Tuesday, August 24, 2010

A is for Asperger's, B is for Billing...

My blogfather Ricky asked the following question a couple times, as he was curious to get my take on the matter:
I'd love to see your opinion on the new law in Mass. that makes insurance companies include autism in their coverage. Your *honest* opinion, not what you'd think your old buddy would like to hear. :)
(Link added for emphasis)

I guess I just don't know enough about the whole debate or something, but I was surprised to hear that this was even news. More precisely, I'm stunned that autism treatments weren't already covered. TheBoy has a friend with Asperger's Syndrome (which I understand is different than autism, but certainly analogous), and while it's not a life-threatening disease, it's certainly something that can't be fixed with two aspirin and a call in the morning.

As far as I can tell, the primary treatments available for autism are behavioral in focus; I imagine this is where the main thrust of opposition comes in. We've got almost a hard-wired opposition to mental health problems it seems; anyone incapable of "shaking it off" or "suck[ing] up and deal[ing]" with their problems is viewed with suspicion or hostility for some perceived imperfection. Some of the opposition, possibly, stems from those who game the system - claiming mental illness where not exists - but other than that it's pretty mystifying that an alcoholic who decides to finally shake the monkey is lauded, whereas someone suffering from a behavioral anomaly who needs therapy is viewed with suspicion.

From a financial/conservative standpoint, if treatments are covered for other, similar issues, then it's a no-brainer. If one's health insurance will cover physical therapy after an accident, or speech therapy for the recipient of sugery to repair a cleft palate, then it should cover the physical therapies needed for someone with autism. If insurance will cover behavior modification therapy - like stop-smoking clinics or OCD - then it should cover treatment for autism as well. Perhaps I'm oversimplifying or missing some other critical part here, but it seems that omitting autism from insurance coverage has (had) no basis in medical fact.

Ricky, feel free to correct me if I'm grossly misrepresenting the issue or missing the point.

That is all.

15 comments:

Mark said...

Hey, I've stumbled across your blog over the past couple days and I'm really enjoying it and I really like this post.

My little brother has Autism and my parents were told he would never hold a pencil. This May he graduated high school with the same credentials as the rest of his class.
This was accomplished in part with help from the behavioral therapies that you mention, which he underwent extensively, especially when he was younger. Even tho my parents paid for their own insurance, it wouldn't cover the therapy so the government ended up footing alot of the bill.
I think it's a great idea to include Autism coverage, it will save the government money and allow families to push their children to make the best of their situation.

Teke said...

While not the Same my daughter suffers ADHD to what I would call an extreme. It can make her completely non functional without her meds (and peg my frustration meter). Insurance pays for those. There is no behavioral therapy that I am aware of for her. I think that the course of treatment should be covered as long as it is not "Experimetal" or "questionable". A coworker of mine has an austistic son and it is amazing how far he has come. He is completely normaized in classes as school. This is in part to behavior therapy and also some less common approaches that they took on their own. Detox Dr. and Gluten free diet worked wonders.

Jake (formerly Riposte3) said...

"TheBoy has a friend with Asperger's Syndrome (which I understand is different than autism, but certainly analogous)"

As I understand it, Asperger's is not actually different from autism, it's actually a very mild form of autism (equivalent to or slightly milder than "high functioning autism."). Of course, this categorization seems to be hotly debated, and changes frequently as they learn more about both Asperger's and autism, and depending on who is more prominent in the debates at the time.

Autism absolutely should be covered by insurance (if similar issues are covered), at least in it's more severe forms. Without treatment autistics are generally effectively non-functional, and depend on others or society for care for the rest of their lives. With treatment, they can be at least mostly, if not completely, functional and independent.

I also think the more mild forms should be covered, for similar reasons. The better someone is at functioning in society, the less they will require treatment and care in the long run.

wolfwalker said...

Right, Asperger's Syndrome is an "autism-spectrum disorder." Autism is no more one disorder than cancer is -- it covers a wide variety of mental problems, from mild learning problems all the way up to the almost-completely-dysfunctional, pounding-head-against-the-wall type that most people think of when they hear the word "autism."

Personally I think Asperger's and other mild "autism-spectrum disorders" are used by the medical community a lot like ADD or ADHD: maybe one in ten diagnosed cases actually has a real problem that requires treatment. The rest of the time, it's a chickenshit diagnosis. Pshrynks keep expanding the definitions of vague disorders like "autism" and "ADD" and "ADHD" and "addiction," because they won't be satisfied until they've diagnosed everyone (except themselves and their fellow Beautiful People) as abnormal in some way, requiring daily doses of neurotoxins that render us nice meek pliable "normals", that they can push around any way they like.

That said, however, I'm not at all surprised that insurance companies don't cover autism. Autism is a bitch for insurance companies, because it's a guaranteed payout, and probably a big one at that. Remember, they aren't charities. They're in business to make money. Their margins are thin as it is. A severely autistic person can require hundreds of thousands of dollars worth of care over his or her life. It doesn't take very many such cases to take a big bite out of those thin profit margins.

Teke said...

Jake you are 100% correct. My coworkers son is high functioning. His parents were told that he would probably be able to make through high school and hold a menial job. Now it appears that he will be able to attend college and have a successful carrer of his choice the same as anyone else.

Treatment made this possible for him and he is not destined to be a drain on society.

Mark said...

"Treatment made this possible for him and he is not destined to be a drain on society."

That's exactly how I feel about my brother. I've seen families that just "accept" a disorder and let their child atrophy. It's sickening.

RW said...

Nice synopsis, Jay. Thanks.



This subject has reminded me that while I'm a conservative that seemingly gets a bigger libertarian streak with every passing day, I don't think I could ever be a big-L Libertarain. Oh, I'm in full agreement that the gov't should stay as far away as possible from darn near everything, in cases like this the market has not provided a solution. First, autism isn't covered under almost any insurance policy, which surprises a lot of people. The few places where it's covered are usually where it was implented via law. Here in Georgia, I simply cannot purchase insurance that covers autism. Can't happen. So, for seven straight years we've qualified for the medical deduction clause in our 1040's (get your gross, multiply it by 7.75%...that's less than the percentaget that I've paid out of pocket on health care for 7 years running), mainly due to paying for Jared's autism expenses. It's been tough for me, a market oriented guy, to accept the fact that I must go to my local congressman & ask him to support such an action, but....the market isn't working as it should.

The scientists tell us that 1 out of every 100 kids being born today will be diagnosed with autism. So, with that in mind, it's bewildered me how procedures for hemorroids - the uncomfortable kind, not the lifestyle-threatening kind, birth control, boner pills, etc., are covered under their insurance policies, someone with a distinct neurological disorder is not. Heck, some insurance policies cover flu shots, meaning that you literally have nothing wrong with you but you want a procedure undertaken to make sure it stays that way, and it's covered.

So, I guess my quest has been for a fellow right-leaning person to talk me OUT of seeking that my local gov't mandate this measure. It sure goes against my line thinking to look at the gov't (shudder), but what is the solution when the market (aka in this case, the medical insurance companies) aren't reacting to demand?
-------------
BTW, my son is now in the 4th grade. In his first three, he won the award for highest math average & fell two points short of "genius" in the non-verbal portion of his IQ test. Looks like he'll not only fit in with society, he'll excel, but I still worry about the social interaction part since "nuance" is as foreign to him as "inexpensive" is to a woman. :)

RW said...

Nice synopsis, Jay. Thanks.

This subject has reminded me that while I'm a conservative that seemingly gets a bigger libertarian streak with every passing day, I don't think I could ever be a big-L Libertarain. Oh, I'm in full agreement that the gov't should stay as far away as possible from darn near everything, in cases like this the market has not provided a solution. First, autism isn't covered under almost any insurance policy, which surprises a lot of people. The few places where it's covered are usually where it was implented via law. Here in Georgia, I simply cannot purchase insurance that covers autism. Can't happen. So, for seven straight years we've qualified for the medical deduction clause in our 1040's (get your gross, multiply it by 7.75%...that's less than the percentaget that I've paid out of pocket on health care for 7 years running), mainly due to paying for Jared's autism expenses. It's been tough for me, a market oriented guy, to accept the fact that I must go to my local congressman & ask him to support such an action, but....the market isn't working as it should.

The scientists tell us that 1 out of every 100 kids being born today will be diagnosed with autism. So, with that in mind, it's bewildered me how procedures for hemorroids - the uncomfortable kind, not the lifestyle-threatening kind, birth control, boner pills, etc., are covered under their insurance policies, someone with a distinct neurological disorder is not. Heck, some insurance policies cover flu shots, meaning that you literally have nothing wrong with you but you want a procedure undertaken to make sure it stays that way, and it's covered.

So, I guess my quest has been for a fellow right-leaning person to talk me OUT of seeking that my local gov't mandate this measure. It sure goes against my line thinking to look at the gov't (shudder), but what is the solution when the market (aka in this case, the medical insurance companies) aren't reacting to demand?

RW said...

Okay, @#$% it, it gave me a message saying that there was an error on the first go 'round. Sorry for the double post, folks.

RW said...

Personally I think Asperger's and other mild "autism-spectrum disorders" are used by the medical community a lot like ADD or ADHD: maybe one in ten diagnosed cases actually has a real problem that requires treatment.

I'm not all that up to date on asperger's, but I get asked about autism a lot. Basically, if you have a kid that (1) doesn't/can't communicate; (2) hums incessantly, as in "pretty much all the time"; (3) shakes their hands over and over and over and over....chances are pretty good that you should seek the advice of an expert, as those are the tell-tale signs. There are others, but those stick out. One of them can be a quirk. Two...reach out, immediately. Early intervention can equal recovery. My son is a walking example.

Jake (formerly Riposte3) said...

"Personally I think Asperger's and other mild "autism-spectrum disorders" are used by the medical community a lot like ADD or ADHD: maybe one in ten diagnosed cases actually has a real problem that requires treatment. The rest of the time, it's a chickenshit diagnosis."

While I agree, I also believe there are nearly as many undiagnosed Asperger's/mild-autism cases, or cases that are mis-diagnosed as something else (like ADD/ADHD). It's not widely well-understood, even among psychs, and some of the ways it presents can mimic things like ADD/ADHD. Plus the fact that many families view it as a discipline issue and won't go to a shrink for it so they're never diagnosed at all - and may or may not ever learn to compensate.

My (now)ex-wife's therapist once suggested that I may have Asperger's based on some of the things she told her about me (other options were ADD or Bipolar disorder). Knowing what I do about myself and Asperger's, it really wouldn't surprise me if that were the case. I have a hard time reading people, especially if I don't know them; crowds (and sometimes any social interaction, even one-on-one) leave me exhausted; I am very prone to "hyperfocusing" on what I'm doing; I tend to go on and on obsessively about things that interest me; and I find myself "fidgeting" (foot tapping, moving to the beat of a song in my head, etc.) - all very common with Asperger's.

Or, I could just be a socially-challenged geek. A lot of the fad diagnoses tend to overlap geekishness.

wv: antiorco - Opposing misspelled killer-whales?

RW said...

I have a hard time reading people, especially if I don't know them; crowds (and sometimes any social interaction, even one-on-one) leave me exhausted; I am very prone to "hyperfocusing" on what I'm doing; I tend to go on and on obsessively about things that interest me; and I find myself "fidgeting" (foot tapping, moving to the beat of a song in my head, etc.) - all very common with Asperger's.

And, autism.
A lot of that applies to me, as well. Hand to the sky, I had an apparatus that my wife got for me (by way of my son's therapy) that was in my hands & being twisted that is used for busy hands (aka, fidgeting), while I was reading your comment.


Nice mid-day laugh.

Teke said...

RW. I have to agree. My wife is always trying to tell me that I am identical to my daughter and I find myself doing the exact same things you describe. Fidgeting, foot tapping, OCD about certain issues. Mine is computers and firearms ;) yeah shooty goodness. Also not so great socially. Maybe it's the geek part maybe it's what makes us geeks. who truely knows

Jake (formerly Riposte3) said...

A little food for thought from that same link I posted earlier (really, substitute "geek" for "hacker" and it's just as true):

"Many hackers have noticed that mainstream culture has shown a tendency to pathologize and medicalize normal variations in personality, especially those variations that make life more complicated for authority figures and conformists. Thus, hackers aware of the issue tend to be among those questioning whether ADD and AS actually exist; and if so whether they are really ‘diseases’ rather than extremes of a normal genetic variation like having freckles or being able to taste DPT. In either case, they have a sneaking tendency to wonder if these syndromes are over-diagnosed and over-treated. After all, people in authority will always be inconvenienced by schoolchildren or workers or citizens who are prickly, intelligent individualists — thus, any social system that depends on authority relationships will tend to helpfully ostracize and therapize and drug such ‘abnormal’ people until they are properly docile and stupid and ‘well-socialized’."

skidmark said...

I think everybody else has covered the "autism deserves coverage" vs "why should I have to pay for your problems" vs "this will kill small businesses" stuff to the point that one more comment will not add significantly to the dialog.

So I'll go to what really got my notice in the quoted article: Gov. Duvall is signing bills at Fenway Park?!!? Who dreamed up that as an appropriate venue for signing any bill? And especially one regarding autism?

stay safe.

wv = vaculari: what Gov. Duval has between his ears instead of a brain.