The cost that was of the blizzard that wasn't

By Ari Lapin, M.D.

New York's recent non-blizzard and the pre-emptive safety measures taken by Mayor de Blasio have been subjects of much conversation lately. Even before we were aware of just how lackluster a blizzard it would prove to be, his panicky press conferences and predictions of doom and gloom suggested that perhaps the mayor would do well to listen to "Let It Go," from Disney's "Frozen," a time or two and adopt a small part of the fortitude demonstrated by teenage Elsa's attitude toward snow and storms.

There is no doubt de Blasio's precautions took government nannying to unprecedented levels. Streets were closed to non-emergency vehicles, pedestrians were discouraged from walking outside, and for the first time in the 110 years of its existence, the NYC subway system was shut down for a snowstorm. Following the anti-climactic snowfall, I noticed a widespread and disturbing viewpoint that needs addressing. In conversations among friends, interviews in the media and no small number of social media postings, I have seen and heard comments such as these:

Better safe than sorry!

Would you have rather seen people dying if the blizzard had been as devastating as predicted?

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Or in the words of Mayor de Blasio himself, "Would you rather be safe or unsafe?"

I have no doubt that the motivations of these speakers were entirely pure, but statements such as these reveal a fundamental problem that lies at the root of many of the poor policies consistently implemented by legislators at both the local and federal level. You may have heard a similar idea expressed with regard to other policies. For example, "Even if the number of deaths caused by drunk drivers decreases to one person per year, that would still be one person too many." Or, "Of course we should install nets on the sides of the Golden Gate Bridge! If they stop just one person from committing suicide, then they will have been worth it."

Of course, the flaw in these arguments is that they take into account only the benefits of these actions and disregard, or worse, don't even consider, the costs. If one death from drunk driving were really one too many, there exists a very simple plan to guarantee an end to all motor vehicle related collisions: Ban motor vehicles. Or, if you'd prefer, install speed governors on all motor vehicles in the United States limiting their speeds to 5 mph. Contemplate the benefits! No deaths from motor vehicle collisions (the leading cause of death in the U.S. for people 5-34)! Reduced carbon dioxide production! Restored polar ice caps and a burgeoning polar bear population! However, no one in their right mind would implement this, because … wait for it … the cost is too high.

All suicides must be prevented? How much are you willing to contribute from your paycheck to erect nets at all sites frequented by suicidal jumpers? Ten dollars? One hundred dollars? One thousand dollars? The figure may be different for each of us, but there is no question that at a certain amount it is no longer worth the cost to you. To view this as a choice between saving lives or saving dollars is a fatal mistake. In the real world, money translates into lives. The money used to install nets might have been spent on other, more effective suicide prevention programs. Or it might have been earmarked for medical research, foreign aid, disaster relief programs, donations to charity, or any other number of life-saving possibilities.

When seat belts and airbags were made standard equipment, required by federal law, in all cars in the United States, the legislators had the best of intentions. After all, could anyone possibly be against saving lives? But did anyone consider the resulting price increase of those cars? Did anyone consider the newly arrived, poor immigrant or the young single mother who would be more than happy to drive a car without airbags that he or she could afford? What about the tax increase necessary to pay for the bureaucracy to enforce the new policy, which subsequently left less money in citizens' pockets with which to hire employees? Nothing comes free; there is always a cost.

In the early 1990s, the New York State Department of Health instituted a cardiac surgery reporting system that identifies surgeons who have had poor surgical outcomes (e.g. patient deaths). Once again, in theory a terrific way to hold practitioners accountable and enable patients to make educated decisions about where to seek treatment. However, as an emergency room physician, I see the cost of this exacted on the very patients it was intended to help. Interventional cardiologists frequently refuse to operate on those patients who are the sickest and most in need of intervention because the likelihood is that the patient won't survive and that death will then go on their record. Studies have demonstrated that 83 percent of interventional cardiologists in New York agree that the publishing of these statistics has led to patients in need of these procedures being less likely to receive them.

Time magazine estimated the cost of Mr. de Blasio's recent blizzard shut-down to be $500 million to $1 billion, while a Moody's Analytics preliminary report came in at a conservative $200 million. These financial costs do not even begin to encompass the myriad other losses caused by the travel bans. Struggling business owners, hourly employees working to make ends meet, tourists who had saved and scrimped to afford a New York City vacation, brides and grooms whose weddings had to be canceled last minute – all suffered real losses as a result of this policy.

At the Manhattan hospital where I work, ambulances, instead of standing ready to respond to civilian emergency calls, were diverted to transport me and my colleagues to work. To my knowledge this change did not result in any direct loss of life, but did it result in longer wait times for ambulances? Could it conceivably have resulted in loss of life or in a decline in the quality of medical care? Add to this the number of medical staff who were stuck attempting sleep on cots in the hospital hallways to ensure that they'd make their morning shifts, whose competence and proficiency inevitably suffered.

These accountings need to be factored against the possible lives saved before one can argue that the pre-emptive shut-down was warranted. And let's not forget that we're talking about New Yorkers, some of the toughest and most self-reliant citizens in this great country. A city that has braved and survived terrorism, hurricanes and Big Gulp sodas. As Elsa would say, "Let us go, Mayor. The cold never bothered us anyway."

When all the factors are taken into account (financial costs, quality of life costs, health and well-being costs), I do not know whether the travel bans were justified by their potential benefits. For the purposes of this argument, the answer is largely irrelevant. What is important is that we understand that every decision has a cost, and that unless that cost is weighed against potential benefits, it is impossible to arrive at a wise decision. To think otherwise is foolhardy, disastrous and short-sighted. None of this should come as a surprise. These are calculations that all of us make all of the time in our professional and personal lives, weighing risk and reward, cost and benefit. It is only in government, where Mayor de Blasio and politicians of his ilk are playing with our pocketbooks, that they are able to proudly proclaim policies without regard to costs. The rest of us, the ones who actually pay for their misguided policies, can't afford that luxury.

Ari Lapin is an emergency medicine physician and entrepreneur living in Manhattan who writes on politics and culture.