Tuesday, June 20, 2006

The Donorcycle Defense

Thanks to Ben Roethlisberger’s accident, motorcycle helmet laws are in the news again. Supporters of such laws, in dodging the charge of paternalism, often justify them on grounds that riders don’t just hurt themselves but the rest of us as well, since some of their medical costs are covered by public ERs, Medicaid, and Medicare.

I resist this argument because it allows one governmental intrusion (the public funding of medical care) to justify another one (restriction of motorcyclists’ personal liberty). That’s a very slippery slope that gets more slippery the more medical costs are socialized – a point I’ve made before. I’d rather let people make their own decisions and bear their own costs.

But let’s set that response aside and ask whether the argument is even true. Do unhelmeted motorcyclists really impose net costs on the rest of society? To answer that question, you can’t consider only the external costs in terms of greater medical expenditures. You must also consider the external benefits in terms of greater organ donation. It’s no mistake that ER doctors refer to motorcycles as donorcycles.

When I’ve made this argument in the past, I’ve sometimes been accused of being crass. My response is twofold: First, it’s the supporters of helmet laws who brought money into the argument. I’m just taking their argument to its logical conclusion. Second, it’s not as though I’m saying motorcycle riders should be stopped from wearing helmets. Unhelmeted riders choose to do something that creates benefits to others, and I’m just saying we should take those benefits into account when deciding whether to restrict their liberty.

But can we be any more specific? I’m going to try. This page contains numerous statistics collected by the NHTSA before and after Florida’s repeal of its helmet law. Just for the sake of generating some numbers, let’s assume that all differences between the pre-law and post-law periods are attributable to the repeal of the helmet law. This is surely an exaggeration, since the popularity of motorcycling was increasing both before and after the repeal. (One result of this assumption is that even the increase in cyclists’ non-head injuries, such as broken legs, gets attributed to the repeal of the helmet law.)

Keep in mind that these are back-of-the-envelope calculations, so I’m not prepared to defend them rigorously. But here’s what I found: Florida’s total medical expenditures on cycle-related injuries in the post-repeal era were about $23 million higher per year than in the pre-repeal era. Meanwhile, there were about 249 more motorcycle fatalities per year. (These figures are all based on the 30 months pre-repeal and the 30 months post-repeal; money figures are in 1998 dollars.)

That comes out to about $92,600 per potential donor. I’m guessing that the value of organs per body – two kidneys, two lungs, two corneas, a liver, a heart, etc. – is greater, even once you subtract out the unusable organs. I’ve seen estimates (sorry, no link) in the thousands of dollars for just one kidney.

But hold on – not all medical expenses are covered by the taxpayers; the rest are covered by private commercial insurance or self-payment. Assuming self-payers are really a null set (their expenses get absorbed by public hospitals and ERs), about 37% of the costs get carried by the taxpaying public (using Florida's figures for head injuries and applying it to all injuries). That brings the per-donor estimate down to about $34,300. Surely the organs would be worth that much.

While I’ve tried to bias the case in favor of helmet laws, I’ve made one big assumption in the other direction: that everyone who dies in a bike accident is an organ donor. Taking into account non-donation will increase the estimated cost per donor, perhaps to the point where the benefits are swamped by the costs of allowing unhelmeted riding. If so, this might seem to justify helmet laws. But there is an intermediate solution: riders could be required to register as organ donors in order to ride unhelmeted. I suspect that’s a deal most riders would take.

It would also be desirable to account for long-term care for people disabled in motorcycle accidents. This could push the figures up or down. Some unhelmeted riders could suffer greater injuries that necessitate long-term care, but nothing has to be spent on the long-term care of those who die instantly.


Anonymous said...

I liked your analysis a lot because you at least tried to quantify the costs and benefits of allowing people to drive helmetless - a difficult task to be sure.

One "shocking" conclusion is that it's generally better for society if the motorcyclist succeeds in killing him or herself. The organ recipient's life may be saved and the mortician makes a buck. However, the family may experience a significant loss if the accident victim was at fault and was the breadwinner of his family. This brings car/life insurance, charity and government programs to support his immediate family into the picture. So should the unhelmeted motorcyclist be required to carry a hefty motorcycle insurance policy? But then won't the insurance companies require wearing a helmet as part of the insurance coverage contract? The end result is still a requirement to wear a helmet. Back to square one.

Anonymous said...

I also wanted to mention the subtle psychological and human costs that result from someone being left a parapleigic and in a wheelchair for the rest of his or her life. Most people feel pity or sympathy for the injured person. This is a psychological cost on society. Many people feel guilty if they don't help the paralyzed person with his chores and other needs. But frankly you are spending part of your life doing charity when you would rather not be bothered. I don't care if you call it a selfish motive, I'd rather smell the daisies than the foul body odors of a person without bowel control. Let Donald Trump push the spine-damaged cripple around town. FAT CHANCE! There, I made you laugh, I think.

Anonymous said...

Is it really better for everyone to bear the costs of their healthcare themselves? This seems manifestly unfair, since some people are plagued with many more healthcare problems (through no fault of their own), which are devestatingly expensive.

Anonymous said...

Re:" But here’s what I found: Florida’s total medical expenditures on cycle-related injuries in the pre-repeal era were about $23 million higher per year than in the post-repeal era.": Are you sure you don't have that backward? It seems like they were $23m higher per year after the repeal than before?

Glen Whitman said...

Thanks, Ran. I've fixed the error.