Why Any Seatbelt Mandate is an Infinitely Iterated Prisoner’s Dilemma: A Health Economics Perspective

Among the most controversial of public health measures are those that restrict people’s freedom of choice presumably for the purpose of protecting their own health and safety. Mandatory use of automobile seatbelts can inspire allusions to the “tyranny of health” and the ‘health police.” This study revisits state seatbelt legislation, which is in force in all but one state of the USA. In modeling seatbelt mandates as indefinitely repeated Prisoner’s Dilemma (PD) games, the study qualifies and overcomes the limitations of conventional interest group and expressive voting theories. It indicates why and how utility-maximizing players, particularly carmakers, insurance companies, consumer advocates and regulators, may choose to cooperate, even in instances where mutual defection would bring each of them higher payoffs. The study suggests why state seatbelt mandates endure, despite ongoing concerns that they undermine individual autonomy or that their social costs outweigh the benefits of law-enforcement. The evolution and mediating effects of reputation and reciprocity in otherwise highly contestable healthcare decisions are consequently explored. Finally, the study identifies the implications of indefinitely repeated games on the continuing nature of strategic relationships and for mitigating conflict over traffic safety regulation, regardless of time and place.