Too Expensive

[Guest guest]

A Mom wrote this commentary in the Schafer Report. I thought she expressed

herself and the situation well. So I'm passing it along.

Rose

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COMMENTARY

" Because It's Too Expensive "

By Tiesenga

When I read recently about an insurance industry lobbyist in South

Carolina stating, as the rationale for denying behavioral therapy coverage

for autism, " because it's too expensive " , I was simply stunned.

The arguments that insurance companies have been using forever and a

day to deny coverage are, alternatively, that behavioral therapy is

" educational " in nature, " provided by law by public school systems " , or

" experimental " . But expensive? Since when has that been a valid reason for

denying coverage of an efficacious treatment for a severe medical issue?

Every major medical condition is expensive to treat! Every one. Cancer,

AIDs, diabetes, MS, autoimmune disorders, heart disease, Alzheimer's, trauma

care, multiple organ failure--you name it.

Last year, my physician-father fell on the ice walking into a hospital

where he was to perform surgery. He broke his hip and elbow-badly-and ended

up in surgery himself, with complications, and then more complications. He

ended up in intensive care for an extended period of time, and then in a

rehab hospital for another lengthy stint. In two months my father's care

managed to gobble up the same amount of money that it cost our family for

over 3 years of intensive 1:1 ABA therapy for my now previously-autistic

son.

Who paid for my father's care? I did. You did. And both you and I

pay for every major medical problem through our taxes and health insurance

premiums. We pay for cousin 's breast cancer surgery and chemo, Aunt

Elsie's kidney transplant, our neighbor's trauma surgery after the head-on

collision, and the endless succession of new pharmaceutical agents used to

treat nearly every malady known to man-many with Mercedes class price tags

and/or of limited efficacy.

A beautiful little girl in our town was diagnosed with an aggressive,

late stage cancer a few years back. She was not taken to just one

world-class cancer center, but three, with the whole town cheering her on.

She was given a grim prognosis, but we all prayed for a miracle anyway, and

everyone in our town paid for her care (again, through their medical

insurance premiums and tax dollars)--gladly, I might add, with no one

questioning for a second how " expensive " it was.

Ahhh, and who paid for my son's care? Did we all help with that too?

Nope. That was all on us -- and inexplicably so. The science behind ABA is

now so old and so solid, and both the partial and complete rates of response

so impressive, that my drug-developer husband informs me that, if a drug, it

would surely be among the greatest " blockbusters " of all time, with

reimbursement assured. It is a sad commentary, that in the absence of

pharma lobbyists to get the job done, the medical professional organizations

such as the AAP and AMA, along with our public health establishment, have

not managed to convince the appropriate authorities and organizations to

provide coverage for this care.

The result has been beyond tragic, and is multi-dimensional. Families

have no choice but to go it alone and are gutted financially. Most don't

even come close to providing their child with the amount and quality of

therapy associated with good outcomes. The appropriate government and

educational infrastructures around training and funding the therapy fail to

develop or develop dysfunctionally, resulting in a vast undersupply of

therapists, in turn driving prices up and quality down. The physical and

emotional stress associated with both running and funding effective

programming is crushing and unrelenting. Virtually everyone runs out of

money at some point, divorce is rampant, and, most tragically, many children

who could have gotten better don't.

What the expense argument is really all about is the effective

rationing of healthcare in this country, based on cost. If we've come to

the point of needing to ration medical care, fine, let's have an honest

discussion about it, because using virtually any criteria upon which to

limit care, ABA would land at near the top of the heap of things to cover,

not deny. Behavioral therapy is astonishingly effective, and even more

astonishingly cost effective. My son, the one they told me to put in an

institution, who is now in a regular kindergarten, is living proof. And

please, don't tell me he wasn't worth it.