Saturday, August 16, 2008

A Little Autism Means Big Money

Reviewed: "New Ways to Diagnose Autism Earlier" by Jeremy Singer-Vine of the Wall Street Journal and "Autism Cures" a critique of the Singer-Vine article by Thomas Sowell.

Pertinent Points from "New Ways to Diagnose Autism Earlier":

  • New diagnostic methods indicate whether children under 30 months old may be at risk for autism.
  • "At-risk" children can begin early behavioral treatment. Pre-school treatment is shown to be more successful in raising IQ and improving language in autistic children than later treatment.
  • New methods provide "useful clues" as to whether the child may have autism. The author notes that "there is something about a clinician that adds to the predictive value."
  • Early intervention may be expensive, but if successful, may decrease overall spending on treatment of autism.
  • "Just eight states have passed bills mandating coverage by private insurers for autism and related disorders." The author notes that 27 other states are working on autism initiatives.

Pertinent Points from "Autism Cures"

  • An "Autism spectrum" allows for easy false diagnosis based on a range of autism symptoms.
  • Parents that allow children to be diagnosed as autistic can receive funding for desired therapies such as speech therapy. This encourages diagnosis of autism even when the existence of that condition may be questionable.
  • False positive diagnosis of early autism makes "curing" the disease easy work and generates false data about cure rates.
  • False positive diagnosis diverts money from truly autistic patients that need treatment.

The implications:

Of course FMP has no problem with parents electing to utilize non-definitive early diagnosis methods and expensive early treatment if they so desire. The problem comes when these elective procedures become the public burden.

For evidence that it is becoming the public burdern, note two excerpts from the Autism Votes website, an activist site dedicated to support bills benefiting autistic patients. These excerpts are two of many such notices.

1)(Baton Rouge, LA - July 2, 2008) Today, Louisiana Governor Bobby Jindal signed House Bill 958, the autism insurance reform bill passed last month by the state legislature, into law. The new law will require health insurance coverage for the diagnosis and treatment of autism disorders in patients under age 17. Benefits are capped at $36,000 per year and $144,000 per lifetime.

2)NEW YORK, NY (July 9, 2008) -- Autism Speaks today commended Pennsylvania Governor Ed Rendell for signing into law the most comprehensive autism insurance bill in the nation. The new law provides $36,000 a year for Applied Behavior Analysis (ABA) and other necessary treatments, and goes beyond many state insurance reform measures by mandating coverage up to age 21 with no lifetime cap. It also creates, for the first time under Pennsylvania law, an expedited appeals procedure for denied claims as a safeguard to ensure compliance by insurance providers. Private insurers will be required to provide coverage beginning in July 2009.

We can't help but wonder how this mandating of particular coverages on the insurance industry is affecting health insurance premiums. Health insurance isn't a charity program. Every time coverage expands the price of premiums must go up. These diagnostic and treatment procedures certainly have a place. But, should the government mandate non-conclusive, early-diagnostic procedures for autism and similar procedures for other illnesses?

Especially in these financially questionable practices, parents and doctors must be the decision makers- not the government. Efforts by the government to enforce a standard of care on the health insurance industry and on taxpayers can only make health care more expensive and less acessible to Americans.

Rusty Scalpel


Anonymous said...

Before people write articles and "critique" the work of others, they truly should do their homework. At least a little bit of research is not too much to expect - or it shouldn't be.

You chose to comment on the "Autism Cures" critique and it is obvious to anyone who has any experience - actual experience - with autism that this person also did not do any research at all. "Parents that allow children to be diagnosed as autistic can receive funding for desired therapies such as speech therapy." From WHO?! Unless you happen to live in one of those 8 states who recently passed laws (almost none of which are in effect, yet!), there is NO money to pay for therapies! NONE! Zip, zero, nada. Autism is the ONLY condition - the only one - that is excluded from coverage by insurance companies!! Are you understanding this?? Completely excluded from coverage - for ALL therapies, including the aforementioned speech therapy. There are a couple of states (mostly the same who just passed laws) who have a limited amount (not nearly enough to cover all those ALREADY diagnosed) of "grants", but there are usually income requirements, waitlists and it isn't adequate to pay for more than a couple of weeks of therapy.

So, tell me again, exactly WHAT is the incentive to get a diagnosis? A diagnosis of autism means you will lose insurance coverage - period!

Individuals with autism are discriminated against in a way that nobody else is. People with brain injuries get speech therapy, people who have a stroke can get speech therapy, even someone diagnosed with a "speech delay" is provided speech therapy and it is all covered by insurance. What justification can you give for denying the SAME coverage that everyone else is provided?!

"False positive diagnosis of early autism makes 'curing' the disease easy work and generates false data about cure rates." Again, WHAT?! "Cure" rates?! There is NO cure for autism! This is another ridiculous argument made without doing any research into the subject whatsoever. "False positive diagnosis diverts money from truly autistic patients that need treatment." Outrageous, again! Diverts what money?! There is NO money to be diverted!!

Perhaps both authors should "walk a mile in another's shoes" to have an inkling of understanding of this issue before expounding on the topic and presenting completely false "data"?

"FMP has no problem with parents electing...early treatment...the problem comes when these 'elective' procedures become the public burden." Does FMP also consider it a "public burden" when cancer patients receive chemo therapy? Or is it a "public burden" when diabetics (another condition for which there is no "cure") receive medication? These things are all covered by insurance, which is precisely the way insurance is supposed to work - all contribute to cover for those who need treatment. Why are children with autism the only ones who should be excluded from this process? Why are they solely discriminated against in such a manner? THIS is the reason - the outright discrimination of a single population - that the government is finding it necessary to step in and pass laws. The 8 states who passed the laws did so because they found that insurance companies were indeed discriminating against these children! They also passed the laws because they found the cost to be a non-issue - that is how small it is. Again, a small amount of research and you would have found this out for yourself. These coverages range anywhere from $.48 to $4.00 per month. In other words, the worst-case scenario (even CAHI, the insurance companies' own group, found this to be true!) is that the cost to cover all these children is less than 1 gallon of gas. Are the futures of all these kids really worth less than a gallon of gas?!

Covering these kids now, so they can receive early interventions, will cost taxpayers much less than paying for their care as adults if they do NOT receive the treatments they need. We are talking about an entire generation of kids, would you truly throw them all away to save $4.00?!

Rusty Scalpel said...

Dear Anonymous,

First of all, thanks for reading and thanks for commenting. We'd love to hear more from you in the future.

You may be right in your criticism of the "Autism Cures" article. If it is the case that funding is generally unavailable from the insurance policies for treating autism, the author may have been referring to Medicaid.

The point of my commentary may have been unclear and poorly constructed. Of course I have no bias against insurance coverage of autism or any other illness. If autism is indeed rarely covered in insurance policies, then that is unfortunate.

My point was that continued government interference in the health insurance and health care industries is driving up the price of health care and insurance and contributing extensively to the general unafforability of it. If an insurance company finds it unprofitable to cover certain illnesses, I believe they have the right to exclude those illnesses from their policy. If consumers find the policy fiscally or morally unattractive, the policy will not be purchased and more attractive policies will be. In this case the company that perceives public mood and need and covers autism will be lionized and patronized.

If government mandates the inclusion of certain illnesses for coverage in a given state, competition is squashed. All plans include the illness, raise their rates and become uniformly more expensive and unattractive to consumers. You point out that the price raise is minimal in the case of autism. The problem is that government intrusions into the industry are becoming increasingly common.

My arguments may sound oversimplified and unresearched, but they are the principles of market economics. Deviation from these principles, efforts to control the market, make health and insurance and health care less affordable and accessible to all consumers- including these autistic patients that need medical care.

Thanks again for your comment.

Rusty Scalpel