NOTE: link may not all appear on one line...... www.oregonlive.com/news/oregonian/index.ssf?/base/front_page/10479058172 66650.xml Bush weighs life's worth, cost of rules 03/17/03 JIM BARNETT WASHINGTON -- The Bush White House is pushing federal agencies to slash the dollar value they place on human life, a move that has ignited an ethical debate with administration critics and allies alike. To calculate benefits of rule changes, such as cutting power plant emissions, agencies typically assign a uniform value to each life saved. The Environmental Protection Agency uses $6.1 million, a value set under President George H.W. Bush and indexed for inflation. But the method is unfair and economically unsound, according to officials in the current Bush administration, because it fails to recognize differences in quality of life: An elderly person with chronic illness is equal in value to a healthy child with decades to live. Under the White House approach, agencies would account for the health and age of people who benefit from new rules. It's the same principle used a decade ago to justify the Oregon Health Plan, which sparked national controversy by proposing to ration medical care for the poor. Leading the charge is John D. Graham, administrator of the White House Office of Information and Regulatory Affairs. Graham wants agencies to identify what types of people would benefit from regulation and by how much. His goal: Get more bang for the buck. "The method will focus agencies on developing rules that have the most public health promise, measured by both the number of life years saved and improvements in quality of life," he said. "The method is pro-health." But the approach has produced some unsettling results. In Bush's signature Clear Skies plan, for example, EPA values the lives of some people who benefit from cleaner air as low as $96,000 less than 2 percent of its standard measure. Business and industry stand to gain from the White House initiative. Regulators must weigh benefits against costs of regulation, so lower life values can limit government's reach in cutting emissions and requiring companies to invest in new equipment. Indeed, opponents fear that consequences could ripple across the bureaucracy as agencies apply the method to an array of laws intended to protect human health -- from toxic-waste cleanup to workplace safety and food labeling. "It can prevent EPA and other agencies from taking action they otherwise would have taken," said Wesley Warren, an assistant budget chief under President Clinton. Potentially more troubling for President Bush is a growing unease among religious conservatives -- some of his most stalwart supporters -- who believe that differentiating lives by age and health would give bureaucrats a God-like power to pick favorites. "In general, if you're valuing one life over another, we've got lots of problems here," said Walt Grazer, who tracks environmental issues for the National Conference of Catholic Bishops in Washington. Clear Skies proposal EPA has served as the boiler room for the White House's new approach, with the first public signs contained in an "alternative analysis" that was included in the fine print of Clear Skies and other recent proposals. Bush unveiled Clear Skies in February 2002 as a market-based answer to more rigid regulation. To build support, EPA chief Christie Whitman and other officials touted Clear Skies' big payoff -- health benefits valued at $93 billion by 2020. EPA arrived at its estimate in part by assuming that 12,000 lives could be extended by cleaner air and that each life should be valued at its standard rate of $6.1 million, according to documents on the agency's Web site. But in comparison, EPA's alternative analysis appeared to undercut the proposal by pegging benefits at a dramatically lower figure -- just $14.1 billion, an amount far closer to the $6.5 billion cost of the plan. Although benefits still outweigh costs, opponents said, the lower estimate serves as a barrier against more stringent emissions limits. And in the long run, it could discourage agencies from developing new rules that might protect health at higher cost, they said. "It's not rocket science to see that the purpose is to smother some of these proposals in the cradle," said Warren, now a fellow at the Natural Resources Defense Council. "The public will never know they are being denied these protections." A major factor in the alternative estimate: EPA officials challenged the agency's longstanding method for assigning a dollar value to lives improved by cleaner air. First, the agency rejected most of the 26 academic studies that served as the basis of its $6.1 million-per-life standard. The agency kept only five studies that were based on public opinion surveys. That cut the estimate to $3.7 million a life. EPA then cited a single study -- published in 1989 and later challenged by its author -- concluding that elderly people would pay only 63 cents for every $1 that younger people would pay to reduce their risk of death. The result: Elderly lives valued at $2.3 million. Next, EPA assumed each beneficiary suffered from heart disease and therefore could expect to live just five more years. On that basis, it capped elderly lives at $1.4 million. And it assumed some people would live only six extra months -- a benefit worth $96,000. Measuring effectiveness Cost-benefit analyses, like those applied to Clear Skies, are required of all regulations expected to have economic impact greater than $100 million. Results rarely dictate a decision, but policy-makers generally regard the exercise as helpful in building consensus. The White House's effort to refine the analysis is the latest chapter in a long-running conflict over how to balance demands for cleaner air, cleaner water and safer workplaces against the cost to industry and consumers. Graham, who founded the Harvard Center for Risk Analysis before joining the budget office, is prodding agency leaders to measure the relative effectiveness of proposed rules in addition to simply tallying benefits based on a series of subjective assumptions. By applying quality-of-life considerations, EPA's alternative analysis allows for comparisons with rules proposed by other agencies, he said. That way, policy makers can determine which course of action achieves the greatest benefit at the least cost. "OMB's role is to strive for some consistency across agencies in how they address analytic issues," Graham said in an interview in his office overlooking the West Wing. "It is not desirable to have the same disease, for example Alzheimer's disease, evaluated differently by the various federal agencies." Federal agencies have been dabbling with quality-of-life analysis at least since the Clinton administration, Graham noted. And some leading social researchers favor the approach because they think it serves both common sense and economic efficiency. "I'd rather save my life when I'm healthy than when I'm sick," said Richard Zeckhauser, a professor at Harvard's Kennedy School of Government. "It's giving people what they say they want." But the approach opens the door to difficult ethical questions: Who's to say that a heart patient doesn't value his life as much as a perfectly healthy person? And what about the terminally ill, whose life quality and expectancy could pencil out to zero? "Any effort to try to gauge the relative value of a human life in the context of a public safety issue like this is inherently suspect," said Andy Imparato, president of the American Association of People with Disabilities. Similar questions have haunted relatives of those who died in the terrorist attacks of Sept. 11, 2001. Many have received compensation based on a hodgepodge of factors -- age of the deceased, income, insurance, number of dependents and more -- and some have decried the formula as unfair. Experimenting in Oregon In the early 1990s, Oregon political leaders also tried an experiment in valuing lives to make government more effective. But instead of encouragement from the White House, they received threats. The goal was to extend coverage to more low-income people under the Oregon Health Plan. Money was limited, so state officials commissioned a public-opinion survey to rank more than 700 procedures in order improvement in quality of life. "I always said it was rational care, not rationed care," recalled former Gov. Barbara Roberts, a Democrat. But groups representing the disabled and the elderly attacked the plan, saying it was based on prejudices of able-bodied people. Religious groups joined in, hoping to head off what they regarded as government intrusion on "the sanctity and dignity of life," recalled Robert J. Castagna of the Oregon Catholic Conference. They found a powerful ally in the first President Bush. The White House regarded the Oregon plan as a dangerous precedent, and Bush's advisers launched an administration effort to block it. In a letter dated Aug. 3, 1992, Health and Human Services Secretary Louis Sullivan told Roberts that the plan would violate the Americans with Disabilities Act. And on Bush's last full day in office, Jan. 19, 1993, a top Justice Department lawyer outlined the legal case against assigning relative values to people's lives. "(A)ny methodology that would intentionally ration health care resources by associating quality-of-life considerations with disabilities does not comport with the mandate of the ADA," wrote Timothy J. Flanigan, who later served as deputy White House counsel in the current Bush administration. Putting value on lives Ultimately, state health officials abandoned the telephone survey results, said Darren Coffman, director of the Oregon Health Services Commission. They substituted opinions of health-care professionals and were allowed to proceed by the Clinton administration. Since then, the debate has been confined largely to circles of academics, mostly economists, who are trained to focus on questions of efficiency. Ethical and moral considerations have taken a back seat. EPA has yet to grapple with those issues, but it is considering how to solicit ethical advice, said Jeffrey Holmstead, an assistant administrator. In the meantime, the agency will continue looking for ways to improve its quality-of-life analysis. "I don't disagree that it certainly raises some difficult issues to be valuing one life different from another," Holmstead said. "But it's the only way we feel like we at least have a tool that can help inform these sorts of policy decisions." Likewise, there has been little debate in Congress about the method used in EPA's alternative analysis. But leaders of several advocacy groups said they hoped to raise public awareness as members take up Bush's Clear Skies initiative. "This looks on the surface like a really technical, geeky, wonky thing, so it's hard to pull out moral arguments," said Daniel Swartz, executive director of the Children's Environmental Health Network. "But as people figure out what's going on certainly as they see things like 63 cents on the dollar for the elderly -- there's starting to be some outrage." *** NOTICE: In accordance with Title 17 U.S.C. 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