title: The radiation exposure compensation act: what is fair?
abstract: In 1990 the U.S. Congress passed a law providing compensation to former uranium miners who became ill while the U.S. Government was the sole purchaser of uranium. Ten years later, in 2000, the law was amended to correct widely perceived problems. We reviewed the content of the Radiation Exposure Compensation Act (RECA) laws and regulations, cataloged complaints about the 1990 law, compared the law to the scientific knowledge base in 1990 and in the present, reviewed the 2000 amendments to RECA, and drew lessons about how such compensation programs might be better structured. We concur with popular sentiment that the 1990 law had numerous flaws, the central one being that it failed to compensate many miners who by most other standards would have been deemed deserving. This problem arose through setting exposure criteria very high (at six to 15 times elevated risk), with a disproportionate burden placed on miners who had smoked. The additional burden on smokers was exacerbated by a very stringent definition of smokers (one pack-year in a lifetime). Federal compensation laws should prioritize payment to deserving claimants rather than excluding un-deserving claimants. Thus, a doubling of risk should be an upper limit for setting an eligibility threshold and a lower "significant contributory effect" standard could be considered more appropriate. Uncertainties in exposure and in dose response should be considered and resolved with a bias toward compensation. Beyond setting appropriate criteria, an active effort is needed to inform potentially eligible people and to assist them in qualifying; the eligibility criteria and the requirements for documentation should be appropriate for Native Americans and other cultural groups. Built-in evaluation mechanisms are needed for all compensation programs to assess whether they are meeting their stated objectives.
authors.affiliation: Department of Community Health, Tufts University, Boston, MA 02111, USA. dbrugge@aol.com
authors.forename: Doug
authors.initials: D
authors.lastname: Brugge
authors.forename: Rob
authors.initials: R
authors.lastname: Goble