Page 13 - Volume 69, Number 4
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legislation. But perhaps my prior assertion that the legislators were unconcerned about increasing health care costs was a bit too strong. After all, the new law did require that the non-helmeted riders get enough additional medical insurance to cover about
15-30 minutes of intensive care unit time.
The ABATE crowd emphasized personal choice and
individual autonomy as the main rationale for this change. They did not address the issue of additional health care system costs, which suggests they never expected to be injured or if they were, expected someone else to pick up the tab. And cost to society should have been a big concern. Here is why. First, trauma care is expensive. Second, non-helmeted motorcyclists will have neither sufficient insurance nor financial assets to cover the complete cost of their care should they be injured. Finally, the number of neurologically damaged folks would rise, assuming more injured patients require hospital, nursing home and rehab care, and society will be paying for nursing homes to change the diapers of these neurologically devastated, non-helmeted, motorcycle crash victims for decades.
Of course, if they die at the scene, they cost the health care system very little.
What have been the effects of this change in the law? Let’s look at some numbers. According to state data, in 2011 there were 113 fatal motorcycle crashes and 2353 motorcycle crashes with injuries. In 2016, there were 146 fatal cycle crashes and 2460 crashes with injuries, a 29% increase. Striker and others reported on changes in the clinical impact of motorcycle crash victims comparing the pre-repeal period to the following three motorcycle seasons.(1) More people died in the hospital (and at the scene) in the post repeal period. Injury severity increased, costs increased, days on ventilators increased, and intensive care unit stays increased. The head injury portion of the abbreviated injury scale was higher in the non-helmeted riders. About half the non-helmeted riders had a blood alcohol level over 0.08 compared to only 14% of the helmeted riders. While not a perfect predictor, it appears that not wearing a helmet is a proxy for poor judgment.
My Modest Proposal
At the time of the repeal debate, I advocated a very utilitarian approach. My modest proposal was to put up signs at our borders saying: “Welcome to Pure Michigan. If you aren’t wearing a motorcycle helmet, we will assume you are cool with us donating your organs if you are brain dead after a crash.” People who wished to opt out of this approach could request sufficient personal injury insurance to cover the long-term costs of care in the event of injury before proceeding. This would truly be a win-win, as it would allow motorcyclists the opportunity to save money on insurance if they choose.
Those who make a different choice can contribute to the greater societal good through organ donation. Or a third option is available: wear a helmet!
It is no longer clear to me that I relocated to a more intelligent state in 2006. It is too soon to say whether my fears of the increased burden on society of the health care of the chronically debilitated victims of motorcycle crashes will come to pass. I sincerely home not, but In the meantime, we can encourage our patients to wear helmets. At the very least, we can say that we now know that more people are dying and we can appeal to the families to reason with their loved ones to be as safe as possible. Finally, if we can’t agree how to manage the increase in costs within the current health care system, we can always move to a single payer health care system. This would allow us to spread the costs of all poor decisions across the whole population. If society decides they don’t want to pay for this particular poor individual decision in this way, I suggest we restore the helmet law.
1. Rebecca H. Striker, D.O., Alistair J. Chapman, M.D., Rachel A. Titus, M.D., Alan T. Davis, Ph.D., Carlos H. Rodriguez, M.D., F.A.C.S. Repeal of the Michigan helmet law: the evolving clinical impact. Am J Surg 2016;211(3):529–533
Volume 69 • Number 4 Washtenaw County Medical Society BULLETIN 13


































































































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