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On the Third Hand: Autism

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Of course, when reporters who are trying to write hard news also write columns, that creates an obvious conflict between the newswriting role and the columnist role.

Wearing the reporter hat and the columnist hat during the same week pretty much wrecks the comforting illusion that reporters are mechanical robots who have no opinions about anything and just “report the facts.”

Of course, even if Google could develop apps that would report the news in an engaging, automated fashion, the Google apps’ articles would still reflect inherent biases because, of course, whoever developed the apps would have inherent biases. The apps probably would be biased in favor of the idea that national news is generally more important than news about your next-door neighbor (unless your next-door neighbor is involved in national politics), and the apps would probably also reflect other biases, such as the idea that readers are more interested in what’s happening with the stock prices than with baseball card prices.

I try to get around the conflict when writing about the Patient Protection and Affordable Care Act (PPACA) by imagining that I have Robert Heinlein, Karl Marx and Adam Smith in my office and figuring out what they would agree on. Or, if they at least agreed to proceed based on common assumptions just for the sake of argument, to come up with a column idea based on those assumptions.

Example: Robert Heinlein (sorry, but I’m just plain more familiar with him than I am with Ayn Rand or Rose Lane Wilder) might hate the idea of the government paying for health care, and Karl Marx might want the government to provide all health care, but maybe they could agree, for example, that whoever does provide health care should avoid killing people on purpose, or make it easy to vaccinate babies against polio, or on other basic principles like that.

To me, it seems as if one thing that they might possibly agree on is that the current efforts to design the PPACA “essential health benefits” (EHB) benchmark.

The idea is just that the benchmark will determine the minimum types and amounts of coverage that a major medical plan sold in a particular must provide, both to help consumers shop for coverage, by standardizing the coverage, and by discouraging insurers’ from holding down prices by skimping on coverage.

The PPACA drafters and the U.S. Department of Health and Human Services (HHS) seem to have had mixed feelings about what should go into the EHB package. HHS punted the political football to the states, by putting each state in charge of outlining its own EHB preferences. HHS officials have suggested that the EHB package should probably be more like the “Silver” level plan offered by a popular small group health plan, not Gold- or Platinum-level coverage.

But, at the same time, PPACA has required the EHB to provide pediatric oral and dental health benefits, and also to offer “habilitative” services — essentially, rehabilitative-type services for children with autism or other developmental issues who never had the ability to speak, control their behavior, handle school or engage in other activities of daily living to start with.

States seem to be having an easy time adding some pediatric dental and vision benefits, because those don’t cost much. The states are having a harder time dealing with questions about coverage of services for children and adults with autism and other developmental disorders. The comment letters from the groups representing the desperate parents of those children make for sad reading.

I don’t know what the answer is for fixing the U.S. health care finance system, and I’m not totally convinced that, once you add up all types of social services spending — health care, education and housing support — that the United States system as expensive as people say. (Maybe our system is so much more system than the otherwise similar Dutch system, for example, because the Dutch so much more money on educating doctors and doctors’ children. If getting a medical degree and getting a doctor’s children bachelor’s degrees were as cheap in the United States as it is in the Netherlands, maybe our health care system would be as cheap as the Dutch system.)

And I know the whole idea of thinking about whether certain people “deserve” certain levels of medical care is pretty horrible. Example: I’m fat. (Although, thanks to Dr. Atkins, less fat than I was a few months ago.) I can understand why whatever health care finance system we have might penalize me by charging me spending less on caring for me if I have a heart attack, but it seems as if it would be pretty unfair for the health care system to spend less on my care if I slip on ice and break my arm.

On the one hand: It does seem as if starting the whole debate over management of access care by talking about children with autism is pretty mean. 

On the other hand: The families of those children are in the crosshairs because they’re asking for new benefits at a time when money’s tight, not just clinging to old benefits.

On the third hand: It still seems less than gallant that the EHB debate is focusing on children with autism like a laser, without giving much attention at all, at this point, to the huge number of fat people who may be needing added diabetes  and heart disease treatment benefits in a few years. I wish that, if states and HHS will be obsessing about how to keep children with autism from flooding insurers with $50,000 annual claims for applied behavioral analysis (ABA) therapy in the next few years, they could also be obsessing about the flood of Type 2 diabetes-related claims that’s likely to pour in over the next few decades, or other potentially controllable sources of expensive new claims.

On the fourth hand: I violated my principles, and Robert Heinlein would probably be drawing his saber at this point to slice up my keyboard. Adam Smith would be wagging his finger, saying, “You know that all of this will end up with poor people paying huge taxes or premiums to cover questionable ABA therapy sessions for relatively affluent children who may not even need all of that therapy.” Karl Marx would probably steal my wallet to put the cash in the kitty of the dictatorship of the proletariat. But, anyhow, the bottom line is: The EHB comment letters from the groups representing people with autism are just plain sad. I wish there was a better way.

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