Insurance, HMOs, and Bike Rides

"Legislation for autism treatment" has practically become synonymous with "insurance coverage for ABA" here in the US. As I've noted, ABA has been the basis of my own son's education since he was two years old; while it's hardly the only way to teach kids on the spectrum, it has helped him to learn, speak, ride a bike (and by the way, Jim has told me he wants to write another bike-riding post soon---I am more than encouraging him, now that June is here!).

There's more that insurance should cover for autism than ABA, and not only for children. Autism is a lifelong disability, and individuals may well need services of different sorts at different times in their life. We do know many families who've noted how insurance coverage would help them out a great deal and I was puzzled by a recent article from the "Sunday Insight" section of SFGate that specifically points the finger at children on the spectrum and their families as driving up costs at HMOs. The article is by Alain Enthoven, professor emeritus of management at the Graduate School of Business at Stanford University, who argues that ABA is strictly an "educational intervention[s]" that health insurance need not cover:

There are proposals, not yet in legislative language, to require California HMOs, in addition to the medical services they already provide, to cover extensive educational and behavioral services for autistic children, services that are more appropriately the responsibility of state regional centers for the developmentally disabled and of school districts. These services have been estimated to cost more than $40,000 per child per year.

The state and the schools are in financial trouble, funding for the regional centers is being cut back and parents of autistic children understandably want HMOs to be required to provide the services. As a grandparent, my heart goes out to the families of autistic children who are working to procure potentially beneficial services such as behavioral modification. But these are not health care services, and the solution is not to burden already straining health care budgets with the costs of intensive educational interventions best delivered in schools or at home.

Certainly it's not only the potential needs for therapy of children on the autism spectrum that are driving up health care costs. While it would be great if school districts could provide all the necessary therapies and services for children on the spectrum, most do not. Some parents have been able to work out a combination of services from school districts and insurance companies. We've been able to find a school district that provides ABA for Charlie at school and some parent training at home, but this is hardly the norm.

For Charlie, learning is directly connected to being "well."

Riding a bike has, there is no question, improved Charlie's quality of life. I guess that might seem a rather odd statement to make but it is very true. Aside from the obvious benefits of exercise, and fitness, bike riding has given Charlie a kind of freedom that he rarely is in the position to have, due to the extent of his needs. As he's 12 now, he'd be able to drive in just four years here in the US, but becoming a "student driver" is something Charlie is most definitely not going to do. He'll have to rely on Jim and me or someone driving him places, or on public transportation, or on his own two feet. He's not able to go on a bike ride by himself, but I know from Charlie's face when he's whizzing down the street with Jim behind that he knows the thrill that he can get places by himself.

And that knowledge (and the aerobic exercise) help Charlie tremendously, in terms of his health of course, but also in his learning, his sense of himself---his self-esteem. And (in a most likely unscientific way) that adds up to him doing well, in whatever setting.

Alain Enthoven writes that "as a grandparent, my heart goes out to the families of autistic children who are working to procure potentially beneficial services such as behavioral modification," but his singling out those very families as somehow improperly seeking insurance coverage for their children makes his statement ring more than a bit hollow. Far from "straining health care budgets," providing insurance coverage for children on the spectrum can help them be well, be healthy and----one more than hopes---have a good life and the life that they---that my son---more than deserves.