Mandatory Passive Restraint Systems in

Automobiles: Issues and Evidence

September 1982

NTIS order #PB83-159822
TECHNOLOGY

AND

HANDICAPPED PEOPLE

SEPTEMBER 1982

BACKGROUND PAPER #l: MANDATORY PASSIVE

RESTRAINT SYSTEMS IN AUTOMOBILES:

ISSUES AND EVIDENCE

Kenneth E. Warner, Ph. D.

Department of Health Planning and Administration

School of Public Health

University of Michigan, Ann Arbor, Mich.

OTA Background Papers are documents containing information that supplements

formal OTA assessments or is an outcome of internal exploratory planning and evaluation. The material is usually not of immediate policy interest such as is contained

in an OTA Report or Technical Memorandum, nor does it present options for Congress to consider.

-.

CONGRESS OF THE UNITED STATES

., ~ Office of Technology Assessment

‘ Washington, D C 20510
Library of Congress Catalog Card Number 82-600546

For sale by the Superintendent of Documents,

U.S. Government Printing Office, Washington, D.C. 20402
Foreword

Technology exerts a powerful influence over the lives of everyone, making life easier,

more fulfilling, but sometimes more painful and frustrating. This is especially true for

people with disabilities. The appropriate application of technologies to diminishing the

limitations and extending the capabilities of disabled and handicapped persons is one

of the prime social and economic goals of public policy.

The Federal Government is deeply involved in programs that affect the development and use of technologies for disabilities. Congress and other institutions have been

increasingly interested in how well programs that directly develop technologies and support their use have been performing. The Senate Committee on Labor and Human Resources requested the Office of Technology Assessment (OTA) to conduct a study of

technologies for handicapped individuals. That study examined specific factors that affect the research and development, evaluation, diffusion and marketing, delivery, use,

and financing of technologies directly related to disabled people. The problems and processes of the development and use of technologies were analyzed in the context of societal

allocation of resources and the setting of goals for public policy. The main report of

the study Technology and Handicapped People was released in May 1982.

This case is background paper #1 of the study. A number of case studies will be

published as part of the assessment, and each will be issued separately. The case studies

were commissioned by OTA both to provide information on specific technologies and

to gain lessons that could be applied to the broader policy aspects of technology and

disability.

Drafts of each case study were reviewed by OTA staff; by members of the advisory

panel to the overall assessment, chaired by Dr. Daisy Tagliacozzo; by members of the

Health Program Advisory Committee, chaired by Dr. Frederick Robbins; and by numerous other experts in medicine, disability policy, Government, economics, public

interest and consumer rights, and rehabilitation engineering. We are grateful for their

assistance. However, responsibility for the case studies remains with the authors.

#

.

.

JOHN H. GIBBONS

Iii
Advisory Panel on Technology and Handicapped People

Daisy Tagliacozzo, Panel Chair

Department of Sociology, University of Massachusetts, Harbor Campus

Miriam K. Bazelon

Washington, D.C.

Tom Beauchamp

Kennedy Institute-Center for Bioethics

Georgetown University

Monroe Berkowitz

Bureau of Economic Research

Rutgers University

Henrik Blum

University of California, Berkeley

Frank Bowe

Woodmere, N. Y.

Jim Gallagher

Martha Porter Graham Center

University of North Carolina, Chapel Hill

Melvin Glasser

Committee for National Health Insurance

Ralf Hotchkiss

Oakland Calif.

John Kimberly

The Wharton School

University of Pennsylvania

Robert Leopold

Department of Psychiatry

Hospital of the University of Pennsylvania

LeRoy Levitt

Mount Sinai Hospital

A. Malachi Mixon, III

Invacare Corp.

Jacquelin Perry

Rancho Los Amigos Hospital

Barbara W. Sklar

Mount Zion Hospital

William Stason

Veterans Administration and Harvard School of

Public Health

Gregg Vanderheiden

Trace Research and Development Center

University of Wisconsin

Michael Zullo

Corporate Partnership Program

U.S. Council for International Year of

Disabled Persons
OTA Staff for Background Paper #1

H. David Banta, Assistant Director, OTA

Health and Life Sciences Division

Clyde J. Behney, Health Program Manager

Clyde J. Behney, Project Director

Anne Kesselman Burns, Analyst

Chester Strobel, Analyst

Kerry Britten Kemp, Editor

Virginia Cwalina, Administrative Assistant

Mary E. Harvey, Secretary

Pamela J. Simerly, Secretary

OTA Publishing Staff

John C. Holmes, Publishing Officer

John Bergling Kathie S. Boss Debra M. Datcher Joe Henson
Chapter Page

I. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2, AUTOMOBILE SAFETY PROBLEM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Health Consequences of Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Record of Federal Safety Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Manual Seatbelts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

3. ALTERNATIVES TO MANDATORY PASSIVE RESTRAINT SYSTEMS . . . . . . . . . . 15

Do Nothing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Information/Education Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Mandatory Seatbelt-Use Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

“Technological F ix’’.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Economic Incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4. PASSIVE RESTRAINT SYSTEMS: THE BAG AND THE BELT . . . . . . . . . . . . . . . . . . 21

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Safety and Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Costs of Passive Restraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

5. COST-BENEFIT ANALYSES OF PASSIVE RESTRAINTS . . . . . . . . . . . . . . . . . . . . . . . 31

6. PHILOSOPHICAL AND ETHICAL ISSUES IN THE PASSIVE

RESTRAINT DEBATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

7. CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

List of Tables

Table No.

1.

2.

3.

4 .

5 .

6 .

7.

8 .

Motor Vehicle

Motor Vehicle

Fatalities in the United States by Age, 1979 . . . . . .

Fatality Rates of Licensed Drivers by Sex and Age

Distribution of Injuries by Injury Severity . . . . . . . . . . . . . . . . . . . . .

Existing Federal Standards Intended To Provide Protection in the

Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Seatbelt

Seatbelt

Relative

Usage in 1977-78 by Car Model Year . . . . . . . . . . . . . . . . .

Usage in 1977-78 by Sex, Region, and Capsize . . . . . . . .

Strengths of the Two Passive Restraint Systems . . . . . . . .

Root Mean Square AIS Ratings for Occupants in Frontal Crashes

by Body Region and Restraint System . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

Event of an

. . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

With VDIs 3-5,

. . . . . . . . . . . . . . . . .

Page

7

7

8

9

10

10

21

2 5

vii
1 .
1

Introduction;

The OTA study Technology and Handicapped

People concentrated on an examination of

technologies developed for and used by people

with handicaps. An alternative, or complementary focus, would be on technologies designed to

prevent handicaps. There are literally hundreds

of prevention technologies that constitute familiar

aspects of 20th century American life. Many prevention technologies have derived from scientific

research; the vaccines that prevent crippling childhood diseases are among these. Others represent

a more prosaic application of common sense to

everyday problems; an obvious example is the

ubiquitous rubber bathtub mat. Some prevention

technologies require the installation of elaborate

safety equipment, such as that found in a nuclear

power plant, others require only the installation

of a simple idea in people’s minds—e.g., the advice not to drink and drive.

Regardless of their diverse technical characteristics, all prevention technologies can be viewed

in a common perspective vis-a-vis the class of

technologies designed to treat, restore, rehabilitate, and palliate handicapped individuals. Prevention technologies complement these “after-thefact” technologies in the battle to ameliorate the

consequences of handicaps. But prevention technologies also compete with treatment technologies, for a primary goal of the former is to obviate the need for the latter. Thus, physicians can

exhort their patients not to smoke, or years later

they can attempt to assist them to learn to live

with emphysema.

Obviously, from a humane perspective, society wants to prevent all preventable handicaps. But

here, as in so many other desirable human endeavors, practical considerations enter—in particular, what will prevention cost? In the coldest

of analytical perspectives, the purely economic

costs of preventing handicaps can be compared

*NOTE: The writing of this background paper on passive restraints in automobiles was completed in May 1982. As the paper

went to press in September 1982, the situation regarding passive

restraints had been further altered by court decisions but had not

yet been finally resolved.

with the purely economic costs of dealing with

preventable handicaps after they are realized. But

the challenge of social resource allocation decisionmaking calls for a more complex and somewhat “warmer” cost-benefit calculus, one which

blends the economic and humanitarian concerns.

In the effort to minimize the adverse consequences

of handicaps, analysts must develop measures (or

at least concepts) of social cost which incorporate

both pecuniary and nonpecuniary costs, which

add the costs of suffering to the costs of materials.

The purpose of this background paper is not

to develop such a social cost-benefit calculus, nor

even to array the attributes of alternative prevention and treatment technologies in a comparative

framework. Rather, the paper is intended merely to complement the main body of the OTA

study by introducing the prevention perspective

through a case study of a single prevention technology. It is hoped that this will enrich policymakers’ deliberations, implicit or explicit, on the

social costs and benefits of alternative strategies

for dealing with the problems of handicaps.

This case study examines issues in the debate

on whether passive restraint systems—air bags

and automatic belts—should be required in all

new automobiles sold in the United States. In

1977, Federal Motor Vehicle Safety Standard

(FMVSS) 208, as amended, decreed that all new

cars would have to have a passive restraint system

capable of meeting a 30-mph crash performance

requirement by September 1, 1983 (1984 model

year), with phase-in beginning with the largest

1982 model cars by September 1, 1981.

On April 9, 1981, the National Highway Traffic Safety Administration (NHTSA) announced

a delay of 1 year in implementation of FMVSS

208, and new hearings were held in August 1981

to consider whether the (delayed) rule should be

put into effect or one of three alternatives should

be adopted. Two of the alternatives involved a

reordering of implementation dates for the various

sizes of cars; the third involved elimination of the

passive restraint requirement.

3
4 . Background paper #1: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

On October 29, 1981, NHTSA announced that

it was rescinding the requirement altogether. Lawsuits to reverse the decision have been filed, and

congressional action with a similar intent has been

threatened. Thus, though the passive restraint requirement has been eliminated by administrative

fiat, the issue is not entirely dead.

Congressional hearings have been held only

once since the 1977 decision, but several agency

hearings have been held, and debate has raged

over issues as diverse as effectiveness, safety, cost,

and individual liberty. The automobile, the quintessential symbol of American affluence and individualism, has thus become a battleground for

a major political issue of the early 1980’s—governmental regulation.

The preceding paragraph should suggest the

multidimensional significance of the outcome of

the Federal rulemaking, but the raison d’etre of

passive restraint systems links the debate integrally into a consideration of technology and handicapped people: motor vehicle accidents annually

kill more than 50,000 Americans (over half of

them frontseat occupants of vehicles) and inflict

disabling injuries (ranging from temporary and

minor to permanent and serious) on an additional

2 million people. Automobile accidents are the

leading cause of death and accident-produced

handicaps among young people. Some analysts

have estimated that passive restraint systems could

prevent up to half of the deaths of frontseat occupants and over 100,000 moderate to critical injuries each year.

The remaining chapters of this paper explore

the issues and evidence in the passive restraint

system debate. Chapter 2 considers the nature and

extent of the automobile safety problem, examining accident, death, and injury data and reviewing the record of automobile safety standards and

devices, including the current (“active”) seatbelt

system. Chapter 3 offers a glimpse at approaches

to improving the use of passenger restraints by

means other than mandating passive restraints.

Attention then turns in chapter 4 to a description

of the two passive restraint systems—air bags and

automatic belts—and a presentation of data on

their estimated costs, safety, and effectiveness in

reducing deaths and disabilities. The fifth chapter

reviews and compares cost-benefit analyses of

these systems. Chapter 6 identifies and discusses

the philosophical and ethical issues related to mandating passive restraint systems. Concluding

thoughts are presented in chapter 7.

In closing this introduction, it seems worthwhile

to reflect momentarily on a peripheral but important theme—20th century technology and its impact on health (a theme which is well illustrated

by the case of the automobile). Certainly, overall,

technological developments in this century have

enhanced the quality of life and added years to

its average duration. Many developments have

directly attacked common sources of disability

and mortality (polio vaccine is one prominent illustration), while other developments have reduced health hazards indirectly (for example, the

affluence bred of modern industrialization has improved our diets and thereby rendered us more

resistant to disease). But 20th century technology

has not invariably reduced health hazards. Rather,

the history of new technology is one of continual

redefinition of the types and sources of risks to

health, with new hazards replacing old, and the

gains generally exceeding the losses: the overall

trend in disability and mortality has been downward.

The automobile serves as a prime example of

the complexity of modern technology’s role in

health. Its invention introduced an era in which

the time distance between a health crisis and

curative medical care would be reduced by critical

minutes, in which timely rescue from a burning

building would become increasingly feasible, and

in which distribution of life-sustaining food and

medicine would occur ever more rapidly and inexpensively. Accompanying these health benefits

of motor vehicles, however, have been the significant health costs of street and highway travel, and

the deaths and injuries which reflect the size, structure, and velocity of the vehicles, as well as characteristics of the roads and of the operators of the

vehicles. The disproportionate impact of motor

vehicle accidents on the young is particularly

tragic, as thousands of lives are cut short in their

prime and healthy bodies are committed to decades in beds and wheelchairs. The economic costs

of treatment and rehabilitation as well as lost

future productivity are substantial. The emotional

toll is enormous. It is toward reducing these

burdens that the technology of passive restraints

is directed.
2

Automobile Safety Problem
2 m

Automobile Safety Problem

HEALTH CONSEQUENCES OF ACCIDENTS*

In 1979, motor vehicle accidents killed 51,900

Americans, including 9,400 pedestrians and

42,500 nonpedestrians. The vast majority of the

latter group, 28,900, were occupants of passenger cars; 6,700 were in trucks, and 3,700 were on

motorcycles. An additional 2 million people received disabling injuries. All told, there were 18.1

million accidents involving 29.7 million vehicles,

the large majority of which resulted primarily in

property damage or nondisabling injuries. One

in twelve vehicles registered in the United States

was involved in an accident, and a similar ratio

characterized the fraction of the population involved in an accident. Additional consequences

included the following:

● 3.5 million hospital bed-days beyond initial

emergency care;

● 35,700 person-years of work effort lost; and

● an estimated $35.8 billion in economi c

costs, * * almost half of the total costs of all

types of accidents.

The motor vehicle accident toll is not distributed proportionately among the population.

Over 40 percent of accident-involved drivers are

under the age of 25, an age group constituting just

under 23 percent of licensed drivers. Table 1

shows the most tragic consequence of this phenomenon: the motor vehicle death rate for 15- to

24-year-olds is twice the national average and five

times that of younger children. Table 2 demonstrates further that there is a strongly unequal sex

distribution of motor vehicle fatalities, with male

drivers’ age-specific death rates exceeding those

of females by a factor of from 2.4 to 4.6. The

*Data in this section are from the National Safety Council (31)

and the National Highway Traffic Safety Administration (29). It

should be noted that many accident-related data are estimates and

that numerous data inconsistencies are found in the literature on

motor vehicle accidents.

**This figure includes lost wages, medical expenses, insurance administration costs, and property damage. It does not include police,

fire, and court expenses, the value of lost cargo on commercial vehicles, etc. (31). A recent independent study estimated the costs of

motor vehicle deaths and injuries at $20 billion (11).

Table 1 .—Motor Vehicle Fatalities in the

United States by Age, 1979

Age Number of fatalities Fatality ratea

<5 years. . . . . . . . .

5 to 14 years . . . . .

15 to 24 years . . . . .

25 to 44 years . . . . .

45 to 64 years , . . . .

65 to 74 years . . . . .

>75 years. . . . . . . . . .

Total . . . . . . . . . .

1,500

2,900

18,900

15,000

7,900

3,000

2,700

51,900

9.6

8.4

45.7

25.0

18.0

19.6

28.8

23.6

aDeaths per 100,000 population.

SOURCE: National Safety Council, Accident Facts (Chicago: NSC, 1980).

Table 2.—Motor Vehicle Fatality Rates of

Licensed Drivers, by Sex and Age

Fatality ratea

Age Males Females

<20 years. . . . . . . . . . . . . . 131.8 35.1

20 to 24 years . . . . . . . . . 107.9 23.6

25 to 34 years . . . . . . . . . 69.1 15.2

35 to 44 years . . . . . . . . . 52.1 13.7

45 to 54 years . . . . . . . . . 44.6 12.0

55 to 64 years . . . . . . . . . 36.4 12.5

365 years . . . . . . . . . . . . . . 37.0 15.6

aDeaths per 100,000 population.

SOURCE: National Highway Traffic Safety Administration, Highway Safety

Facts 3 (Washington, D.C.: Department of Transportation, 1978).

worst rate for females (women under the ages of

20) is less than the best rate for males (men 55

to 64 years old). More than 1 in every 100

15-year-old boys will die in an accident before the

age of 25, a death rate 20 times higher than that

attributable to polio at its worst (13). *

Unfortunately for the purposes of this study,

there are no good national data on the types and

● Age-specific motor vehicle death rates are in part a function

of exposure. For example, the number of passenger-miles per year

varies from 16,000 for males in their early thirties to under 3,000

for elderly women. From their mid-twenties to early sixties, men

ride from 50 to 100 percent more passenger-miles than women. As

a result, fatality rates per 100 million passenger-miles by age differ

from the simple age-specific fatality rates. The young males’ rates

remain the most socially alarming, but the highest rates per 100

million passenger-miles belong to the very elderly (over 75) (6).

7
8 ● Background paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

numbers of handicaps that result from motor vehicle accidents. The National Highway Traffic Safety Administration (NHTSA) is trying to refine

data collection to produce such information, but

today’s data on disabilities do not permit a useful

assessment (34). Currently, data indicate severity of injury but do not follow through on the outcomes of injuries.

Table 3 presents the percentage distribution of

injuries in a recent NHTSA sample by injury

severity. The data indicate that over 70 percent

of all injuries are scored as minor on the Abbreviated Injury Scale (AIS), a common index of

injury severity. Under 12 percent of injuries are

in categories (AIS 3 to 5) in which survival is probable or possible and in which serious handicaps

could be a result. Given the total number of injuries, however, this relatively small percentage

still represents many tens of thousands of people.

Furthermore, moderate injuries (AIS 2) can also

result in disabling handicaps. Thus, while reliable

data on accident-produced handicaps are not

available, injury severity data suggest the substantial probable burden.

Despite the “bad news” contained in the above

motor vehicle accident data, there is also good

news. During the 1970’s, total motor vehicle

deaths declined 7 percent—dropping from 55,791

deaths in 1969 to 51,900 in 1979. Given growth

in the population and in the number of registered

Table 3.—Distribution of injuries by injury Severity

AIS Percentage

Percentage in class

Code no. Definition of persons surviving

1 . . . . . . . . . Minor 71.1 99.989

2 . . . . . . . . . Moderate 16.4 99.878

3 . . . . . . . . . Serious, not life 8.1 99.158

threatening

4 . . . . . . . . . Severe, life threatening 2.2 91.978

5 . . . . . . . . . Critical 1.5 41.799

6 . . . . . . . . . Maximum injury, 0.8 0.000

virtualIy unsurvivable

SOURCE: S. Partyka, “Effects of Traffic Accident Injuries on the Workforce

Estimated From NCSS and NASS Data” (Washington, D. C.: National

Highway Traffic Safety Administration, National Center for Statistics and Analysis, June 1981).

vehicles, the decline in death rates was quite

dramatic. For example, the death rate per 10,000

registered vehicles dropped 37 percent, from 5.19

to 3.26. In 1979, the death rate per 100 million

vehicle-miles stood at an all-time low of 3.4; in

the 1940’s and earlier, that rate was in the teens.

The death rate per 100,000 population fell by 15

percent over the course of the decade; this included a lo-percent decrease in the 15- to 24-yearold age category, the smallest age-specific decline.

A variety of factors contributed to these improvements, including the national 55-mph speed limit

implemented in 1974, the increasing price of

energy in the mid to late 1970’s, and automobile

safety features (47). We now turn to a look at the

record of Federal governmental regulation of

automobile safety.

RECORD OF FEDERAL SAFETY STANDARDS

As substantial as the accident toll is today, there

is evidence that it would have been considerably

greater in the absence of existing Federal Government safety regulations. Analyzing data from the

Fatal Accident Reporting System of NHTSA,

Robertson (37) has estimated that for the years

1975 through 1978, some 37,000 fewer deaths occurred than would have been expected in the

absence of the Federal safety standards.

Robertson observed a total death rate of 5.5

persons per 100 million vehicle-miles for cars not

subject to safety regulations, but a rate of only

3.4 for cars meeting the Federal safety standards.

A differential characterized all classes of victims

(including pedestrians, motorcyclists, and pedalcyclists), but occupants of automobiles meeting

the standards realized the greatest benefit, with

a death rate of 1.5 per 100 million vehicle-miles

compared with 2.9 for occupants of vehicles not

subject to the standards.

Robertson did not examine the impact of safety standards on injuries and disabilities, but a

qualitatively similar benefit would be expected. *

Other studies also have documented decreased oc-

● It is possible that a safety standard which reduced deaths might

thereby result in increases in nonfatal injuries. The evidence gathered

to date, however, suggests that reductions in fatal and nonfatal injuries go hand-in-hand.
Ch. 2—Automobile Safety Problem

cupant deaths and nonfatal severe injuries associated with State and Federal safety regulations

(7,16,21,35).

Most Federal safety standards are technological

and fall into two categories: vehicle crashworthiness and crash avoidance. Table 4 lists

prominent examples of existing Federal Motor

Vehicle Safety Standards (FMVSSs) intended to

protect automobile occupants solely in the event

of an emergency; these standards are similar in

intent to passenger restraint systems. It should be

noted that nontechnological standards can have

a comparable or greater effect in reducing the accident health toll; the national 55-mph speed limit

stands as perhaps the most prominent example.

In a 1979 study, the National Safety Council

(NSC) estimated that there would have been an

additional 5,500 motor vehicle, accident deaths per

year were it not for reduced speeds and a narrower

speed distribution, both of which are attributable

primarily to the 55-mph law. NSC also estimated

that if all States had raised their speed limits to

65 or 70 mph in 1978, an additional 5,200 to 7,800

deaths would have resulted that year (47).

The magnitude of the remaining accident health

toll suggests the considerable potential for using

additional technology to further decrease highway-produced deaths and disabilities. High usage

rates of passenger restraint systems alone could

reduce the toll by half (see ch. 4). Belted occupants

of automobiles experience 50 percent fewer highway deaths than unbelted occupants (40)—yet it

is estimated that only 10 to 15 percent of the

population wears seatbelts, and the percentage has

been falling in recent years (15). Automatic (i.e.,

passive) restraint systems are advocated precisely because of this failure of the vast majority of

the population to use manual (i.e., active) belts.

The reasons for, and implications of, the nonuse

of manual belt systems are considered further

below.

Table 4.—Existing Federal Standards Intended To Provide Protection

in the Event of an Emergency

FMVSS

Title Automatic performance required

105-75 . . . . . . . . .

110 ., . . . . . . . . . .

111 . . . . . . . . . . . .

201 . . . . . . . . . . . .

203 . . . . . . . . . . . .

205 . . . . . . . . . . . .

212 . . . . . . . . . . . .

215 . . . . . . . . . . . .

301 . . . . . . . . . . . .

Hydraulic brake

systems

Tire selection and rims

Rearview mirrors

Occupant protection in

interior impacts

Impact protection for

the driver from the

steering control system

Glazing materials

Windshield mounting

Exterior protection

Fuel system integrity

Requires split brake system for redundancy if primary

system fails

Rim must retain tire from 60 mph to stop after rapid

deflation

Breakaway inside mounting for mirror

Contactable interior surfaces must be padded or meet performance requirements with headform impact at 15 mph

Steering assembly must absorb driver impacts under controlled crash criteria

Windshield has a high penetration resistant inner layer

Requires windshield mounting retain specified periphery of

windshield in crashes

Provides vehicle protection in certain crash impacts

Provides protection against fuel systems rupture and

leakage in crashes

SOURCE: W. Haddon, Submission of Documents to W. Coleman, Jr., Secreta~, Department of Transportation, Washington,

D. C., Sept. 17, 1976.
10 ● Background paper #1: Mandatory passive Restraint Systems in Automobiles: Issues and Evidence

MANUAL SEATBELTS

Front-lap seatbelts were first installed in all cars

as standard equipment in 1964, when 14 States

required them (41). By the late 1960’s, lap and

shoulder belts were required as standard equipment on all new cars sold in the United States.

Thus, almost all cars on the road today are

equipped with lap or lap/shoulder belts; the vast

majority have the lap/shoulder combination.

Studies indicate that, when worn, belts reduce the

risks of death and serious injury by 50 percent

or more (28,40). Although most people may not

be familiar with the precise statistics, virtually

everyone is aware that “seatbelts save lives, ” as

the publicity slogan put it years ago.

Yet, according to recent observations of manual

belt use, only 11 percent of drivers wear their belts

(15). Usage rates have fallen in recent years,

following a brief period of increases in the mid1970’s. The increases in the mid-1970’s may have

been attributable in part to the ignition-interlock

systems that were installed on 1974 and some 1975

model cars. The interlock systems provoked a

loud and angry public response as drivers found

themselves unable to start their cars when they

placed cargo on the passenger seat (e.g., groceries

or the family dog) that exceeded the weight minimum which activated the system. The congressional response was to prohibit the Department

of Transportation from requiring the system on

later cars (41).

Table 5 shows how belt usage varied in 1977-78

by automobile model year. The American Automobile Association claims higher usage rates in

some of the (then) newer model cars with improved belt systems (13). Table 6 indicates how

belt usage varied by sex, region of the country,

and car size.

The result of such low usage rates is that manual belts in cars currently reduce the fatality and

serious injury rates by less than 10 percent. Thus,

a tremendous potential for saving lives and preventing injuries is going unrealized, despite the

ready accessibility of the technology and the relative ease of its use.

Table 5.—Seatbelt Usage in 1977-78 by Car

Modei Year

Usage (percent)

Car model year Lap only Lap and shoulder Total

1964 -67. ........, . 8. 9

1968 -71 . . . . . . . . . . . 8.5

1972-73 . . . . . . . . . . . 12.7

1974 . . . . . . . . . . . . . . 2.7

1975 . . . . . . . . . . . . . . 1.7

1976 . . . . . . . . . . . . . . 1.4

1977 . . . . . . . . . . . . . . 1.1

1978 . . . . . . . . . . . . . . 1.2

—

2.4

4.2

14.4

12.7

12.2

12.2

12.5

8.9

10.9

16.9

17.1

14.4

13.6

13.3

13.7

SOURCE: National Highwai{ Traffic Safety Adminlstration, Occupant Protect)orr Program Progress Report No. 2 (Washington, D. C.: Department

of Transportation, April 1979).

Tabie 6.—Seatbeit Usage in 1977=78 by Sex,

Region, and Car Size

Characteristic/Car model years Total usage (percent)

Sex, 1964-78:

Male drivers . . . . . . . . . . . . . . . . . 12.6

Female drivers. . . . . . . . . . . . . . . 16.4

Region of country, 1964-78:

West coast. . . . . . . . . . . . . . . . . . 18.3

All other regions (average) . . . . . 11.4

Car size, 1976-78:

Subcompact . . . . . . . . . . . . . . . 19.5

Compact . . . . . . . . . . . . . . . . . . 12.5

Intermediate . . . . . . . . . . . . . . . 10.3

Full , . . . . . . . . . . . . . . . . . . . . . . . 9.6

SOURCE: National Highway Traffic Safety Administration, Occuparrt Protection Program No. 2 (Washington, D. C.: Department of Transportation, April 1979).

What accounts for the extremely low usage

rates? Two factors invariably cited in polls are

discomfort and inconvenience (28), although a

survey sponsored by General Motors (GM) has

identified other factors as being of greater significance (e.g., fear of being trapped in a vehicle) (18). The issue of discomfort reflects belts’

pressuring or abrading hips, chests, and necks and

creating an unpleasant sense of confinement or

restriction of movement. For some people, inconvenience refers simply to the minor effort involved

in buckling a well-functioning belt system, while

for others it relates to difficulties in retracting the

belts or latching or releasing them.
Ch. 2—Automobile Safety Problem ● 11

In a study of its own, NHTSA concluded that

many of the complaints about belts were well

founded. A representative sample of Detroit-area

drivers identified moderate or serious problems

with comfort or convenience in all of the 30 cars

tested, with the best-performing car cited as having a problem in 35 percent of the trials and the

worst-performing car cited in 85 percent. In anticipation of automatic belt systems, NHTSA has

been developing comfort and convenience specifications intended to address these problems (28).

If the GM-sponsored study is correct, however,

improvements in comfort and convenience may

not lead to significant increases in belt usage (18).

The decision not to wear a belt presumably reflects a judgment that the disutility associated with

discomfort, inconvenience, or other factors outweighs the perceived utility of reducing risk.

Arnould and Grabowski (3) offer two related explanations for why this judgment is so common.

The first explanation, referred to as the “insensitivity-to-low-probabilities” hypothesis, suggests

that for very low-probability events (such as a

serious car crash on a single outing), individuals

become insensitive to the high potential cost of

not protecting themselves and indeed may not

comprehend the meaning of the tiny probability; instead, they respond primarily to the unlikelihood of the event.

Arnould and Grabowski discuss a study (44)

which illustrates the principle: two groups of experimental subjects were given data on the probability of experiencing a fatal or disabling accident. One group was given the figures for a lifetime (SO years) of driving (a l-in-100 chance of

a fatal accident and a l-in-3 chance of at least one

disabling injury), while the other group received

the same information calculated on a per-trip basis

(where the odds of the accident outcomes are

minuscule). Compared with the latter group, the

group given the lifetime figures responded by indicating a much greater increase in expected seatbelt usage and a greater disposition toward seatbelt laws.

Arnould and Grabowski also present evidence

that people significantly underestimate their risk

of involvement in an automobile accident. For example, a recent survey (45) queried: How likely

do you think it is that you will be involved in an

automobile accident of any kind in the next year?

Fewer than a quarter of the survey respondents

selected an answer equal to or greater than the

actual societywide average, roughly 1 in 10. A

majority selected odds of 1 in 100 or smaller still.

The second explanation for the judgment that

the disutility of buckling up outweighs the utility of protection is that the expected value of the

protection for any given trip is extremely low,

owing to the low probability of a serious accident,

and thus, a driver (or passenger) simply may value

avoidance of discomfort or inconvenience more

than protection. This will be particularly true if,

as above, the individual significantly underestimates the probability of an accident.

Arnould and Grabowski estimate the annual

per-person benefits of buckling up at between $38

and $78 (in 1975 dollars) and state that, at prevailing wage rates (the assumed opportunity cost of

time), this amount must exceed the time costs of

buckling up. Hence, they conclude that a rational

weighting of costs and benefits cannot explain the

failure of so many people to wear their seatbelts.

The authors acknowledge that “there may be significant discomfort costs to some individuals to

wearing seatbelts. ” Nevertheless, they suggest, “it

would seem hard to argue that [this] would so

change the . . . benefit-cost calculus to explain the

80- to 90-percent current nonutilization rate of

seatbelts. ”

While it is agreed that discomfort costs could

not explain the entirety of nonutilization, it could

be argued that they might explain much of it, particularly if “discomfort” is defined to include the

psychological discomfort of those who fear being

trapped in their cars by belts. Certainly, many

riders who experience discomfort from seatbelts

would accumulate hundreds of hours of discomfort if forced to wear them, and one would not

need to value discomfort time highly to conclude

that nonuse was rational behavior for these individuals.

Numerous characteristics differentiate belt

wearers from nonusers (41). The latter tend to

have less education than the former, rate belts as

more uncomfortable and inconvenient, and are

more likely to be smokers. The victims of serious
—

72 ● Background paper #1: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

crashes are less likely to wear belts than people risk-averse, or perhaps more risk-loving, than

not involved in serious accidents, especially in the their belted counterparts.

case of youthful drivers and drivers under the influence of alcohol. Furthermore, unbelted drivers Whatever the explanation, the fact remains that

tend to follow the cars in front of them closer than only a small minority of automobile occupants

do belted drivers. Collectively, all of these char- choose to wear seatbelts. The consequence in

acteristics suggest that unbelted drivers are less human destruction is tragic.
—

3 .

Alternatives to Mandatory Passive

Restraint Systems
Alternatives to Mandatory Passive

Restraint Systems

Prior to its rescission, Federal Motor Vehicle

Safety Standard (FMVSS) 208—the requirement

that all new cars come equipped with passive

restraint systems—represented a policy judgment

that passive restraints were the best way to address the failure of the vast majority of Americans

to wear their (manual) seatbelts. But passive systems are not the only option; other alternatives

have been suggested and some have been tried.

Advocacy for the passive restraint alternative

reflects in part the experienced or predicted failure

of the other alternatives. In this chapter, the alternatives are briefly identified, and the evidence that

relates to their effectiveness is presented. (Ch. 4

considers the nature, effectiveness, and costs of

passive restraint systems. ) It should be noted that

the alternatives listed below are by no means mutually exclusive:

1. Do nothing—i.e., leave the current manual

lap/shoulder belts in place, leave the deci00 NOTHING

This alternative has few proponents in the political arena. Lacking some bone tossed in the

direction of promoting passenger restraint, the “do

2.

3.

4.

5.

sion of restraint to the individual automobile

occupant, and do nothing to promote the use

of manual belts. *

Actively promote the use of manual belts

through media campaigns and other educational efforts. This is one of the options the

Reagan administration has favored.

Pass legislation requiring the wearing of

seatbelts.

Require a “technological fix” that forces

manual belt use (e.g., the previously tried

ignition-interlock system).

Offer economic incentives to automobile occupants to wear their seatbelts.

● A still more laissez-faire option would be to eliminate the requirement that cars have manual belt systems as standard equipment, leaving purchase and installation of belts as a buyer option.

There are sound theoretical reasons to oppose this possibility (discussed in ch. 6 below), in addition to the political uproar it would

create.

INFORMATION/EDUCATION CAMPAIGN

nothing” alternative must be dismissed as being

of unlikely political viability.

The theoretical appeal of this alternative is considerable, and the Reagan administration has

adopted this approach as its policy to promote

use of passenger restraints. Provision of information—education—is the conceptually appropriate

approach if one perceives the problem of belt

nonuse as resulting from riders’ ignorance of the

true risks of automobile travel and/or the true effectiveness of wearing belts. Public education addresses the public’s information deficit and still

preserves the freedom of (informed) riders to

choose not to be restrained (see also ch. 6).

Borrowing from related health education experience, one might be tempted to conclude that

major publicity efforts could increase the voluntary use of seatbelts. For example, there is

evidence that the antismoking campaign of the

past nearly two decades has had a substantial impact on cigarette smoking (49), and specifically,

15
16 ● Background Paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

that the major broadcast media antismoking campaign of 1968-70 significantly reduced cigarette

consumption (48). Unfortunately, however, the

evidence on whether the smoking experience generalizes to the case of seatbelt use is not encouraging and is at best ambiguous.

Influenced by evidence such as the following,

a number of experts (30,41) have concluded that

information/education campaigns are unlikely to

significantly increase belt usage. In 1968, the National Safety Council (NSC) received $51.5 million

worth of media public service announcement time

to encourage seatbelt use; similar NSC campaigns

were mounted in 1972 and 1973, yet interview

data indicated no change in reported seatbelt

usage (15). Several controlled experiments and

quasi-experiments with media promotion of belt

use also have failed to produce increases in use

(8,43). The American experience is echoed by experience in Canada, Great Britain, and France:

major publicity campaigns either did not increase

belt use at all or, at best, they increased use slightly and only in a transitory manner; i.e., campaign-induced increases disappeared soon after

conclusion of the campaign (15).

Proponents of the information/education approach claim that it has not been given a fair trial,

that more sophisticated understanding of the factors influencing seatbelt usage will permit development of more effective education and publicity

packages. They also argue that an effective campaign requires a long-run approach, with successive education and information efforts reinforcing preceding ones and gradually converting nonbelt users into users.

However, even the most optimistic assessment

suggests that an “all-out” campaign could not

boost usage rates to greater than 40 percent (13).

Thus, if one’s objective is to reduce preventable

motor vehicle fatalities by as much as possible,

this alternative clearly cannot be relied on by

itself. *

MANDATORY SEATBELT-USE LAWS

● The difficulty of promoting truly informed decisionmaking—

the objective of this alternative—is more substantial than one might

think at first. As Arnould and Grabowski (3) demonstrate, people’s

understanding of accident risks is poor, and the statistical or probabilistic nature of such risks constitutes a subtle message to communicate to a comprehending public. This is illustrated by evidence

that the public’s understanding of the health hazards of cigarette

smoking is remarkably unsophisticated despite nearly two decades

of publicity, education, and public discussion of those hazards (26).

This alternative—passing mandatory seatbelt

use laws—has precedents around the world in well

over a dozen countries. In Australia, New

Zealand, Canada, Sweden, and West Germany,

mandatory belt laws have been in effect for

several years and prelaw and postlaw belt-usage

data are available. The first such law, in the State

of Victoria, Australia, produced belt-use rates of

70 to 80 percent and accounted for reductions in

fatality rates of 20 percent in urban crashes and

10 percent in rural crashes. In the Provinces of

Ontario and Quebec in Canada, “weakened” laws

(i.e., exempting shoulder belt use because of the

public’s concern about discomfort) have produced

usage rates in the vicinity of 40 to 50 percent. Four

years after passage of its belt-use law in 1972, New

Zealand was reported to have a compliance rate

of from 80 to 90 percent. An 80-percent rate has

been reported for Sweden; and in West Germany,

observed rates have ranged from 45 to 80 percent

(9).

No U.S. State has adopted a seatbelt law applying to drivers. The traditional American sense

of independence :normally would create significant opposition to such laws—a poll 4 years ago

found more than three-quarters of respondents

opposing them (13)—and the antiregulatory climate of the early 1980’s presumably would increase the level and intensity of opposition. As

a representative of the Consumer Federation of

America stated (13):

All too often State legislators, faithfully reflecting

the sentiment of the people in the State, see mandatory

belt legislation as an outrageous and unnecessary intrusion into people’s lives. Whether one agrees with

that view or not, it is a sentiment that is prevalent in

the large majority of our States.
Ch. 3—Altematives to Mandatory Passive Restraint Systems ● 17

This mentality is reflected in the fact that over

half of the States have recently repealed laws requiring motorcyclists to wear helmets, despite

solid evidence that helmet laws save lives (25,51).

Several States—including Tennessee, Rhode

Island, and Michigan—have adopted laws requiring that children be restrained in moving automobiles. The laws often include exemptions or exceptions (e.g., permitting babies to be unrestrained when nursing). Observational studies

conclude that belt-usage rates by children have

increased, though they remain low overall (approximately one-third) (41).

“TECHNOLOGICAL FIX”

Also unlikely is the “technological fix”

alternative-unless a system can be designed that

is technically superior to, and much more publicly

palatable than, the ignition-interlock system

found in 1974 (and some 1975) model cars. The

technical problems with that system and the

resulting public furor led to the elimination of the

Federal requirement of the system.

A sequela of that experience was that FMVSS

208 prohibited use of an interlock system in any

ECONOMIC INCENTIVES

The remaining alternative-offering economic

incentives to wear manual belts—has not been

tried directly, though a few insurers do offer

premium discounts of up to 30 percent on medical

or personal injury protection coverage for cars

equipped with passive restraints (air bags or automatic seatbelts) (3). It is conceivable that premium

discounts or increases in coverage could be

granted users of manual belts, but the problem

of verifying compliance is not a minor one. Similarly, insurers could offer positive or negative

benefit incentives. For example, medical payments

could be increased for belt-wearing accident victims (an approach adopted by at least one insurer), or payments could be conditioned on belt

use at the time of an accident.

Mandatory belt-use laws are potentially the

most effective approach to ensuring passenger

restraint. Experience in other industrialized countries suggests that a mandatory law might result

in usage rates exceeding those achievable with

passive seatbelts, because so many passive belts

would be detached. Nevertheless, in today’s political climate in the United States, mandatory

seatbelt-use laws seem unrealistic. It also should

be noted that this assessment of belt laws has utterly ignored the

ing the laws.

question—and cost—of enforcpassive restraint system developed to satisfy the

(then-existing) requirement. Certainly, it is possible that passive belt systems could be developed

which would make permanent, or even temporary, disconnecting difficult or inconvenient,

and this might have a marginal impact on passive

belt use. But given the public’s clear opposition

to evident and burdensome “technological fixes, ”

manufacturers and the Government seem unlikely

to go this route.

If the compliance problem could be resolved

(mechanical solutions are conceivable), the potential for the premium approach is intriguing. For

a car with automatic belts, Nationwide Insurance

has estimated premium savings of roughly $20 per

year. Over the lifetime of a car, this translates into

a present discounted value of $150 (33). Since

many automatic belts are disconnected, * assur-

● A survey found a disconnect rate of 22 percent among owners

of VW Rabbits equipped with automatic belts. The finding that

owners of Rabbits with manual belts tend to use their belts more

frequently than the average automobile owner suggests that the automatic belt disconnect rate under a mandatory passive restraint law

might be greater than 25 percent. The rate could be considerably

greater. In particular, the automatic-belt Rabbits have had an interlock system, so disconnection requires action after the car has started

–perhaps a more active form of passive-belt rejection (23),
18 ● Background paper #1: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

ance of compliance with manual belts should be

worth at least as much as the initial presence of

automatic belts. Thus, the lifetime insurance value

of buckling up might prove to be a significant

incentive.

Even if the insurance incentive “worked,” it

seems unlikely that it would raise effective

restraint rates high enough to satisfy people who

want to see maximum reduction of the highway

death and disability toll. Aside from paternalism,

an argument grounded in the existence of negative

externalities suggests that self-selected compliance

rates will be too low from a social point of view

(see ch. 6). Furthermore, the economic incentive

approach would take time to achieve widespread

effect—compliance technology would have to be

developed and installed, insurance companies

would have to be sold on the desirability (and

amount) of discounts, etc. Despite these drawbacks, the incentive approach would seem to warrant more attention than it has received to date.

To my knowledge, it is not now, nor has it been,

an option under serious policy consideration.

This chapter’s review of the policy alternatives

should suggest one of the reasons many people

concerned with automotive safety have been so

supportive of passive restraint systems: for one

reason or another-be it effectiveness or political

acceptability-each of the alternatives, considered

individually, has significant drawbacks. There is

a school of thought that advocates a mix of several

of these alternatives as a cost-effective means of

achieving effective passenger restraint (9,18).

Given the recent demise of FMVSS 208, it seems

probable that more attention will be directed

toward a multiple-approach strategy.
4

Passive Restraint Systems;

The Bag and the Belt
.

4

Passive Restraint Systems;

The Bag and the Belt

BACKGROUND

There are only two major passive restraint

systems: air bags (or cushions) and automatic

belts. Table 7 identifies their relative strengths

(many of which are discussed in this chapter), but

the important point is that, when used properly,

both passive restraint systems are quite effective

in reducing the risk of death and serious injury.

Technically, the automatic belt system is quite

simple. Most systems in operation consist of a

single shoulder belt (a “two-point system”) that

crosses the rider automatically upon entry into

the car, and a padded knee panel below the dashboard to provide added protection. Automatic

belts with a lap as well as a shoulder component

(a “three-point system”) have also been designed.

Some systems offer automatic shoulder belts and

manual lap belts. Close to half a million automatic

belt systems are currently on American roads,

almost all of them in VW Rabbits and Chevrolet

Chevettes, offered as part of option packages.

Air bags consist of deflated bags situated in the

steering wheel (driver) and glove compartment

area (passenger) sides which inflate virtually instantaneously when front end or dashboard sensors detect crash forces substantial enough to be

harmful. Different systems have different inflation mechanisms, and all include ancillary equipTable 7.—Relative Strengths of the Two Passive

Restraint Systems

Air bag Automatic belt

Less obtrusive Less expensive

Less uncomfortable No chemicals involved

Greater protection in most serious Potentially greater protection

accident situations (particularly in some accident situawhen used with manual lap tions a

belt)a

Less likely to be disconnected Redeployment following

emergency use less

expensive

a

see the discussion of safety and effectiveness below.

ment (e.g., knee restraints to prevent riders from

sliding under bags, a readiness monitor, and an

indicator light) (28). Altogether, over 10,000 airbag-equipped cars have accumulated over a billion miles on American roads since they first appeared in 1972.

This more complex technology has a history

which dates back 30 years. In 1952, the first of

several patents for automatically inflating air

cushions was filed. Federal Government interest

dates from 1968, when prototype development became sufficiently advanced to consider large-scale

application in the near future. In 1969, the National Highway Safety Bureau (NHSB, predecessor of the National Highway Traffic Safety Administration, NHTSA) announced a proposed

rulemaking for an “Inflatable Occupant Restraint

System,” with an initially proposed effective date

of January 1, 1972. This marked the beginning

of a longstanding adversarial relationship between

automobile manufacturers and the Department of

Transportation (DOT) which saw dozens of debates over the effectiveness and cost of passive

restraints and delays in implementation of, and

changes in, a passive restraint requirement.

Delay and change have occurred during each

successive administration, with the Reagan administration’s re-examination of the issue being

the latest and most radical. The courts, Congress,

public interest groups, and the media have all been

active participants in the drama. The conflict has

made strange bedfellows of such diverse interests

as Ralph Nader and the Pacific Legal Foundation

(PLF), the latter a public interest group advocating

“limited government.” In 1977, PLF filed suit in

the U.S. Court of Appeals to block the passive

restraint rule, claiming that DOT had an “insufficient basis for the air bag decision.” The following year, Nader and Public Citizen, the consumer

rights group, filed suit in the Court of Appeals

21
zz ● Background Paper #1: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

seeking a ruling that DOT’s scheduled 3-year

phase-in of restraints was illegal; plaintiffs wanted

all new vehicles to have passive restraints at the

same time. The Court of Appeals consolidated the

suits of PLF and Nader and Public Citizen. *

Part of the regulatory debate picture has been

repeated proposals by automakers to introduce

air bags or automatic belts on their own. Each

of these proposals has come in response to a proposed passive restraint rulemaking by the Government. As each of the proposed rulemakings was

altered or delayed, often because of agency actions, occasionally because of judicial decisions,

the automakers’ plans were themselves altered,

invariably in the direction of limiting introduction of passive restraints.

In 1970, for example, General Motors (GM) informed NHSB that it would provide air bags on

all its cars by 1975, introducing the equipment as

an option and then converting it to standard

equipment. In 1973, GM informed DOT that it

was reducing its planned production of air-bagequipped 1974-75 cars from 1 million to 150,000

units, blaming both tooling difficulties and the

Government’s standard-setting process. Half a

year later, a GM spokesperson told the Insurance

Institute for Highway Safety (IIHS) that the figure

of 150,000 was probably too high.

In fact, GM built about 10,000 air-bag-equipped

cars, all large models, during the 1974-76 model

years. The company then canceled production,

● For a detailed chronology of events in air bag development,

debate, and rulemaking, see Back,ground Manual) on the Occupant

Restraint Issue (13).

claiming insufficient consumer demand, a claim

which GM officials have acknowledged was based

in part on a failure of the company to promote

the technology. GM’s revising its plans and departing from the air-bag-equipped automobile

market followed an earlier court decision overturning a proposed NHSB air-bag rule.

A similar picture emerges in the years since the

mid-1970’s, with promises of air-bag-equipped

vehicles repeatedly made and then scaled back or

rescinded (17). Recently, GM announced the termination of its inflatable restraint program, calling the device economically infeasible (23).

Three years ago, the “Big Three” domestic automobile manufacturers and several foreign producers reported to NHTSA that they were working on belt and bag systems and intended to introduce them, as options, on several models

within the next few model years (28). Even prior

to the rescission of Federal Motor Vehicle Safety

Standard (FMVSS) 208, several of the announced

intentions had not been realized.

The technology for both bags and belts is developed and available. As is discussed in the section below, when used properly, these technologies are commonly acknowledged to work, to

save lives, and prevent disabling injuries. What is

less clear is whether the American car rider will

wear belts, active or passive, and whether the consumer’s car-buying propensity will be reduced as

a result of passive-restraint-induced car price increases. This too is examined below.

SAFETY AND EFFECTIVENESS

Following a review of the evidence, William reduce in severity over one hundred thousand

Coleman, Secretary of Transportation in the Ford moderate to critical injuries per year” (13).

administration, concluded that passive restraints

“are a reliable and effective means of substantially The precise quantitative findings can be chalreducing death and injuries on the Nation’s high- lenged-for example, recent estimates have placed

ways.” If air bags were installed on all cars, Cole- the life-saving potential of passive restraints in the

man estimated, they “would probably save over vicinity of 6,000 to 9,000-but the qualitative contwelve thousand lives annually and prevent or elusion is beyond dispute. All of the quantitative
Ch. 4–Passive Restraint Systems: The Bag and the Belt ● 23

evidence supports it and the logic is impeccable:

“The principle behind an occupant restraint is that

an occupant is much less likely to be injured or

killed in an automobile crash if the crash forces

are applied in a controlled way to the strongest

parts of the human body” (28). Furthermore, proponents of passive restraints argue, occupant restraints are much more likely to be used if they

are automatic (i. e., passive) than if they require

action on the part of the occupant, as do today’s

manual belts.

Passenger restraint systems are not perfect; they

reduce but do not invariably prevent deaths and

injuries. Neither belts nor air bags are particularly

effective in rear-end collisions, and the two

technologies have different merits and liabilities

in other types of crashes. In the instance of an impact on the passenger side of a car, for example,

belts are effective in keeping the driver from being

pitched to the side. Air bags occasionally inflate

on side impact, and the passenger-side bag can

then protect the driver, but inflation of the bags

is uncertain. If the bags do inflate, they shield the

driver from flying glass and metal and thereby

afford the driver a form of protection that belts

cannot offer.

The technology of passive restraints might pose

hazards. Concern has been expressed about the

toxicity of sodium azide, a chemical in compounds

used in many air bag systems to inflate the bags.

Testimony has been offered indicating that the

chemicals are confined sufficiently so that car occupants are not exposed to them, either before or

during deployment of a bag. NHTSA is convinced

by the evidence, but is quick to point out that

other, nonchemical inflation mechanisms have

been developed (13).

Other concerns expressed about bags include

fears that inadequately restrained children could

slide beneath and be smothered by the bags, or

even conceivably be thrown backwards into the

rear window. There are worries that air bags

might inflate spontaneously without an impact or

on minor impact, thereby causing a serious accident (12). Again, the bulk of the evidence is that

these are not significant problems. The track

record of the more than 10,000 air-bag-equipped

cars is quite impressive in this regard (13,28).

There may have been isolated incidents, and

might be others in the future, but the life-saving

and injury-reduction potential of air bags dwarfs

these adverse outcomes.

The principal problem with automatic belts is

that they can be disconnected. They have to be

equipped with a safety release for emergencies.

For the person for whom belt-wearing is truly

burdensome, passive belts can be actively disengaged either permanently or repeatedly. In effect,

the individual converts the passive restraint system into an active nonrestraint system, and effectiveness goes to zero.

A common worry expressed about belts (manual or automatic) is that they may prevent a person from being thrown from a car in an accident

in which remaining within the car would prove

to be more damaging. This outcome might occur

in rare instances, but the opposite outcome is

much more probable—i.e., an unrestrained occupant is much more likely to be injured or killed

by being thrown from (or around) the car than

by being restrained within it.

In the remainder of this section, the evidence

on the effectiveness of belts and bags in reducing

death and injury is presented and discussed. The

following caveats should be kept in mind in interpreting the data:

1.

2.

Air-bag field experience relates virtually exclusively to large-size and luxury cars, principally the GM vehicles produced in the

1974-76 model years. Whether this experience generalizes directly to all cars (with

almost all new cars much smaller than these)

remains to be seen.

Automatic belt experience in the VW Rabbit, the source of most relevant data, might

not typify general experience once all cars

were so equipped. Small-car buyers in the

late 1970’s exhibited a greater propensity to

buckle up than did the average driver of the

period: whereas average drivers buckled up

only 10 to 15 percent of the time, owners of

Rabbits with manual (active) belt systems

wore their belts 34 percent of the time (28).

Thus, in a world of passive seatbelts, there

would be reason to expect a disconnect rate
24 ● Background Paper #1: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

in the general population greater than that

of automatic-belt Rabbit owners, particularly since DOT policy could not require the

kind of interlock device found in automaticbelt Rabbits (23).

3. Related to the above point, current users of

passive restraint systems represent a largely

self-selected group. It is possible that their

motivation, particularly their concern about

driving safety, differs enough from that of

the overall population to invalidate generalizations based on their experience. Mitigating this concern are studies which control for

accident severity before assessing the effectiveness of the restraint systems. Also, in the

VW case, the passive belts were part of a luxury option package, one sufficiently expensive that it seems unlikely that people would

buy the package simply to get the belts. Furthermore, evidence from claims data indicates almost identical rates of accident

claims and size of damage awards for Rabbit owners with and without passive belts

(3). Nevertheless, it should be recognized

that victims of serious crashes are less often

restrained than nonvictims (41), so the average effectiveness of restraints in a mandatory

system may be less than that observed with

voluntary experience. *

Subject to these caveats, the evidence is strong

that both air bags and automatic belts are very

effective devices for reducing death and serious

injury. Different studies have employed different

data bases, estimating techniques, and measures

of health outcomes, making direct comparability difficult.

The most effective restraint system is the air bag

combined with use of a (manual) lap belt. In 1977,

NHTSA estimated this combination to be 66 percent effective in reducing fatalities, with the bag

‘A related view is that greater protection from equipment may

cause drivers to drive with greater abandon, since they feel “safer.”

Peltzman (3s) advanced this view in an article in which he claimed

that autoinobile safety regulations had led to a redistribution, rather

than reduction, in highway deaths, with occupant deaths falling and

pedestrian deaths rising. Peltzman’s work has been criticized on both

empirical and theoretical grounds (38).

alone rated as 40 percent effective. * NHTSA estimated the effectiveness of seatbelts, when worn,

at 50 to 60 percent (3). Other estimates of effectiveness range from 25 percent (12) to 79 percent

(12) for the air bag and from 28 percent (12) to

72 percent (13) for seatbelts. However, with both

the lowest and highest figures, biases may be exaggerating the estimates. * * From the entirety of

the studies, a figure in the vicinity of 50 percent

seems reasonable for both passive restraint technologies when used properly.

While the effectiveness ratios are close to each

other, air bags rank distinctly higher as life-saving

devices for one simple reason: they are used when

needed. Disconnect rates for passive belts might

run 30 to 40 percent, conceivably much higher,

and almost certainly would exceed 20 percent

(VW Rabbit experience being estimated at 22

percent).

Many of the studies share the finding that passive restraint effectiveness decreases with a

decrease in injury severity, particularly as one

moves to the most minor accidents. Automatic

belts and air bags are most effective in protecting

against fatal and life-threatening accidents, less

so but still highly effective for severe but not lifethreatening accidents, less effective for moderate

injuries, and least effective for minor injuries. * * *

NHTSA, for example, estimated that belt effectiveness drops 1 to 5 percentage points as one

moves from life-threatening to non-life-threatening but severe injuries, another 1 to 5 points

*In studies of air bag deployments, 16 or 17 percent of occupants

were wearing manual lap belts (24).

**For example, Huelke and O’Day (12) examined rural accidents

and relied on a team of medical and other experts to estimate the

probability of occupant survival with different kinds of restraints.

Rural accidents tend to be more severe than average, which may

produce a downward bias in the authors’ estimaws (3).

● **As discussed in ch. 2, automobile accidents are categorized

according to the Abbreviated Injury Scale (AIS), which runs from

minor injuries (AIS 1) to fatalities (AIS 6). Attempts to utilize injury data in a comparative framework often involve manipulating

AIS codes (e.g., using the root mean square of the AIS). More recently, in an attempt to combine the effects of the severity and number

of injuries, an Injury Severity Score (1SS) was developed. The 1SS

has been shown to be highly correlated with the probability of death,

length of hospitalization, and extent of disability (24).
Ch. 4–Passive Restraint Systems: The Bag and the Be/t ● 25

moving to moderate injuries, and 20 to 27 points

to minor injuries (3). For air bags, NHTSA estimated more precipitous drops, by 10 to 20 percentage points moving to the severe-but-not-lifethreatening category, 8 to 13 points to moderate,

and 8 to 22 points for minor. The air bag’s effectiveness, without a lap belt worn, is rated at close

to zero for minor injuries, since the bag will rarely

deploy.

Mohan, Zador, and O’Neill (24), provide support for this general finding. In their assessment

of the mean Injury Severity Score (ISS) for the

two restraint systems and unrestrained occupants

by Vehicle Deformation Index (VDI), * Mohan, et

al., found that for high VDISs (considerable vehicle deformation), both restraint systems performed well: lap/shoulder belts resulted in an

average ISS 55 percent below that of the norestraint situation, and air bags scored an ISS 66

percent below the no-restraint condition. Both of

these differences were statistically significant.

While the small difference between the two

restraint systems was not statistically significant,

it was consistent with laboratory test data indicating the superiority of air bags in severe frontal crashes.

Mohan and colleagues found that for lower

VDIs (less vehicle deformation), belts continued

to show a considerably lower mean ISS than no

restraints; air bags, however, did not. The authors

explain this, at least in part, as an artifact of the

accident-designation process: an accident was

recorded as involving an air-bag- equipped vehicle only when an air bag deployed; at low VDIs,

deployment might indicate a stronger-thanaverage crash force for the VDI class. Regardless

of the explanation, however, the data are consistent with the finding that relative restraint effectiveness decreases with decreasing accident severity, and that air bag effectiveness decreases more

rapidly —i.e., an occupant is better off wearing

a seatbel in a minor accident but perhaps better

off being in an air-bag-equipped car in a severe

crash. And, again, wearing a belt in an air-bagequipped vehicle is the safest form of restraint.**

● The VDI is exactly what the name suggests-an index of the

severity of damage to the body of a vehicle.

● *A GM study in 1976 concluded that air bags’ effectiveness in

reducing injuries ranged from only 6 to 20 percent. An NHTSA criFrom the relationship between probability of

death and IS, Mohan and colleagues estimated

the expected number of deaths per 1,000 occupants in cars in frontal crashes with VDIsof

3 to 5. Their estimates, given in percentage terms

above, constitute very high estimates of belt and

bag effectiveness. Nevertheless, it seems worth

presenting these striking numbers: for 1,000

unrestrained occupants, the estimated deaths total

19.4; for 1,000 lap/shoulder-belt-restrained occupants, deaths equal 5.4; and for 1,000 air-bagrestrained occupants (16 percent also wearing a

lap belt), the figure is 4.0 The authors caution

that these estimates apply only to full-size and luxury cars. I would caution, further, that they are

estimates, based on a general correlation between

an index and an extreme outcome—death.

The different technologies have comparative

advantages in the specific injury protection they

confer. Table 8 presents data on the root mean

square Abbreviated Injury Scale (AIS) ratings, by

body region and restraint system, for occupants

in frontal crashes with VDIsf 3 to 5. The data

show that both air bags and lap/shoulder belts

provide greater protection for all body regions

(with one exception) than no restraint.

Air bags are particularly effective in reducing

head and neck injuries (by 58 percent compared

with no restraint) and have their greatest advanTable 8.—Root Mean Square AIS Ratings for

Occupants in Frontai Crashes With VDis 3-5 by

Body Region and Restraint System

Restraint system

Body region Air baga Lap/shoulder belt None

Head and neck . . . . 0.5 0.7 1.2

Face . . . . . . . . . . . . . 0.7 0.8 1.2

Chest . . . . . . . . . . . . 0,8 0.8 1.4

Abdominal or

pelvic region . . . . 0.3 0.8 0.5

Extremities and

pelvic girdle . . . . . 1.1 1.2 1.8

approximately 16-percent lap belt use.

SOURCE: D. Mohan, at al., “Air Bags and Lap/Shoulder Belts—A Comparison

of Their Effectiveness in Real World, Frontal Crashes” (Washington,

D. C.: Insurance Institute for Highway Safety, 1976).

tique of the study identified two potential sources of serious bias

that led NHTSA to conclude that the data supported an effectiveness

estimate of from 30 to 60 percent (28). GM has defended the methodology of its study [D. Martin, General Motors, personal communication, 1982].
26 ● Background paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

tage over belts in the abdominal and pelvic regions, where belts actually perform worse than

no restraint at all (though the injury severity level

is not great). Belts are less effective than bags in

all regions except the chest area, where they confer equal protection.

The most serious injuries occur to the extremities and pelvic girdle, with both restraint systems

affording relatively less protection than in most

other areas. While bags dominate belts in this

analysis, it must be remembered that in the minor

accidents not recorded in this table (VDIs less than

3) in which air bags do not deploy, the unbelted

occupant of an air-bag-equipped car generally receives no additional protection, while the belted

occupant does.

Most of the estimates presented above have

been based on actual accident data; some have

derived from laboratory tests and theoretical analysis. In most, though not all, attempts have been

made to correct for sources of bias, differences

in types of drivers, and so on. Nevertheless, it

seems useful to close this consideration by presenting some unadjusted on-the-road data, numbers in the simplicity of which lies clarity.

With regard to passive belts, experience with

the VW Rabbit is considerable. From 1975

through early 1981, VW produced 400,000 cars

with automatic belts satisfying the requirements

of FMVSS 208. These cars have averaged 0.78

deaths per 100 million vehicle-miles, compared

with a national average of 2.4—a 68 percent

reduction in the death rate (14). In an earlier comparison of accident-death experience in Rabbits

with automatic v. manual belts, there were 51 percent fewer deaths per 1,000 car-years with the

former than with the latter (28). Since some of

the automatic belts were disconnected (an estimated 22 percent) and many of the manual belts

were being used (about 34 percent), this difference

provides an underestimate of, or at least a lower

bound on, the life-saving potential of passive belt

systems. *

● Once again, it is important to keep in mind potential differences

by car size, etc. However, the VW data suggest an incremental belt

usage of 44 percentage points (78 percent of automatic belt owners

With regard to air bags, almost all of the experience clusters at the other end of the car line:

full-size and luxury cars, primarily the 10,000 to

12,000 produced by GM between 1974 and 1976.

By 1979 these cars had accumulated over 700

million miles of driving on American roads. Statistical expectations for deaths and moderate to

critical injuries would have been 10 and 124, respectively, yet experience showed half of these

figures: 5 occupants of air-bag-equipped cars had

died and 62 had received moderate to critical injuries. There had been some 200 air-bag deployments and only two known deployment failures,

one attributable to a mechanic’s mistakenly disconnecting the mechanism (28).

Finally, while fatality and injury data constitute

the bottom line, it is interesting to note that

passive restraints may be beginning to pass

another acid test–-i.e., their effect on automobile

insurance. Beginning in the late 1970’s, a few insurance companies, including Nationwide and

Allstate, offered owners of passive-restraintequipped vehicles reductions of approximately 30

percent on the portion of car insurance premiums

applicable to medical (Medpay) or personal injury protection (PIP) coverage. Nationwide has

estimated insurance savings of roughly $20 per

year for a car equipped with automatic belts. Over

the lifetime of the car, this translates into a present value of $150 (33). A Highway Loss Data Institute study found reductions in Medpay and PIP

claims of from 20 to 27 percent when comparing

VW Rabbits with and without passive belts (13).

These market data support the accident data findings that passive restraints are an effective means

of reducing death and disability.

not disconnecting their belts minus 34 percent of manual belt owners

wearing their belts). The national discomect rate under a mandatory

system would have to exceed 45 percent, given manual belt usage

in the vicinity of 11 percent, for incremental belt usage to fall below

that of the Rabbit (5s – ’11 = 44). Some participants in the passive

restraint debate believe that such a disconnect rate would be

exceeded.
Ch. 4—Passive Restraint Systems: The Bag and the Belt ● 27

COSTS OF PASSIVE RESTRAINTS

Estimates of the costs of passive restraint

systems are abundantly available, but determination of the likely true costs remains a challenge.

Most of the estimates come from the automobile

companies, and according to one nonindustry

analyst, these companies (33):

. . . have a very strong incentive to engage in

strategic estimates of costs. If the estimated costs

are high enough, they may well persuade

[NHTSA] to rescind the rule [FMVSS 208].

For some observers, both leaked company

documents and analytical work have raised questions about the validity of manufacturers’ estimates.

During hearings leading to the l-year delay in

implementing FMVSS 208, Ford and GM provided estimates of incremental automatic belt cost

which averaged $114, including $88 for manufacturers’ cost, $20 for markup, and $6 for incremental fuel costs (additional fuel consumed as a result

of installation of the technology). Nordhaus (33)

has argued that these estimates are inconsistent

with the companies’ estimates of their investment

programs. He believes that a reasonable estimate

for the true incremental cost to the consumer

would be $60, instead of the $88 cited by GM.

Nordhaus’ figure is not inconsistent with earlier

NHTSA and GM estimates based on incremental costs in Rabbits and Chevettes, which run (in

1981 dollars), from $42 to $85. GM points out,

however, that automatic belt systems for large

cars would be more expensive than those designed

for small cars. * In terms of annual costs (i.e.,

amortizing and depreciating over the life of the

car), the small-car range becomes $8.25 to $15.45

(3) (figures updated to 1981 dollars).

The costs of air bags are still less clear.** At

one point, GM claimed that it would sell air bags

for an incremental cost of from $290 to $325, assuming mass production. More recently, the company estimated large-volume consumer costs in

excess of $600 per car. Ford’s estimates have also

● Personal communication, 1982. Manufacturers’ estimates in 1978

(updated to 1981 dollars) ranged from $84 to $140, depending on

comfort and convenience features (28).

● ● All of the dollar figures in the remainder of this section are updated from their original sources to 1981 prices.

varied. In 1976, Ford estimated a consumer cost

of close to $400, but a recently leaked internal

memorandum placed the figure at from $425 to

$1,150. The same source indicated that for both

Ford and GM, manufacturer cost would run only

$135 to $140 (2). other cost estimates by manufacturers range from $150 to $280. DOT developed

an estimate of $190 (13,28).

Put together, these figures suggest that incremental consumer cost for the basic air bag

systems probably would run from $250 to $425.

Annual costs would range from $55 to $115. In

addition, for those air bags deployed in vehicles

which were not demolished, costs of reinstallation would become relevant. Such costs would

certainly exceed initial installation costs under

conditions in which air bags would be mass-produced standard equipment. However, such costs

would apply to a very minor proportion of vehicles, since only a small percentage of air bags

would ever deploy during the lives of the vehicles.

The variation in air bag cost estimates may

represent some strategic gaming, as Nordhaus (33)

suggests, but it also reflects several technical

changes and uncertainties. Of fundamental importance is the question of scale. Several analyses

emphasize the great economies to be realized from

large-scale production. Ford estimated a 200-

percent difference in per-unit manufacturer cost

between producing a total volume of 885,000 cars

and a volume of only 200,000 cars (2). In 1980,

GM estimated a consumer cost of $1,100 based

on a volume of 100,000 units, falling to between

$650 and $700 if 400,000 units were produced. *

A separate estimate, based on quotations of

components, found that the cost of a driver bag

and inflator module would be 25 percent of its

base cost (which assumed 13,000 units) if 900,000

units were purchased (28). Similarly, a passenger

bag and inflator module would fall to 33 percent

of base cost at the high volume. Some components, such as sensors and diagnostic parts, are

not so sensitive to the scale, but the fact remains

that the cost of an air bag system would be very

dependent on the number produced and sold (28).

● D. Martin, General Motors, personal communication, 1982.
28 ● Background Paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

The costs discussed above are direct costs attributable to manufacture and installation of the

passive restraint systems, plus small items of indirect cost (e.g., additional fuel consumption). Ignored in these numbers is the potential direct

monetary benefit the owner of a passive-restraintequipped vehicle might derive from lower insurance premiums. As noted above, the present

discounted value of this benefit over the life of

a typical car will total is $l50 (33), a considerable

offset to the incremental cost incurred by the consumer. Indeed, in the case of the automatic belt,

the insurance savings outweigh the incremental

price of the belt, implying that the purchaser of

a passive-belt-equipped car could end up saving

at least $35 over the life of the car (33).
5

Cost-Benefit Analyses of;

Passive Restraints
5

Cost= Benefit Analyses of

Passive Restraints

Should passive restraints be required on all new

cars in the United States? Theoretically, the

answer can be determined by a comprehensive

cost-benefit analysis (CBA), one which accounts

for all of the social costs and benefits associated

with implementation of the rule—pecuniary and

nonpecuniary, tangible and intangible. In practice, however, few CBAs even approach such a

complete analysis.

Nonquantifiable costs and benefits and those

which are quantifiable but not readily valued are

commonly mentioned and then put aside; often

they are ignored altogether. In either case, they

are left out of the final calculus of the CBA which

arrives at a “bottom line, ” an economic assessment of the worthiness of the program in question. As such, the “bottom line” is deficient. It

can and should be recognized as a useful input

into an overall assessment of the program, but

it should not be viewed as the sole determinant

of the program’s desirability (20,50). This caveat

should be kept in mind when reading this chapter.

CBA is in its ascendancy as a tool of policy

analysis, particularly with regard to the issue of

governmental regulation. Thus, it is not surprising to see that new CBAs entered the debate over

Federal Motor Vehicle Safety Standard (FMVSS)

208 prior to the October 1981 rescission. What

may seem more surprising, however, is that CBAs

pertaining to the restraint issue date back more

than a decade.

In 1970, Lave and Weber (20) examined the

costs and benefits of seatbelts from the perspective of the individual and found that benefits exceeded costs if the value of an individual’s life was

at least $10,000, a number more than a full order

of magnitude below the smallest estimates of the

value of life (or livelihood) (50).

Lave and Weber failed to explain why, with

benefits so much larger than costs, the majority

of occupants choose not to wear belts. Thaler and

Rosen (46) addressed this question in an analysis

in which they compared the time costs of buckling up with the expected benefit. Thaler and

Rosen estimated an annual benefit from wearing

lap belts of approximately $10 (using a value of

life of $200,000), and they argued that the individual’s opportunity cost of time involved in

buckling and unbuckling the seatbelt could easily exceed this amount.

Recently, Arnould and Grabowski (3) reexamined Thaler and Rosen’s analysis (46) and

undertook two CBAs: 1) the lap/shoulder belt

from the perspective of the individual, and 2) from

the point of view of society as a whole on passive

restraint systems.

In the former, Arnould and Grabowski work

with three different weighting schemes to value

individuals’ willingness to pay to avoid injuries

of varying severity. They conclude that the expected annual benefits from regular belt use, $38

to $78 (in 1975 dollars), must exceed the time opportunity costs associated with buckling up.

Subject to two qualifications which they dismiss

as insufficient to reverse their conclusion, ArnouId

and Grabowski argue that belt nonuse is not the

result of rational, informed decisionmaking, as

Thaler and Rosen had suggested it might be. To

the contrary, these authors interpret their findings

as supporting the “insensitivity-to-low-probabilities” hypothesis, discussed in chapter 2. It was

found, however, that Arnould and Grabowski

dismiss too readily the possibility that people

value the freedom from discomfort (physical or

psychological) produced by belts at more than the

expected benefits. Over hundreds of hours of driving per year, the hourly discomfort cost would

have to be extraordinarily low to dismiss this

factor.

Arnould and Grabowski’s passive restraint

analysis is a competent, if standard, CBA of the

social desirability of a system of mandated passive

31
32 . Background Paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

restraints, either automatic belts or air bags. The

analysis finds that both systems would produce

substantial social benefits, with the benefits of air

bags slightly exceeding those of automatic belts.

However, the costs of the bags are so much higher

than those of the belts that Arnould and Grabowski conclude belts are superior on the basis of net

benefit (or benefit-cost ratio). Indeed, they find

that only under very favorable conditions will air

bags result in positive net benefits—i.e., the costs

of bags quite likely would exceed the benefits.

Arnould and Grabowski’s study is noteworthy

for its sensitivity analysis, which tests the impact

of varying assumptions on the benefit-cost conclusions. The analysis is thorough in its consideration of economic costs and benefits, but it merely mentions the costs of inconvenience and discomfort associated with belts—costs which must

be considered potentially large, given all of the

evidence on belt use. And, like almost all CBAs,

the analysis ignores the costs of the suffering experienced by the loved ones of automobile accident victims. (This is discussed further below.)

Subject to these limitations, Arnould and Grabowski’s analysis estimates that in a steady-state

situation, i.e., after passive restraints were in virtually all automobiles (commonly estimated to require about 10 years), net benefits of passive belts

could be as high as $8.5 billion and would not

be likely to be less than $3.4 billion. Net benefits

of air bags, by contrast, could reach $6.6 billion

but could also be as low as –$4.9 billion. The

analysis also calculates expected annual costs per

life saved, which range from $135,000 to $557,000

for belts and $472,000 to $2,159,000 for bags. *

Obviously, these cost figures attribute no value

to injuries avoided. Lave (19) concurs with the

finding that passive belts would be more cost effective than air bags, though he does not demonstrate analytically the basis of his conclusion.

Another recent CBA, by Nordhaus (32,33), was

undertaken precisely to feed into the Department

of Transportation’s (DOT’s) reconsideration of

FMVSS 208. Sponsored by five major automobile

insurance companies, this analysis also examined

and compared the two passive restraint systems,

“All of these figures are Arnould and Grabowski’s estimates (3)

inflated to 1981 dollars.

although it was focused on passive belts, the system generally expected to dominate if FMVSS 208

had gone into effect.

The analytical slant taken in Nordhaus’ CBA

is somewhat different from that in Arnould and

Grabowski’s. Nordhaus concentrates on the (net)

cost of delaying or reordering implementation of

FMVSS 208, rather than making an “either-or”

comparison of the status quo or a fully implemented passive restraint rule. As one of DOT’s

options was to rescind FMVSS 208 altogether,

Nordhaus’ analysis of the net cost of this option

is directly comparable to other analyses of the net

benefit of fully implementing a passive restraint

rule.

Nordhaus estimates that, in a steady state, the

annual net cost of a rescission would equal $2.4

billion, assuming that all cars are equipped with

automatic belt systems. This number was derived

from National Highway Traffic Safety Administration (NHTSA) and manufacturer data which

Nordhaus believes to be in error, biased against

the belt system; so he views his estimate as a lower

bound on the net benefits of passive belts. Under

these conservative assumptions, the benefits of the

passive belt system ($3.6 billion) are three times

greater than the costs ($1.2 billion). Nordhaus

estimates the total discounted net social benefits

of the passive restraint rule at $33 billion. Alternatively, $33 billion represents the net cost to society of a complete rescission of the rule. Under the

assumptions that he believes to be more reasonable, this figure rises to $69 billion. Nordhaus

summarizes his findings as follows:

[T]he passive restraint rule is, from an economic point of view, as important as any environmental, health, or safety rule on the books. If the

estimates of the impact on fatalities are accurate,

a rescission would be equivalent to repealing a

law that cuts in half the homicide rate. It is equivalent to forgoing the medical advances that allowed the virtual elimination of death from tuberculosis over the last quarter century.

Nordhaus’ CBA shares with Arnould and Grabowski’s an effective use of sensitivity analysis.

Unlike Arnould and Grabowski, Nordhaus finds

that a world of air bags would be preferable to

a world of automatic belts. Despite the high cost

estimate he uses to evaluate bags ($425), Nord-
.

Ch. 5—Cost-Benefit Analyses of Passive Restraints ● 33

haus concludes that an all-bag system would generate total discounted net social benefits of $47

billion. * He does not dwell on the comparison,

however, since at the time of his study belts appeared to be the wave of a 208 future.

As part of his policy analysis, Nordhaus examines the impact on the automobile manufacturers

of implementing FMVSS 208. The only major organized opposition to implementation of the rule

through the years, the manufacturers have expressed concern about the costs of adding passive

restraints as standard equipment and what this

would do to the demand for their product. The

potential problem is of particular concern in 1982,

with the domestic industry in a depressed condition. Nordhaus presents a case that adverse effects would be minimal. He suggests that it is even

conceivable that the industry would benefit from

implementation of FMVSS 208. This would occur if consumers recognized the net economic savings involved in buying a passive-restraintequipped car, given an associated reduction in

automobile insurance costs.

Nordhaus’ is not the first CBA undertaken directly in connection with governmental evaluation of a passive restraint rule. In 1974, NHTSA

released a CBA that demonstrated “the superiority

of passive restraint systems compared to belt systems presently required” (13). The analysis was

revised in response to criticisms and still came up

with the same conclusion (13). Two years later,

another CBA accompanied the announcement of

a public hearing to be held by DOT.

At about the same time, Robertson (39) directed

a survey which, though not itself a CBA, produced a finding of direct relevance to CBA: a sample of new car buyers expressed a willingness to

pay an average of $12 more per month ($144 per

year) in car payments to save 6,000 lives per year

and $17 per month ($204 per year) to save 12,000

lives. ** It appears that many new car buyers

might stand prepared to pay considerably more

● Recall that under the assumption he finds more realistic, Nordhaus found a greater net benefit for the belts. However, he does

not apply a set of “more realistic” assumptions in the air bag case,

relying instead on manufacturers’ estimates of cost. Thus, this $47

billion figure should be compared with the $33 billion estimate for

the belts.

**The dollar figures have not been adjusted for inflation, so they

understate current value.

than the amount passive belt systems would require. Whether answers to a hypothetical question would translate into equivalent action in the

marketplace remains to be seen.

Graham, Henrion, and Morgan (9) have identified half a dozen other CBAs on the occupant

restraint issue and have produced a detailed analysis of their own, one which compares passive restraint systems with other methods of encouraging restraint. Their analysis ranks FMVSS 208 below other alternatives in terms of both net benefits and benefit-cost ratio, with a compulsory belt

usage law having the highest ratio (in large part

because its measurable costs are so low) and a

combined air-bag/mandatory-belt usage law producing the greatest net benefits (and saving the

most lives). All of the alternatives these authors

examine produce positive net benefits—i.e., each

alternative is preferable to the complete absence

of occupant restraints (and superior to the current system of merely requiring belts in cars). In

particular, they estimate that the benefits of

FMVSS 208 would have exceeded the costs by 95

percent.

Thus, CBAs have served as inputs, the importance of which is difficult to assess, throughout

the long debate on a Federal passive restraint rule.

Each of the analyses differs from the others in certain important ways: some adopt a human capital

approach to valuing life (or livelihood), while

others use willingness-to-pay (50); basic data

sources, and hence magnitudes, often vary significantly; restraint alternatives studied differ from

one analysis to the next; some analyses incorporate concerns like the effect of restraint systems

on insurance costs, while others ignore them, and

so on.

Almost all of the studies can be faulted for their

failure to treat analytically the inconvenience and

discomfort costs which, though nonpecuniary,

seem to play a significant role in many people’s

decisions about using manual belts. It maybe difficult or unreasonable to place a dollar value on

such costs directly. However, there are sensitivity analysis techniques that would permit an evaluation of the potential significance of these costs.

For example, one might employ break-even analysis to determine how highly people would have

to value the inconvenience and discomfort in
34 ● Background Paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

order to make passive belts appear to be socially

undesirable (so).

Despite their idiosyncrasies and their individual

and collective flaws, as a body the passive restraint CBAs present an impressive case that society would benefit more than it would lose from

a compulsory passive restraint rule. The findings

are reasonably consistent and robust. In general,

the studies rank air bags ahead of passive belts

as life-saving devices, in large part reflecting the

ability (and desire) of many passive-belt vehicle

owners to disconnect their belts. With some

notable exceptions, the analyses rank belts higher

than bags on cost-effectiveness and cost-benefit

grounds, primarily reflecting the much lower cost

of the passive belt option. While all of the studies

find passive belts to produce positive net benefits,

several note that the positive net benefit of air bags

is sensitive to assumptions.

Despite the uniformity of these studies’ findings,

the analyses have articulate critics who challenge

basic assumptions of the models. In particular,

while industry critics argue that belt cost estimates

in the analyses are too low, most of the criticism

is focused on estimates of passive seatbelt use. The

automobile industry seems convinced that incremental belt-usage rates would be extremely low,

assuming passive belts that could be easily disconnected (a condition that they believe would be

demanded by the public). Thus, the industry

views passive belts as increasing vehicle costs

without significantly increasing effective passenger

restraint. Current (manual) belt users would thereby be “punished” by an unnecessary additional

charge, while confirmed nonusers would have to

bear the same additional burden but would realize

no additional protection (23).

In closing this glimpse at occupant restraint

CBAs, several caveats should be mentioned. The

first, illustrated by the work of Graham, Henrion,

and Morgan (9), is that a finding that a mandatory passive restraint rule would be cost-beneficial

does not necessarily mean that it would be the

most cost-beneficial approach to saving lives

through occupant restraint. Other alternatives

should be compared in order to seek the approach

that would maximize net social benefits.

Use of the phrase “net social benefits” suggests

an important aspect, and limitation, of using CBA

in a policy framework: as was noted at the outset

of this discussion, reasonable costs and benefits

are not the only, nor necessarily the most important, variables in policy decisionmaking. Above,

studies were faulted for their failure to value

discomfort and inconvenience; but other unmeasured variables may be of much greater consequence. For example, CBAs generally do not adequately address the issue of who benefits and who

loses—not everyone realizes a net gain from implementation of a passive restraint rule-and it

is this distinction that has made a (slow) horse

race out of what appears to be a socially desirable

objective (22). The distributional issue—winners

and losers—constitutes one of the themes of the

next and concluding chapters.

Finally, it should be noted that none of the

CBAs attempts to directly value avoidance of the

pain and suffering of accident victims and their

loved ones. * As a result, the CBA's findings of

positive net economic benefit support the noneconomic desire to minimize human suffering.

● This is considered indirectly in willingness-to-pay valuations,

though these generally cover only the victims themselves and not

the suffering of people close to them. Furthermore, willingness-topay estimates suffer from people’s inability to fully comprehend and

contemplate their own deaths or serious disabilities (50).
6

Philosophical and Ethical Issue;

in the Passive Restraint Debate
Philosophical and Ethical Issues

in the Passive Restraint Debate

Historically, the principal argument against

Federal Motor Vehicle Safety Standard 208 has

had a common two-pronged antiregulation structure: 1) mandating passive restraints represents

one more example of governmental intrusion into

individuals’ rights to make their own decisions and

run their own lives; it is a flagrant example of

paternalism; and 2) mandatory passive restraints

will increase the cost of car ownership, * unnecessarily raising expenses for people who currently use their manual belts and people who

prefer not to be restrained (many of whom might

disconnect automatic belts).

The “individual freedom” argument is not without merit, nor is it without very close precedent.

The debate over delay or rescission of the passive

restraint rule echoed the debate which has been

repeated in recent years in one State capitol to

the next as a majority of States have repealed their

motorcycle helmet laws (51). Nevertheless, several

factors mitigate the force of the freedom theme.

These include economic and equity considerations, public opinion, and precedent.

Regarding the last of these, there are numerous

precedents for Government’s mandating auto safety features. Some involve driving behavior, such

as speed limits and drunk-driving laws; and many,

like the passive restraint rule, involve physical attributes of cars themselves—to name a few, shatterproof glass, energy-absorbing steering-wheel

columns, padded dashboards, and today’s manual

lap/shoulder belts. Precedent does not make the

next related case—i.e., passive restraints—necessarily “right,” but it does serve as a supporting

argument.

Public opinion is another consideration—in a

democracy, ultimately perhaps the most important one. While survey results concerning passive

*As was noted in the preceding chapter, if insurance rates for passive-restraint-equipped cars fall, the net cost of owning a car with

an automatic belt might decrease, even though the showroom sticker

price would rise.

restraints have varied, it is decidedly not the case

that the public opposes passive restraints. For example, a 1977 Gallup poll found that of the 83

percent of respondents who had an opinion, a majority favored installation of air bags on all cars.

This theoretical support for air bags does not disappear when respondents are reminded that they

will have to pay extra to have this extra protection (13). * The will of the majority should not

invariably dominate the rights of the minority,

but in this case, given the limited input of public

opinion into the decision, at least there is no question of the tyranny of the majority.

Conceptually, the most compelling responses

to the “individual freedom” view have a theoretical base grounded in economic theory. Perhaps

the most important of these are the negative externalities associated with the absence of adequate

occupant restraint. Loosely, negative externalities

are negative consequences visited upon one or

more persons as a result of some other person’s

independent decisions or actions. In the occupant

restraint case, negative externalities are of two

types: economic and noneconomic.

Concerning the former, the nature of automobile and health insurance is such that the insured

costs of automobile accidents are spread over large

numbers of car and health insurance policyholders

(and taxpayers in the instance of public health

insurance). Thus, if an unrestrained victim of an

automobile accident experiences greater inju~

and hence higher medical bills than would have

been the case had he or she been restrained, others

share in the economic liability created by the

medical treatment. In effect, one person’s independent decision not to wear a seatbelt has ad-

● Once again, the question is whether (or how much of) such

survey support would translate into market decisions. The automobile manufacturers seem convinced that in practice consumers

will not be willing to pay the high cost air bags would entail (23).

It should be noted, however, that the industry’s limited experience

in this regard involves a radically different set of circumstances than

would obtain in a world of mandated air bags.

37
38 ● Background Paper#1:Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

verse consequences for other people’s pocketbooks. Pecuniary negative externalities such as

this constitute a technical market failure and serve

as a theoretical rationale for governmental intervention. *

The noneconomic negative externalities concern

the health risks imposed on people other than the

initial car buyer, and refer specifically to air bags,

not passive belts. If the initial buyer purchases a

car equipped with an air bag, all future frontseat

occupants-passengers, children, second and third

owners-will receive that protection. If the initial

buyer does not purchase an air-bag-equipped vehicle, future passengers will be subjected to greater

risk. This argument depends further on some specific economic conditions, which will be returned

to, but it is sobering to note the following statistics

from a study of 137 crashes (with 172 people injured) in Baltimore County, Md. (4):

approximately half of the people injured were

occupants of vehicles no longer owned by

their original purchasers;

nearly 60 percent did not own the vehicles

in which they were injured;

three-quarters of the passengers were not related to the vehicle owners; and

almost two-thirds of the victims were under

the age of 30, and only one-third of 16- to

29-year-olds injured owned the vehicles in

which they were injured.

In effect, these data challenge, or at least question, the argument that new-car purchasers should

be free to determine whether to invest in safety

devices like air bags since it is their own protection that is in question. The health and safety of

many others are also involved. In a well-functioning market, one might find this potential externality acceptable. After all, people can and should

choose not to ride in cars in which they do not

feel adequately protected. And, more to the point,

future owners of used cars can have desired safe-

● Some of these pecuniary externalities could be overcome through

the market. For example, insurers could charge lower (actuarially

fair) personal injury protection (PIP) and medical (Medpay) premiums for owners of passive-restraint-equipped vehicles, as a couple of insurers are currently doing. However, other pecuniary negative externalties could not be addressed by the market. Consider,

for example, the accident-related medical costs of Medicare and

Medicaid beneficiaries.

ty equipment added when they purchase their

cars. But can they, in the case of air bags?

There may be firms that will retrofit a car to

have air bag protection, but the cost is quite high

because of the small scale of the business and the

sizable economies of scale that pertain to air bag

manufacture and installation. Thus, the prospective buyer of an air bag system is penalized economically by the small scale of active demand for

air bags. Alternatively, all of those people who

would want to purchase air bags at mass-produced prices would benefit from a requirement

(or industry decision) to install bags in much of

the new-car fleet. *

Clearly, there is one obvious group of potential economic victims of a passive restraint law:

current regular users of manual lap/shoulder

belts. They are already receiving all of the protection that would be afforded them under a mandatory passive restraint rule, yet under such a rule

they would have to pay more for their new cars.

In effect, they would be penalized for other drivers’ poor judgment. If Nordhaus’ (33) assessment

is correct, the net cost of automobile ownership

would drop under a passive restraint rule, benefiting current belt users as well as nonusers. But

one might argue that current users should already

be receiving an insurance break, something insurers do not offer—in large part presumably because of the problem of verification of belt use

(see ch. 3).

Thus, the “individual freedom” argument has

pluses and minuses. Certainly there is a public interest in passive restraints which competes with

the private interest in free individual choice; this

is not clearly a case of unwarranted governmental intrusion, pure and simple. Which of the interests one rates as dominant probably reflects

one’s basic political philosophy as much as the

inherent merits of the case.** In this regard, it is

● A ready response to this problem is that people can use the

already required lap/shoulder belts and receive nearly the same

amount of protection. However, the above argument applies to the

apparently sizable segment of the population that chooses not to

wear belts, perhaps for reasons of discomfort, but would like to

purchase air-bag protection at a reasonable cost, though not at current small-scale high market prices.

● *For a recent debate on this theme, see Perkins (36) and Baker

and Teret (5).
Ch. 6–Philosophical and Ethical Issues in the Passive Restraint Debate ● 39

interesting to read the assessment of George Will consenting adults to behave in ways disastrous

(52), noted conservative political analyst, com- to themselves. Besides, too many children pasmenting on the view “that Government has no sengers are sacrificed on that altar. And a large

business requiring drivers to buy and use inex- part of the bill for the irrationality of individual

pensive devices that might save them from self- drivers is paid by society.

destruction:”

There is a pitiless abstractness, and disrespect

for life, in such dogmatic respect for the right of
7.

Conclusion
7

Conclusion

There is a basic philosophical issue in the debate

on passive restraints—one which has risen to

prominence in an antigovernment, antiregulation

era. Nevertheless, it is important to recognize that

the principal deterrent to implementation of a passive restraint rule has been opposition on the part

of automobile manufacturers—grounded, it appears, in concern about the economic implications

of passive restraints for the industry, and not the

issue of individual freedom. * Nordhaus (33) has

concluded that the ramifications probably would

not be as dire as industry statements and documents seem to suggest, at least with regard to the

demand for automobiles and manufacturer and

dealer revenues. However, there is a long history

of manufacturer opposition, with repeated proposals for the voluntary phasing in of passive restraints generally going unrealized (13,17).

The impact of higher car prices on the demand

for automobiles—the issue addressed by Nordhaus—is only one of the manufacturers’ concerns.

Manufacturers have also expressed concern over

*This point is made quite clearly in General Motors’ (GM’s submission to the Department of Transportation for the 1981 hearings

on passive restraint options (23):

We believe that [this issue of mandatory passive restraints] hinges

squarely on what the American public is willing to accept in terms of

economic or behavioral burden. Inflatable restraints are too costly to

be acceptable to most . . . automatic belts that are coercive will be rejected by the public. Noncoercive (separate) automatic belts will not

significantly increase belt use over that achievable with manual belts,

and thus will not be cost effective.

Because we believe that the rule will not work, we recommend that

it be rescinded .

Should the Government determine that additional regulation is necessary, a mandatory belt use law will be more effective, sooner, and

at a fraction of the cost of a passive restraint rule.

The mandatory belt use law clearly violates the individual freedom

perspective at least as much as would passive restraints. Thus, GM’s

concerns seem firmly grounded in pragmatic economic considerations.

On that pragmatic level, GM’s points are worthy of serious attention. GM is arguing, in essence, that the CBAs overestimate the

amount of incremental belt usage that would be achieved under a

passive restraint rule, and that the low levels GM anticipates would

flip the cost-effectiveness balance over. In this regard, note that

Arnould and Grabowski (3) found that an incremental belt usage

rate of only about 20 percentage points is all that would be needed

to make passive belts cost effective. Of course, while they might

be cost effective at that level, their effectiveness would be small compared with the injury problem and the potential of belts to reduce it.

the effect of passive restraints on product liability claims, worrying “that ‘endless lawsuits’ would

allege the failure of automatic restraints to provide adequate protection” (28). Furthermore, given a climate of “exaggerated public expectations”

about the effectiveness of passive restraints, they

have anticipated lawsuits as a result of an occupant injury even when restraints worked as they

were supposed to. Thus, the availability and cost

of liability insurance, manufacturers have feared,

could loom as serious problems.

But some evidence suggests just the opposite.

For a variety of reasons, insurance might be abundantly available. And there is reason to believe

that passive restraints might decrease, rather than

increase, the number and size of liability claims.

For one thing, automatic restraints should decrease the number of deaths and serious injuries

resulting from crashes attributable to manufacturing defects and design problems such as stalling

engines, malfunctioning brakes, and tire blowouts

(28).

In considering the support for and opposition

to mandatory passive restraints, one should recognize that most of the organized interests fall into

the support camp. Insurers have expressed their

support frequently and strongly. The American

Mutual Insurance Alliance, a group representing

over 95 percent of all of the automobile insurance

written in the United States, has gone on record

as unequivocally favoring mandatory passive restraints (13). And, as discussed above, a few

major insurance companies have already put their

corporate mouths where their money is, offering

premium reductions to owners of passive-restraint-equipped vehicles.

There is an irony, however, in the likely outcome of implementation of a passive restraint rule:

a major but unorganized interest group, automobile consumers, has expressed an apparent preference for air bags over passive belts; yet the National Highway Traffic Safety Administration

(NHTSA) has estimated that if passive restraints

were required, 99 percent of the new-car fleet

43
—.

44 . Background Paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

would have passive belts, with only 1 percent of

cars coming equipped with air bags. The manufacturers must have concluded that whatever consumers’ abstract preferences might be, in buying

practice most consumers would not choose to pay

the extra cost required for air bags (23).

There is further irony here, one that has a distinct Catch-22 flavor: air bags are clearly effective in significantly reducing motor vehicle injuries

and fatalities—yet because the automakers are

convinced that consumers would not be willing

to pay the high cost for the air bags, they planned

to produce primarily passive belts had Federal

Motor Vehicle Safety Standard (FMVSS) 208 remained in effect; yet because they believed that

most passive belts would be disconnected, they

argued forcefully, and successfully, that passive

belts were not cost effective, and hence that

FMVSS 208 should be rescinded.

Mandatory passive restraints would have represented only one addition to a lengthy list of

technological safety features required on automobiles by the Federal Government. But passive

restraints are of special interest and importance

for two reasons: 1) because of the long delays and

often acrimonious debate over implementation of

FMVSS 208, and now over its rescission; and

2) due to the realistic potential of these technologies to make an extraordinary dent in the death

toll of automobile accidents. Estimates vary, but

the consensus suggests that passive restraints

could prevent a minimum of 6,000 and perhaps

as many as 12,000 highway deaths a year. Given

the current total of roughly 27,000 frontseat occupant deaths a year, a savings of this magnitude

would constitute a truly major public health

victory.

Less dramatic than lives saved, but more numerous, would be injuries avoided. Here the estimates also vary widely, depending in large part

on the severity of the injuries considered. Arnould

and Grabowski (3) estimate that from 20,000 to

40,000 severe injuries (Abbreviated Injury Scale

3 to 5) would be prevented by passive restraints

each year; Nordhaus (33) estimates that 120,000

moderate to critical injuries would be avoided.

However they are grouped and counted, injury

reductions would be impressive.

With the demise of the passive restraint rule,

and over a decade of working toward its realization, NHTSA has a special obligation to seek alternative strategies to reduce the motor vehicle

accident toll. The chore remains the same as before—to find a cost-effective, politically acceptable means of providing effective vehicle occupant restraint. The air bag represents a technology

that is effective and that would apparently be acceptable to the public, were it not for its great cost.

At the other extreme lies the mandatory belt-use

law—an approach that might be quite effective

and inexpensive, yet appears to be politically

unacceptable. In between lies a myriad of alternatives that are probably more acceptable and less

effective (e.g., a renewed public information campaign). Recent analyses suggest that a mix of approaches should be explored.

From the point of view of OTA’s study Technology and Handicapped People, it is unfortunate

that automobile accident data do not permit a

careful assessment of the number and severity of

handicaps resulting from automobile accidents.

Data on disabilities resulting from accidents are

not particularly good, and disabilities do not invariably become permanent (or longstanding)

handicaps. Nevertheless, despite these data deficiencies, simply considering the number and

nature of serious motor vehicle accident injuries

suggests the truly extraordinary potential of occupant restraints to reduce disabilities and handicaps.

In the context of a case study of the technological prevention of handicaps, the importance of

this reduction is twofold. From a social/fiscal

point of view, the resource savings attributable

to this prevention technology appear to be substantial. The costs of technologies for handicapped

people, both individual and collective, are considerable, as a glimpse at the main OTA report

immediately suggests. The prevention of handicaps requiring use of these technologies implies

a savings of economic resources by reducing the

need for the technologies. * Thus, any policy

● This is a benefit of the prevention of technology that should be

included in a cost-benefit analysis (CBA). The CBAs on passive restraints consider many such resource savings-e. g., medical expenses

avoided—but undoubtedly miss the reduction in the need for many

of the collective technologies for the handicapped. To this extent,

the passive restraint CBAs understate the net benefits of mandating

passive restraints.
Ch. 7—Conclusion ● 45

deliberations on resource allocation to address the

problems of the handicapped should give serious

consideration to prevention efforts as viable

means of reducing the total societal costs of

handicaps.

More to the point, the true costs of handicaps

vastly exceed those that can be readily measured

in dollars and cents. The physical and psychological suffering that accompany handicaps are costs

for which no technology can ever fully compensate. But some technologies, like motor vehicle

passenger restraints, can prevent this suffering.

The full value of this benefit, included in none

of the passive restraint CBAs, must be enormous

(1). Thus, regardless of its purely fiscal implications, the prevention approach warrants especially

careful attention.
References
References

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

Abt, C., “The Social Costs of Cancer,” Social In-

&ators 2:175, 1975.

“Air Bag Cost Put at $100 in Memo, ” Ann Arbor

News, Aug. 13, 1981, p. A-1.

Arnould, R., and Grabowski, H., “Auto Safety

Regulation: An Analysis of Market Failure,” Bell

j. Econ. 12:27, 1981.

Baker, S., “Who Bought the Cars in Which People Are Injured? An Exploratory Study,” At. 1.

Pub. Health 69:76, 1979.

Baker, S., and Teret, S., “Freedom and Protection:

A Balancing of Interests,” Am. ~. Pub. Health

71:295, 1981.

Carsten, O., “Use of the Nationwide Personal

Transportation Study To Calculate Exposure,”

The HSRI Research Review II 11(6):1, 1981.

Comptroller General, General Accounting Office,

“Effects, Benefits, and Costs of Federal Safety

Standards for the Protection of Car Occupants, ”

report to the Committee on Commerce, U.S. Senate, Washington, D. C., 1976.

Fleisher, G., An Experiment in the Use of Broadcast Media in Highway Safety: Systematic Analysis of the Effect of Mass Media Communications

in Highway Safety (Los Angeles: University of

Southern California, Department of Industrial and

Systems Engineering, 1972).

Graham, J., Henrion, M., and Morgan, M., “An

Analysis of Federal Policy Toward Automobile

Safety Belts and Air Bags” (Pittsburgh: CarnegieMellon University, Department of Engineering and

Public Policy and School of Urban and Public Afkaks, 1981).

Haddon, W., submission of documents to W.

Coleman, Jr., Secretary, Department of Transportation, Washington, D. C., Sept. 17, 1976.

Hartunian, N., Smart, C., and Thompson, M.,

“The Incidence and Economic Costs of Cancer,

Motor Vehicle Injuries, Coronary Heart Disease,

and Stroke: A Comparative Analysis, ” Am. J.

Pub. Health 70:1249, 1980.

Huelke, D., and O’Day, J., “Passive Restraints: A

Scientist’s View, “ in The scientific Basis of Health

and Safety Regulations, R. Crandall and L. Lave

(eds.) (Washington, D. C.: Brookings Institution,

1981).

Insurance Institute for Highway Safety, Background Manual on the Occupant Restraint Issue

(Washington, D. C.: IIHS, 1978).

Insurance Institute for Highway Safety, “Committee Leader Backs Automatic Restraints,” H@hway

Loss Reduction Status Report 16(7):1, 1981.

15.

16.

17.

18.

19.

20.

21.

22,

23,

24,

25,

26,

27,

28,

29.

Insurance Institute for Highway Safety, “Promotional Campaigns To Increase Seat Belt Use: A Review” (Washington, D. C.: IIHS, July 1981).

Joksch, H., and Wuerdemann, H., “Estimating the

Effects of Crash Phase Injury Countermeasures—

11: The Fatality Trend and Its Modification by

Countermeasures,” Accident Analysis & Prevention 5:1, 1973.

Kelley, B., “GM and the Air Bag: A Decade of Delay,” Bus. & Society Rev. (35):54, 1980.

Kuechenmeister, T., and Yanik, A., “Summary of

Market Opinion Research Study: An Analysis of

the Factors Affecting Seat Belt Use” (Detroit, Mich:

Market Opinion Research, 1978).

Lave, L., The Strategy of Social Regulation: lkcision Frameworks for Policy (Washington, D. C.:

Brookings Institution, 1981).

Lave, L., and Weber, W., “A Benefit-Cost Analysis of Auto Safety Features, ” Applied Eon.

2:265, 1970.

Levine, D., and Campbell, B., “Effectiveness of

Lap Seat Belts and the Energy-Absorbing Steering

System in the Reduction of Injuries” (Chapel Hill,

N. C.: University of North Carolina Highway Safety Research Center, 1971).

Luft, H., “Benefit-Cost Analysis and Public Policy

Implementation: From Normative to Positive

Analysis, “ Pub. pol. 24:437, 1976.

Martin, D., “Comments of General Motors Corporation Regarding Passive Restraints (FMVSS

208),” docket 74-14; notice 22, Department of

Transportation, Washington, D. C., 1981.

Mohan, D., Zador, P., O’Neill, B., et al., “Air

Bags and Lap/Shoulder Belts—A Comparison of

Their Effectiveness in Real World, Frontal

Crashes” (Washington, D. C.: Insurance Institute

for Highway Safety, 1976).

Muller, A., “Evaluation of the Costs and Benefits

of Motorcycle Helmet Laws, ” Am. J, Pub. Health

70:586, 1980.

Myers, M., Iscoe, C., Jennings, C., et al., Staff

Report on the Cigarette Advertising Investigation

(Washington, D. C.: Federal Trade Commission,

1981).

National Highway Traffic Safety Administration,

H&hway Sa&ty Facts 3 (Washington, D. C.: Department of Transportation, 1978).

National Highway Traffic Safety Administration,

Occupant Protection Program Progress Report

No. 2 (Washington, D. C.: Department of Transportation, April 1979).

National Highway Traffic Safety Administration,

49
— .

N ● Background paper #l: Mandatory Passive Restraint Systems in Automobiles: Issues and Evidence

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40,

41<

Report on Traffic Accidents and Injuries for 1979

(Washington, D. C.: Department of Transportation, 1981).

National Highway Traffic Safety Administration,

Task Force Report on Saidy Belt Usage Laws

(revised) (Washington, D. C.: Department of

Transportation, 1978).

National Safety Council, Accidimt Facts (Chicago:

NSC, 1980).

Nordhaus, W. “Comments of William Nordhaus

on Notice of Proposed Rulemaking on Federal

Motor Vehicle Safety Standards: Occupant Crash

Protection, ” Department of Transportation,

Washington, D. C., March 1981.

Nordhaus, W. “Comments of William Nordhaus

on Notice of Proposed Rulemaking on Federal

Motor Vehicle Safety Standards: Occupant Crash

Protection,” docket No. 74-14, notice 22, Washington, D. C., Department of Transportation, May

26, 1981.

Partyka, S., “Effects of Traffic Accident Injuries

on the Work Force Estimated From NCSS and

NASS Data” (Washington, D. C.: National Center

for Statistics and Analysis, NHTSA, June 1981).

Peltzman, S., “The Effects of Automobile Safety

Regulation,” J. PoZit Eon. 83:677, 1975.

Perkins, R., “Perspective on the Public Good,”

Am. J. Pub. Health 71:294, 1981.

Robertson, L., “Automobile Safety Regulations

and Death Reductions in the United States, ” Am.

J. Pub. Health 71:818, 1981.

Robertson, L., “Car Crashes: Perceived Vulnerability and Willingness to Pay for Crash Protection,” J. Community Health 3:136, 1977.

Robertson, L., “A Critical Analysis of Peltzman’s

‘The Effects of Automobile Safety Regulation’, ” J.

Ekon. Issues 3:587, 1977.

Robertson, L., “Estimates of Motor Vehicle Seat

Belt Effectiveness and Use: Implications for Occupant Crash Protection,” Am. J. Pub. Health

66:859, 1976.

Robertson, L., “Public Perception and Behavior

42.

4 3 .

4 4 .

4 5 .

46,

4 7 .

4 8 .

4 9 .

50.

51,

52.

in Relation to Vehicle Passenger Restraints, ” presented at the International Workshop on the Analysis of Actual v. Perceived Risk, National Academy of Sciences, Washington, D. C., June 1-3,

1981.

Robertson, L., “State and Federal New-Car Safety Regulation: Effects on Fatality Rates,” Accident

Analysis & Prevention 9:151, 1977.

Robertson, L., Kelly, A. B., O’Neill, B., “A Controlled Study of the Effect of Television Messages

on Safety Belt Use, ” Am. J. Pub. Health 64:1071,

1974.

Slovic, P., Fischoff, B., and Liechtenstein, S., “Accident Probabilities and Seat Belt Usage: A Psychological Perspective” (Eugene, Oreg.: Decision

Research, 1977’).

Teknekron Research Inc., “1979 Survey of Public

Perceptions on Highway Safety” (Washington,

D. C.: Department of Transportation, 1979).

Thaler, R., and Rosen, S., “The Value of Saving

a Life: Evidence From the Labor Market, ” in

Household Production and Consumption, Studies

in Income and Wealth No. 40, N. Terleckyj (cd. )

(New York: National Bureau of Economy

Research, 197s).

Tofany, V., “Life Is Best at SS,” Traffic Q. 35:5,

1981.

Warner, K., “Clearing the Airwaves: The Cigarette

Ad Ban Revisited,” Po]. Analy. 5:43s, 1979.

Warner, K., “Cigarette Smoking in the 1970’s: The

Impact of the Antismoking Campaign on Consumption,” Science 211:729, 1981.

Warner, K., and Luce, B., Cost-Benefit and CostEfkctiveness Analysis in Health Care: Principles,

Practice, and Potential (Ann Arbor, Mich.: Health

Administration Press, 1982).

Watson, G., Zador, P., and Wilks, A., “The

Repeal of Helmet Use Laws and Increased Motorcyclist Mortality in the United States, 1975-1978,”

Am. J. Pub. Health 70:579, 1980.

Will, G., “Driving Without Restraint,” The Washington Post, Apr. 14, 1977.

U.S. GQVHWMENI PRINI’ING OFFICE : 1982 0 - 98-607 : QL 3