 5 percent deemed credible
- "A handful" technically would mean five or less, but charitably might total a few dozen. Still, that translates to far less than 1 percent of leads investigated resulting in a criminal prosecution.
But, and here's the kicker,
- None -- zero, zip, nada -- foiled a specific terrorist plot.
On the face of it, this seems like a waste of time and resources that should be spent elsewhere.
There are several plausible explanations, however, for why I'm wrong and why those who believe that we are not dedicating sufficient resources to combating terrorism are right.
- Perhaps other government agencies have been far more effective at disrupting terror plots. (But when the relative comparison is zero, it isn't very hard to clear that bar.)
- Perhaps Schmitt got his facts wrong. (Doubtful. He is one of the most experienced and reliable reporters on the beat.)
- Perhaps the knowledge that 5,000 people chasing down 5,500 leads deters would-be terrorists from even attempting anything. (Or it could simply be helping bin Laden's plan "to make America bleed profusely to the point of bankruptcy.")
Two other points bear consideration. First, it is possible that arresting, prosecuting and convicting people of lesser crimes disrupts what might someday become a full-scale terror plot. There is no reason to think that the guy trying to cut down the Brooklyn Bridge with a blowtorch was much smarter than the 15 guys who provided the muscle for the 9/11 attacks. The difference was leadership, which defined a plausible terrorist attack and devised the means to carry it out. That said, there are problems associated with the expansion of federal laws, and the growing power of prosecutors, and I would still much prefer that common criminals be handled in a run-of-the-mill fashion. Local cops, local prosecutors, local jails.
Which leads to the second point. Reflecting the growing federalization of the criminal law, the FBI strayed into a number of areas even before 9/11 that should have been handled by local law enforcement. This expansion of the federal criminal law poses a threat to individual liberty. (Thanks to Tim Lynch for pointing to this source.) But counterterrorism is one of the few legitimate functions for a federal law enforcement agency, and if the FBI is devoting more resources to that than to other crimes, that in and of itself wouldn't be a bad thing.
I remain unconvinced, however, that what we are seeing is a wise expenditure of resources. And while I understand that zero terrorist plots uncovered is not equal to zero threat of a future attack, it is incumbent on the FBI -- and more generally those who think that the problem is too little, as opposed to much, being devoted to counterterrorism -- to prove why they need still more resources.
Until that occurs, I think that UCLA's Amy Zegart, who is quoted in the Times story, should get the last word on this point:
Just chasing leads burns through resources. ... You’re really going to get bang for the buck when you chase leads based on a deeper assessment of who threatens us, their capabilities and indicators of impending attack. Right now, there’s more chasing than assessing.
The Cato Institute media department sent this press release to media outlets in Latin America, after the Venezuelan government tried to shut down a Cato-sponsored conference this week:
CAUCAGUA, VENEZUELA—A Cato Institute educational seminar fell victim to an attempt by the Venezuelan government to shut it down for expressing ideas critical of the Chavez regime.
Numerous Venezuelan government agencies harassed the Cato Institute event, called Universidad El Cato-CEDICE, or “Cato University,” which took place in Caucagua, Venezuela May 24-26. The event is co-sponsored by the Venezuelan free-market think tank Centro de Divulgación del Conocimiento Económico por la Libertad (CEDICE) and was organized to teach and promote the classical liberal principles of limited government, individual liberty, free markets and peace.
During the course of the event on Monday, the National Guard, state television and a state representative from a ministry of higher education interrupted the seminar, demanding that the seminar be shut down on the grounds that the event organizers did not have permission to establish a university in Venezuela. When the authorities were told that neither Cato nor CEDICE was establishing a university and that the Cato Institute has long sponsored student seminars called Cato Universities, the authorities then insisted that the seminar was in violation of Venezuelan law for false advertising.
After two hours of groundless accusations, the Chavez representatives left but their harassment has continued. One of the speakers at the seminar, Peruvian intellectual Alvaro Vargas Llosa, was detained by airport authorities Monday afternoon for three hours for no apparent reason. He was released and told that he could stay in the country as long as he did not express political opinions in Venezuela.
"The government’s attacks on freedom of speech are part of a worrying pattern of abuse of power in Hugo Chavez's Venezuela,” said Ian Vasquez, director of Cato’s Center for Global Liberty and Prosperity, from Caucagua. “But they have so far not managed to alter the plans of the Cato Institute here, and will hopefully not do so, as we continue to participate in further meetings the rest of this week.”
For more information about Cato programs in Latin America, visit www.ElCato.org.
UPDATE (5/27, 2:30 PM EST) : Cato just received word from scholar Ian Vásquez that "Chavistas are gathering in front of the conference hotel now...Cato is all over state TV."
Vásquez snapped this photo of people carrying anti-Cato signs and protesting the conference.
Last week was an interesting week for transparency, with some good news and some bad news.
On the "good" side of the ledger, the administration rolled out "Data.gov," a growing set of data feeds provided by U.S. government agencies. These will permit the public to do direct oversight of the kind I discussed at our "Just Give Us the Data!" policy forum back in December.
My metric of whether Data.gov is a success will be when independent users and Web sites use government data to produce new and interesting information and applications. The Sunlight Foundation has a contest underway to promote just that. Get ready for really interesting, cool, direct public oversight of the government.
Also under the White House's new "Open Government Initiative," an Open Government Dialogue "brainstorming session" began last week. The public can submit ideas for making the government more transparent, participatory, and collaborative. This is important stuff, an outgrowth of President Obama's open government directive, issued on his first full day in office.
That directive called for the Office of Management and Budget to require specific actions of agencies "within 120 days," which meant the final product was due last week. And that missed deadline is where we start to slide into the "bad" on the transparency ledger.
Last week, President Obama gave an important speech on national security (which I blogged about here and here). But you couldn't find the speech in the "Speeches" section of the Whitehouse.gov Web site. It's buried elsewhere. That's "basic Web site malpractice," I told NextGov.com. And I cautioned my friends in the transparency community not to forget Government 1.0 for all the whiz-bang Gov 2.0 projects flashing before our eyes. Whitehouse.gov should be a useful, informative resource for average Americans.
The current top proposal on the "brainstorming" site referred to above is to require a 72-hour mandatory public review period on major spending bills. This is reminiscent of President Obama's promise to hold bills five days before signing them. But, as Stephen Dinan reports in the Washington Times, the president signed several more bills last week without holding them the requisite time.
The White House protests that they posted links to bills on the Thomas Web site at the Whitehouse.gov blog. But that does not give the public meaningful review of the bills in their final form, as they have come to the president from Congress. "Posting a link from WhiteHouse.gov to THOMAS of a conference report that is expected to pass doesn’t cut it," says John Wonderlich at Sunlight.
President Obama signed nine new laws since we last reviewed his record on the "Sunlight Before Signing" promise. Alas, it's been a case study in pulling defeat from the jaws of victory.
Five of the bills were held by the White House more than five days before the president signed them, but they weren't posted! Simply posting them on Whitehouse.gov in final form would have satisfied "Sunlight Before Signing."
President Obama's average drops to .043, and that's crediting him one win for the DTV Delay Act, which was posted at Whitehouse.gov in its final form for five days after Congress passed it, but before presentment, which is the logical time to start the five-day clock.
Here is the latest tally of bills passed by Congress, including the date presented, date signed, whether they've been posted or linked to at Whitehouse.gov, and whether they've been posted for the full five days after presentment. (Corrections welcome - there is no uniform way that the White House is posting bills or links, so I may have missed something.)