Ontario Autism Announcement — First Thoughts

Today the Ontario government issued the news release Ontario Takes Decisive Action to Help More Families with Autism. I can’t really pass too much judgement on it, because the government hasn’t released too many details. As such, I’m really uncomfortable saying what effects this will have, if any, or even if this is an improvement over the status-quo (though given how awful the status-quo is, it’d be hard not to be). A few additional caveats:

• I tend to get a lot of attention on this because I’m a loudmouth on Twitter and have become “Ontario Dad”, but (not surprisingly), “Ontario Mom” has done most of the heavy lifting for our family on this, so she’s a better person to talk to.
• I don’t have any policy expertise in health care, beyond being “Ontario Dad”. So if health care experts disagree with any of this, take their word over mine.

From a policy point of view, this is an incredibly difficult file for (at least) two reasons:

1. Treatment is ridiculously expensive. $80,000 a year is not uncommon. That will break government budgets quickly, particularly due to the growing need. (And think what it does to family budgets, of those who pay out of pocket!)
2. The need of each child with ASD is so different. It’s called a “spectrum”, though I think the better analogy is a “buffet”. This makes one-size fits all policies impossible.

In an ideal world, we’d treat ASD like most healthcare — your child has a health care need, the government covers that need, and the only thing you get out of your wallet is your OHIP card. Sadly, we don’t live in that world, which is why we have 3+ year waiting lists for treatment where “time is of the essence”. Imagine if we ran the rest of the health system with a 3+ year waiting list! I suppose that would cut down on the cost of all those pharmacare proposals we’re seeing (“yes, the government will pay for your prescription, but it’ll take you 40 months before you get your first pill”).

Other thoughts:

• Eliminating the waiting lists is a lofty goal. Hopefully this will get us there.
• “Doubling funding to expand the province’s five diagnostic hubs so that families can receive a diagnosis sooner”. This is a good thing.
• “ For example, a child entering the program at age two would be eligible to receive up to $140,000, while a child entering the program at age seven would receive up to $55,000.” While a lot of money, this at most pays for two years worth of treatment.
• Ideally, if governments are going to deal with this, they need to figure out how to bend the cost curve, because the sticker price is a massive problem, regardless of who is paying for it. We need to figure out how to make this therapy far more affordable while not sacrificing quality.
• The income phaseouts make some sense (in theory at least, as I haven’t seen any details on how they’d work), since it is kids from lower and middle-income families that are falling through the cracks. That said, we don’t do this for any other form of healthcare. If we’re okay with the government requiring high-income families to pay for their own autism treatment, why not make them pay for their own cancer treatment?
• Perverse incentives: Parents with kids on the spectrum already have an alarmingly high divorce rate due to the stresses involved. Thanks to the income thresholds, parents have further incentive to get divorced, to split into two lower-income families, in order to increase their funding allowance.

That’s it for now. Still looking for more info.