http://usatoday.com/usatonline/20030520/5171561s.htm

This was a USAtoday cover story and I do apologize to the authors and
publication for copying and pasting, but I don't wish to risk wasting
my time and others' by pasting only a link which may or may not get
folks to the story.  As is often the case, there were interesting
side-bars in the print edition which are not present in the online
edition.

This story covers many of the auto safety and insurance-cost themes
I've been thinking about.  There were many different issues here
worthy of discussion, I think, such as the difficulty of showing that
buckling up helps save lives when the state with the lowest fatality
rate has just about the worst buckling up practices (there was a
terrific chart in the Print edition).  Also, the story covered the
effects of civil libertarians' efforts on impeding enactment of laws
which would bring more people to buckle up, and it covered the huge
financial and non-financial costs of these needless and senseless
injuries and deaths.

I liked this quote, among others:

>Why people don't wear belts
>
>Working against high belt use:
>
>* Apathy. When there's no Ford, Firestone or drunk driver to blame, there's 
>little public outrage about car crash deaths. Americans have grown used to 
>losing almost as many people every year in crashes as were lost during the 
>entire Vietnam War.

Page 1A 


U.S. pushes for wider seat belt use Buckling up could save about 9,200
lives a year 
By Jayne O'Donnell
USA TODAY


BOSTON -- Kevin O'Connor, a spinal-cord doctor who teaches people how
to use wheelchairs and control their bowels and bladder, has an
unofficial specialty: car-crash victims, the ones who don't wear seat
belts. 

Before he came to Boston's Spaulding Rehabilitation Hospital last
year, O'Connor worked in San Diego, where it was rare to see teens
lying in traction after flying out of their cars and trucks. But now,
he regularly treats people whose lives changed forever when crashes
stopped their cars -- and they kept going. 

That's because only about half of Massachusetts motorists wear safety
belts, and a greater percentage die unbelted than in any state but
Rhode Island. In both states, three-fourths of those who die in car
crashes are unbelted, a USA TODAY analysis shows.

Cars have had seat belts for more than 30 years, and states started
requiring their use in 1984. But the risk of debilitating injury or
death -- or a ticket -- has persuaded only 75% of Americans to buckle
up. That gives the USA a lower rate than most of the developed world.
Federal officials say if everyone wore belts, it would prevent up to a
third -- about 9,200 -- of the 31,000 deaths in car and truck crashes
each year.

Congestion, which slows traffic, helps Massachusetts maintain the
country's lowest overall highway death toll. But the consequences of
having the lowest seat-belt usage rate in the USA and one of the
highest crash rates are seen in rehab hospitals across the state.

''You never think something like this could happen to you,'' says
Michael Prestipino of Lowell, Mass., a quadriplegic since his unbelted
body was ejected from his pickup on an icy road last year. 

Federal and state officials share the $26 billion annual cost of
Medicaid to care for unbelted drivers and cover their lost
productivity. Still, states vary on the degree of importance they
place on getting people to buckle up.

The National Highway Traffic Safety Administration is spearheading a
massive two-week drive through Memorial Day to fire up the states to
promote safety-belt use and encourage police officers to ticket the
unbelted. The focus is on Memorial Day because it kicks off summer,
the deadliest season on the road. NHTSA wants to achieve 78% usage
this year. 

The usage rate hasn't budged more than a few percentage points in the
last decade, but it isn't for lack of trying. Federal officials
encourage, cajole and threaten states to get them to pass laws that
let police ticket unbelted motorists. Now, NHTSA wants Congress to let
it force states to pass tougher belt laws or be required to spend
highway construction money on highway safety.

NHTSA says data overwhelmingly show that the only way to make major
strides in belt usage is education, coupled with strong police
enforcement of so-called primary belt laws. These laws allow police to
pull people over simply because they are not wearing seat belts.
Federal data show that states passing these laws can expect an
8-percentage-point increase in usage. Still, although almost every
state allows police to stop cars if young children aren't in child
seats, only 19 states have primary belt-use laws. 

Automakers and insurers also lobby for primary laws because seat-belt
usage can save them money. Automakers are sued less because belts
reduce injuries that might otherwise be attributed to the car, and
insurers pay fewer and lower personal-injury claims. North Carolina
insurance data show that drivers there have saved $132 million in
premiums since its seat-belt usage jumped from 65% in 1993 to 84% in
'95.

Higher belt use would also boost states' bottom lines. Massachusetts
pays nearly $40 million a year to care for head- and spinal
cord-injury patients who were unbelted, according to a new study for
the Air Bag & Seat Belt Safety Campaign, funded by the auto and
insurance industries. That's almost six times what Virginia, with 70%
belt use, pays.

Why people don't wear belts

Working against high belt use:

* Apathy. When there's no Ford, Firestone or drunk driver to blame,
there's little public outrage about car crash deaths. Americans have
grown used to losing almost as many people every year in crashes as
were lost during the entire Vietnam War.

Although more people under 60 now die from injuries in car crashes
than from injuries from any other cause, other misfortunes -- breast
cancer, heart disease and AIDS -- have been far more effective
rallying points for fundraising and lobbying. 

* Civil libertarians. Laws in several states have been blocked or
stymied by those who oppose government intrusion in citizens' lives.
In Massachusetts, a now-deceased radio talk-show host almost
single-handedly won two repeals of laws requiring belt use in 1986 and
1993, and his efforts echo in the current debate about whether police
should be able to pull over the unbelted. 

''There's some bizarre equating of not wearing a seat belt with being
a red-blooded American,'' says emergency room physician Richard Herman
of Brockton (Mass.) Hospital. ''Intellectually, you could almost
understand the argument, but these are kids being killed. Aren't these
people parents?''

Massachusetts Republican State Rep. Brad Jones, who opposes a primary
belt law although he wears a seat belt, doesn't find it so strange.
''At what point is the impact of saving one life worth the trade-off
in civil liberties?'' he asks. He says there is a ''mistrust of
authority'' in his state dating to the Boston Tea Party. 

* Racial profiling. Concerns that belt laws will encourage police to
unfairly target minority drivers have stalled or helped defeat primary
belt laws in several states. African-American state legislators in
Virginia cited these concerns in voting against a proposed primary law
there this year. 

* Misinformation. Many people who don't buckle up perpetuate what can
be half truths about the dangers of seat belts. Cases in which people
have been seriously injured or killed because they were wearing a belt
are so rare that many doctors say they've never seen them. And
although there are horrific crashes where the belts' estimated 50%
effectiveness will not save you, medical experts say the benefits
greatly outweigh the risks.

Herman says that any accident that had enough force to cause an
internal injury from a seat belt would kill the person who wasn't
belted.

Massachusetts has a so-called secondary law that requires wearing a
belt but doesn't allow police to pull motorists over only for that
violation. The state has been slow in enforcing the law and in
advertising its belt-use campaign.

But Massachusetts highway safety spokesman Brook Chipman says that
once the state started to push for usage last November, the expected
outrage never developed. ''After all the hesitancy we had, it was
really encouraging,'' says Chipman, who says the state should have
started sooner.

The state will tally its new usage rate early next month. But the push
has come too late for thousands of motorists, including Prestipino. He
says he was never told to wear a belt when he was young, so he never
developed the habit. He was never pulled over for not wearing a belt
and says he never saw any public service messages about belts. 

Children follow parents

Many who don't buckle up say they're only putting themselves at risk.
But Tim Hoyt, safety director at Nationwide Insurance, says the
children of adults who don't buckle up are far less likely to use seat
belts themselves. 

NHTSA chief Jeffrey Runge, a former emergency room physician, says
those who don't use seat belts don't take into account the emotional
and economic toll placed on families or the price paid by taxpayers
and insured motorists. 

Prestipino, who managed a paint store before his January 2002 crash,
says his family has paid less than $1,000 for his medical care. The
rest has been paid by insurance and Medicaid. Treatment for severe
spinal-cord injuries such as Prestipino's average up to $400,000 the
first year and $40,000 a year after, helping explain why
Massachusetts' auto insurance rates are the third-highest in the USA.

Prestipino's wife, Diane, found a teaching job recently to support her
family, which includes a toddler who was 5 months old when her husband
was injured. She has to get up two hours early to get her husband, who
has regained some use of his hands, and daughter ready for their day.
Their home has been redesigned -- with money from friends and
relatives -- to accommodate Michael's wheelchair. 

Among O'Connor's patients at Spaulding Rehab, Prestipino is one of the
lucky ones. Some have brain injuries along with their paralyzed
bodies. Sometimes it takes some convincing for them to realize they
are lucky to be alive. ''They go through a grieving process similar to
when someone dies,'' O'Connor says. ''Then they resolve things in
their head . . . and say 'I want to do the most I can do.' '' 

Massachusetts state Sen. Brian Lees, a Republican, has sponsored
primary belt legislation twice and is fighting the battle again this
summer. ''Life-and-death issues don't come before the legislature very
often,'' says Lees, who often gets hate mail because of his position.
''I try not to just look at things in political terms. I think I'm
going to win on this some day.''

Larry Gentilello, trauma chief at Boston's Beth Israel Deaconess
Medical Center, hopes so.

''Every day, I'm faced with speaking to a mother or a father whose
young adult is in a coma,'' Gentilello says. ''I think, 'Why didn't
you educate your child about wearing seat belts?' They are
experiencing the tragedy of their lives. You look in their eyes, and
you realize they're not there anymore.''

Cover storyCover story 


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