Sam Uretsky

How Do You Want Those Kids to Die?

The debate over health care legislation appears to be stalled, and with it, the outcry against “death panels,” so it’s a bit late to drag out an article that appeared in BMJ (it used to be called the British Medical Journal, but they changed the name for what must have seemed like obvious reasons at the time) in 2003. The title is “The power of stories over statistics” and the author is Thomas B. Newman, professor of epidemiology and biostatistics and Pediatrics at the University of California at San Francisco. Professor Newman makes his point with several stories, but the most dramatic deals with the impact of child safety seats in airplanes.

In 1989, there was an airplane crash in which a child, who had not been placed in a restraint, died. The analysis showed that with a proper child seat, the child would have survived the crash. There were discussions of the wisdom of requiring infant and child restraints, but nothing was done. In 1994, another “lap child” died in a crash that might have been survivable. The US National Transportation Safety Board then recommended a regulation requiring universal child restraints to the US Federal Aviation Administration (FAA). The FAA analyzed the situation, and presented a report to Congress. “The FAA estimated that only about five aeroplane crash deaths could be prevented over 10 years by adopting universal child restraint on aeroplanes. On the other hand, because the additional cost of an aeroplane ticket for a child is likely to lead some families to drive rather than to fly, the FAA estimated the regulation would cause an increase of about 87 deaths over 10 years, due to road deaths resulting from diversion to travel by car.”

If children under the age of 2 had to have a suitable child safety seat, and as a result, parents had to pay for the tots’ seats, instead of being held for free on a parent’s lap, some percentage of parents would switch to cars. Traveling by car is a lot riskier than by commercial airline. According to the National Highway Traffic Safety Administration, there were 37,261 motor vehicle crash related deaths in 2008, compared with no deaths that year caused by commercial aviation in planes with over 10 seats. A regulation intended to make children safer would have put more children at risk.

The congressmen holding the hearing weren’t pleased with this report. Congress likes to do things that are good for industry, but given the choice they would rather be seen as friends to children and small furry animals. There was some dispute over the estimates of how many families would choose to drive rather than take the plane if they had to pay for a child’s seat. Because this was under dispute, the statisticians at UCSF reviewed the calculations, leaving the percentage of families electing to travel by car unspecified. “Even assuming 70% lower than average fatality rates per hundred million vehicle miles travelled, we found that if more than about 5%-10% of families chose to drive rather than fly the policy would lead to a net increase in fatalities. Even ignoring these possible highway deaths, the estimated cost per death prevented was about $6.4 million for each $1 cost of the round trip aeroplane ticket for the child, or $1.3 billion if the ticket cost $200.”

These are real-life choices, variations on the guns vs. butter choices taught in Economics 101. Decisions are based on emotions, economics, political and social motives. In the case of medical decisions over life and death, many are made by private insurers, and perhaps indirectly by government. Government helps determine the number of hospital beds in an area, and the facilities a hospital may have. Insurance companies simply decide how much and whether they’re willing to pay. When the Tea Party people warned against the death panels that weren’t there, they left us in the hands of the death panels that are, and the ones that are, can’t run at a deficit.

In the end, statistics prevailed. The FAA permits young children to be held, but recommends that they travel in an approved safety seat. They also suggest asking the airline for a discount for the child.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, March 1, 2010