Despite Admirable Goal, Autism Bill Ill-Conceived
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.