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Despite Admirable Goal, Autism Bill Ill-Conceived

Posted by on August 7, 2009

[This post was originally written for my employer’s blog, Show-Me Daily.]

The Post-Dispatch has the latest about Gov. Jay Nixon’s struggle to ensure medical coverage for all Missouri children who have autism. I have selected a truly arcane method of judging his argument; in it, I’ll praise his intentions and convictions, while drawing critical attention to the reasonableness of the proposal itself.

The ancient Greeks divided argumentation into three criteria: “ethos,” the ethical credibility of the speaker; “pathos,” the emotional appeal of the speaker; and “logos,” the logic of the speaker’s argument. In this case, Nixon’s ethos is admirable — he wants to help these children and their families. To determine his pathos regarding this matter, look no further than this report about his level of conviction. However, as far as sober logic is concerned, his proposal is ill-conceived.

It goes like this: Autism among children is on the rise, and the treatment is prohibitively expensive. Many families can’t afford the treatment or the insurance coverage that would pay for it, but if we force insurance companies to cover all autistic children, the cost of the treatment would be spread among all the insurance company’s premium paying customers.

The economic logic of this is dubious at best. It externalizes the cost of what should be an internal transaction, forcing many people to pay for something that they will see no benefit from. The plight of autistic children is very sad, and my heart goes out to the families affected by it, but it is unreasonable to make the paternalistic decision to reallocate the money of those who buy insurance. Deadweight loss would inevitably result in such a scenario, and, like other subsidies — especially those for issues that can be so emotionally moving — the question quickly becomes, “Why pay for this treatment and not that one?” A compelling emotional argument can be made in favor of subsidizing all manner of medical care, but someone has to pay the resulting bill.

Criticism is not particularly useful without a proposed alternative. I submit that there are many people right here in Missouri — not just insurance customers — that would be willing to part with a modest amount of money in order to ensure that those who can’t get autism coverage because they can’t afford it are provided for. I would rather see a voluntary system, be it a charity campaign, or a checkbox on your state income tax form or license plate renewal application, etc., with wording along these lines: “Would you like to contribute 1, 5, or 10 dollars to provide help for poor autistic children?” The people who contribute to such a fund would not necessarily be the people who buy insurance, but this would eliminate the deadweight loss.

Sarah Brodsky has been a prolific writer about the topic of mandatory autism coverage, with a great op-ed and several blog posts, all of which are worth reading.

4 Responses to Despite Admirable Goal, Autism Bill Ill-Conceived

  1. Stefan Kolev

    The logic is actually very sound. We as society can pay for intensive therapy of young autistic children and give them a chance to become self-sufficient and productive adults. Or we can pay for their care for the rest of their lives. The choice is clear.

    Insurance is supposed to cover catastrophic events. Autism qualifies.

  2. Josh Smith

    Stefan, the argument you propose makes sense only if you assume that in either case, society will pay. I propose that it is each individual person or family or local social network’s responsibility to take care of themselves.
    One important argument against socializing the costs of care for autistic children that I neglected to make is this: as individuals or as a society, we have only so many resources with which to do all of the things we need to do. In order to argue that we should be spending money on autism treatment, you must determine what it is that we are now spending money on that deserves it less than autistic children. Such paternalistic decisions are not easy to make and rarely have the consequences one imagines when they are made. Decisions about how individuals’ money should be spent are best left up to the individual who has the local information about what is most important in their life. If they can spare it, they may still donate to a charity which supports autistic children.

  3. Stefan Kolev

    Society will pay for the long-term care of autistic adults. If they do not become self-sufficient then they will be drawing disability for the rest of their lives. That is a fact.

    I am saying that we can save society money by investing in early intervention.

  4. vroman

    “If they do not become self-sufficient then they will be drawing disability for the rest of their lives.”

    Then the unspoken solution is to discontinue disability payments to autistic adults.

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