Prioritizing Parks and Patients

By Nathaniel Counts

During the government shutdown in October 2013, a battle in part over the future of healthcare reform, a non-negligible amount of media attention focused on the shutdown of public parks.  Perhaps because the parks were the least expected casualty of the shutdown, or the most ludicrous – many are, after all, large outdoor spaces that functioned for millions of years before there were federal funds for them – Americans were frustrated or amused that they could not walk around outside some places because politicians in D.C. could not agree on a budget.

The healthcare reform debate pitted those who believed that everyone should have health insurance or that access to healthcare was a right against those who believed that health spending was already too high or that everyone does not have a right to access to healthcare.  In a world of infinite resources, where everyone could have complete access to healthcare without anyone having to give up anything of their own, it is difficult to imagine that anyone would say that there should not be universal access to healthcare, that some are not deserving of the service.  It would be strange to require a threshold public showing of effort to obtain health insurance through employment if there was no cost to giving the healthcare – if fairness is an issue, as it appears to be a concern for some, there are certainly other services that could be denied.  It is likely that for most the fairness concern only becomes salient in the face of resource constraints where these same funds could fund other programs or allow others to pursue their interests.

Thus, some individuals prioritize other goods above access to healthcare for indigent individuals.  As parks receive funding while healthcare for some of these individuals is not funded, one may infer that parks may be a higher priority good than healthcare for some individuals.  If this is true, and it is not just an artifact of the piecemeal and special interest-driven legislative process, how could this be justified?  The obvious answer is self-interest – parks are prioritized because they are better for the individual prioritizing, not because they are better under any principled ethical framework, but we will put this aside.  There is also a possible utilitarian justification as many more people can enjoy parks a little bit even though a few people and their immediate family will suffer immensely.

Important, however, is that if one were asked which should be the higher priority, parks or access to healthcare for an indigent individual, moral intuition would likely always favor the healthcare.  If, however, all of the funds were pulled from parks to fund access to healthcare, there would be an almost unimaginable tragedy in watching beautiful spaces, such as Central Park or the Boston Commons, decay until they are eventually forfeited and subsumed into the surrounding city.  I suspect it is the same intuition that makes it acceptable to give guns to the guards at the Louvre and allow them to shoot anyone who tries to steal the paintings.  At times we may value art more than human life.

This line of thinking may pervade our funding decisions.  For example, the government does literally fund the arts.  What is absent from funding discussions though, is any acknowledgement that sometimes the nature that humans enjoy or the works that humans create is being valued more highly than the humans themselves.  If this question were more fully interrogated in relationship to funding decisions, key actors may switch sides and resource rationalization may become more coherent, and we would be left with a clearer idea of what creates value in our society.

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