Wednesday, November 24, 2004

Autism ruling sound; now the province should pay up

VICTORIA - OK, the province doesn't have to pay for treatment that could save autistic children from disastrous lives.
But it should.
The Supreme Court of Canada disappointed parents who hoped it would uphold B.C. court decisions requiring the provincial government to pay for intensive treatment for their autistic children.
The charter of rights and freedoms doesn't guarantee that Canadians will receive the health care they need, the court ruled, only that the provinces will provide core services - the things doctors do, and the care offered by hospitals. Other treatments are optional, and the province's right to say no will be increased if the treatment is new or controversial.
Painful for the families, who say that if their children had cancer they would get treatment without question.
But the ruling is realistic. Governments are elected to make decisions on how much money should be spent, and on what. The charter, and in this case the Canada Health Act, offer minimum guarantees and bar discrimination, but the politicians retain much of the power.
However their exercise of that power should reflect our will, and most British Columbians would support the parents' push for treatment on the grounds of both compassion and common sense.
The parents of four infants diagnosed with autism argued in this case that the government should pay for Lovaas therapy for autistic children, a program that requires intense one-on-one work and costs $45,000 to $60,000 a year. The government will now provide a maximum of $20,000 per year for treatment for children under six. Parents can either scrape up the rest of the money, or accept lesser care.
The therapy was controversial when the court case began under the NDP government, but B.C. courts found that in "some cases" it could produce "significant results."
For a parent, that's enough. Autism remains a baffling syndrome, one that too often locks its victims behind walls, unable to communicate with other people or form relationships, shunned because of odd behaviour. What we do know, the Supreme Court noted, is that 90 percent of untreated autistic children end up in group homes or other residential facilities.
That's not something you or I want for our children. And it is not something, that as a society, we wish upon other people's children.
It's also not something that makes any kind of business sense. The therapy costs about the same, per year, as residential care. A half-dozen years of treatment can head off decades of costly care. The right, and smart, thing to do is to help families help their children when it can make the most difference.
The Liberals used to think that too. About a year before the election Linda Reid - now the junior minister for early childhood development, then the children and families critic - said the province should be paying for the Lovaas therapy if families find it to be the most effective treatment.
"It doesn't work for every child," she said at an autism conference. "In the view of the opposition this has to be a choice for families.'' The NDP - which began the court fight against having to provide the care - was dithering while children and families suffered, Reid said.
None of this is simple. Governments have to choose among competing priorities all the time. Attorney General Geoff Plant says the therapy could cost $250 million a year, instead of the $30 million now spent on autism treatment for about 2,600 children. (Parents put the extra cost much lower, under $100 million.)
But if the treatment could save thousands of children from a difficult and costly life it seems a bargain - just as the Liberals used to argue.
The Supreme Court ruling does reinforce an important principle. We elect governments to make choices about what is important to us as a society, balancing our priorities and concerns.
That's their job, not the courts, and it's a reminder of why politics should matter to us all.
Footnote: The Supreme Court is still weighing an even more critical case about government's obligations. A Quebec man is challenging that province's failure to deliver basic medical care in a timely fashion. The ruling could tilt the health care debate in a whole new direction.

1 comment:

deaner said...

I have trouble understanding Mr Plant's cost estimates. If there are 2,600 children eligible for the treatment, and it costs "from $45,000 to $60,000 per year" that comes to $117M to $156M. The government says that they are spending $30M now, on 2,600 children - that's an average of $11,500 per child (roughly). If they are proposing an increase in the maximum amount they will pay to $20,000 per child, that implies a cost increase from $30M to $52M. The incremental cost of the Lovaas treatment is then the difference between the $156M maximum estimate for the Lovaas treatemnt and the $52M the government is now planning to provide. Call it $100M net. Where does our man Geoff come up with over $250M gross - and presumably $220M net, since he in only quoted as comparing to the "current $30M spending?"

All that being said, I am not sure that we should be publicly funding the Lovaas treatment - but it would at least be nice to have more plausible figures to base our decisions on, wouldn't it?