Government programs are no exception to the constraints of opportunity costs: that is, investing resources in any one program means that those resources cannot be used for some other program. A policymaker deciding whether to support a new action; a legislator deciding whether to vote for a new program; a regulator deciding whether to impose a stringent standard: each decisionmaker faces the question, What will be foregone if I decide to commit the resources for this activity? Especially with respect to environmental, health, and safety programs, increasing sensitivity to the costs of regulations has led some pundits, analysts, and stakeholders to challenge initiatives on the grounds that alternative choices are available that would provide more risk reduction or other benefits at lower cost. When Congress voted on the Clean Air Act Amendments of 1990, columnist George F. Will wrote, "Policy makers face difficult tradeoffs. Comparative returns to health must be considered. The $21 billion spent on cleaner air cannot be spent on immunization, infant mortality, care for poor pregnant women." At a 1997 hearing concerning the Environmental Protection Agency's (EPA's) proposal to tighten the National Ambient Air Quality Standards (NAAQS) for ozone and particulate matter, a Congressman commented, "What are the alternatives to the ... rulemaking? There are clearly better investments that can be made to promote public health. Eight billion dollars could save 3 or 4 times as many women from breast cancer by paying for mammograms." In a "viewpoint" article in Exxon's magazine for shareholders, its author states that sound science and sound economics could lead to smarter regulation by reallocating regulatory expenditures: for example, "it may be smart to invest more in smoking-cessation education for pregnant women and less in making the groundwater in a Michigan rail yard cleaner than drinking water." In a debate counterposing environmental and economic tradeoffs, Paul Portney of Resources for the Future said, "A hundred dollars spent on environmental protection is $100 that can't be spent on housing, or space, or health, or other alternatives." In 1992 Stephen Breyer (who became a Supreme Court Justice in 1994) addressed the need to improve the effectiveness of risk regulation in The Oliver Wendell Holmes Lectures, given at Harvard. His solution featured a centralized administrative group in the federal government to oversee and guide risk regulation. One of the group's missions could be to create a "risk agenda" … that looks for tradeoffs among programs that will lead overall to improved health or safety. It might, for example, look for practical ways to settle some toxic waste dump cases, thereby obtaining funds that might be used to help pay for vaccinations, or prenatal care, or mammograms.... It might, in other words, look for ways to reallocate, transfer, or combine health resources so that they perform more effectively. In the early 1990s the then-head of the Harvard Center for Risk Analysis, John D. Graham, together with his student and colleague Tammy O. Tengs, went beyond the rhetoric and studied these potential tradeoffs. They analyzed the cost-effectiveness of 185 life-saving interventions (including, for example, laws, regulations, and building codes) for which national cost and benefit estimates were available. They found that these interventions cost $21.4 billion per year and averted 56,700 premature deaths and saved 592,000 years of life annually; but there was no relationship between the cost-effectiveness of the interventions and their implementation. Tengs and Graham concluded that if the $21.4 billion per year were devoted only to the most efficient interventions, approximately twice as many lives and years of life could be saved. Alternatively, they found that the nation could maintain the current level of survival benefits—averting 56,700 deaths per year—and "save $31.1 billion over the status quo, because there are many untapped investment opportunities that save both lives and money. That is, not only would we save the $21.4 billion that we are currently spending, but another $10 billion—all the while maintaining our present level of survival benefits." Graham asserted that failing to follow through on the implications of studies showing that tradeoffs could improve the cost-effectiveness of health, environmental, and safety regulations was a "perverse pattern of investment [that] amounts to 'statistical murder' of American citizens." Graham concluded— Legislators should pass broad-based legislation requiring the use of risk analysis and cost-benefit analysis in government decisions. The President and Congress should reexamine annual appropriations to public health and environmental agencies to determine how reallocations of dollars could offer more health protection and no greater costs to the taxpayer or private sector. This view has been broadly accepted among those promoting risk assessment and cost-benefit analysis as ways of rationalizing regulatory activities. For example, summarizing a volume analyzing risk-benefit tradeoffs, Robert W. Hahn, a long-time student of regulatory costs, concluded: "We could save a substantial number of lives and money by reallocating resources from ineffective domestic regulations to other life-saving interventions in the United States or the developing world." Similarly, legal scholar Cass Sunstein observed that studies like Tengs' and Graham's create "a presumption that the current system of regulation suffers from serious misallocation of resources." Sunstein has promoted cost-benefit analysis as a way to require people "to look globally at the consequences of apparently isolated actions." Thus, going beyond rhetoric, analysts like Hahn and Tengs and Graham see quantitative analysis of tradeoffs as a practical way of achieving greater societal efficiency for health, safety, and environmental protection investments. Graham, in particular, has been a strong advocate of using risk and cost-benefit assessments of tradeoffs to improve decisionmaking —a view which he was in a position to further between 2001 and 2006 as Administrator of the Office of Information and Regulatory Affairs in the White House's Office of Management and Budget. And Cass Sunstein likewise has had, since 2009, the opportunity to apply his views on rationalizing regulation with cost-benefit analysis as Administrator of the Office of Information and Regulatory Affairs in the White House's Office of Management and Budget for the Obama Administration. Certainly, risk assessment and cost-benefit analyses of health, safety, and environmental policies have advanced substantially over the past several years, leading to efforts at quantifying tradeoffs to identify the most efficient/least efficient ones. But legislators and other policymakers have found it difficult to effect overt tradeoffs among environmental, health, and safety programs. One reason for this difficulty, and perhaps the one most often cited, is the perceived inadequacy of the assessments themselves. Problematic issues include incomplete assessment of costs and, especially, benefits; discounting future benefits; monetization of noncommercial benefits such as health and environmental amenities; the resources and time necessary to conduct analyses; and a utilitarian bias to the technique, among others. But leaving aside a more detailed discussion of how accurately it is possible to evaluate potential tradeoffs, or how fair such tradeoffs might be, this report examines two institutional reasons why policymakers may be disinclined to make tradeoffs—or may even find it impossible. For even if the tradeoffs can be defined and defended, difficulties in effectuating them remain. One institutional barrier is the limited authority of policymakers to affect decisions across institutional boundaries. For example, in part because of independent decisions made at different times by the relevant congressional committees of jurisdiction, the various health, safety, and environmental statutes manifest differing standards of acceptable risk and differing criteria for assessing them. The second barrier arises from the divergence in decision criteria applied by the different institutional decisionmakers involved in tradeoffs. Health, safety, and environmental policies can involve both public financing (e.g., appropriated grants or loans) and regulations that require private sector investments; they can involve a range of federal, state, local, and private decisionmakers. As tradeoffs change those responsible for making decisions, the bases for acting or financing programs shift as well. A decisionmaker can rarely if ever prescribe that resources freed up by his or her not supporting an environmental protection program or not choosing a regulatory option—or a more stringent option—will go to a more beneficial alternative. These constraints that arise from institutional contexts in which legislators and other policymakers address tradeoffs both limit alternatives that can usefully be considered, and tend to push decisionmakers to make up-or-down, case-by-case decisions rather than choosing among tradeoffs. Typically, a decisionmaker's only option is to approve or disapprove an action, to vote for or against a program, or to implement or delay a regulation—with little power to redirect the resources to a more cost-effective alternative if the choice at hand is rejected. The rules and structures of organizations channel decisions in ways that limit the options of decisionmakers. In Congress, rules of procedures and committee structures can limit tradeoffs available to Members. In particular, jurisdictional limitations affecting congressional subcommittees' and committees' choices and procedural requirements governing floor actions—including especially the "germaneness" rule of the House —impede treating comprehensively the many environmental, health, and safety statutes. These procedural and structural limits play key roles in determining the availability of potential tradeoffs both among program goals and among alternatives for federal expenditures of treasury funds. Similarly, procedures and the bureaucratic structure of the executive branch limit choices of administrators and program managers. The process by which Congress considers annual appropriations illustrates how structure can constrain tradeoffs. While the President, Congress as a whole, each Chamber, and the full Committees on Budget and on Appropriations have the ability to view comprehensively funding priorities and consider tradeoffs, only in exceptional cases can those with comprehensive authority devote attention to the level of detail at which most environmental, health, and safety tradeoffs occur.