this post was submitted on 02 May 2024
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Showerthoughts
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I don't know because I'm in the US, but does universal healthcare in other countries cover autism-related therapies and care such as ABA, occupational and speech at the rates recommend by docs (our docs recommended 20+ hours/week - or roughly the cost of $100k/year)? And is that factored into the equation?
I haven't seen the official modeling, just assumptions around the internet. But back of the napkin math suggests that appropriate autism care alone could be quite high: 1/36 of the 341,500,000 American residents have autism. Assuming 15% need care in the range of $100k, would be somewhere around $138b/year for just autism care. Does that seem in line with what you are thinking? Either way, are you able to point me to some of the modeling you have found? I'd love to learn more about how it tactically works.
Where’s your math coming from? There’s a ton of folks on the spectrum that don’t need assistance at all.
I just estimated that 15% need care. So that would leave a huge number that don't - you are right.
EDIT: A quick Internet search says that 82% of autistic adults want or get support, and only 16% are fully employed. 🤷
"Want to get support" is not the same as "need 20h of a specialists time each week"
You are right, which is why I used 15%, instead of 82%.
But what do you base those 15% on? Might as well be 1%, or even lower. In the end its just your own intuition, based on nothing. Hell, if they were capable of answering that survey, I don't think they'd need that much support.
Nothing, back of the napkin math for discussion purposes based on the 2 diagnosisea and doc recommendations we've gotten. Totally can adjust if you have a more accurate number.
Fyi ABA is considered highly unethical in the autism community.
Fair, take that piece out of the equation. Our docs still advised us on 20+ hours of therapy, all of which is costly.
I’m autistic and I don’t think I need twenty hours of therapy per week.
That sounds excessive to me.
Probably would be - age plays into it as well. My kids are pretty impacted - minimal language, safety issues, etc. I suspect it can vary widely.
I didn’t speak until I was 4 years old. Safety issues were handled by teaching me to swim, light campfires and bonfires and fireplace fires, use power tools, a little firearm safety, and how to interact with horses without getting kicked.
Mom knew I was a special kid, so she pushed me out the door a lot. Like she knew I was extremely different. I distinctly remember her and I sitting at the kitchen table, and her saying that if my face didn’t show emotion spontaneously I was just going to have to fake it to fit in because the world wasn’t going to work if I kept my wooden face.
I had a ridiculous temper. I fought (as in physically fought) my friends often. It always led to cathartic release and an improvement of our bond, which boy fights predictably do.
Sometimes I feel extremely fortunate to have grown up in the 1980s and not today. The way autistic kids are coddled today can be utterly inhumane. It instills in them a self image as a broken person who cannot fit in. That self image is far and away more damaging than autism.
Now, I know some people are unable to vocalize other than incoherent groaning at the age of twenty. I wasn’t that bad.
But among the kids who were enrolled in school, able to form sentences, I had it pretty bad and my little shithole town just treated me as “one of them weird kids”, and it worked out. Our cultures have had autistic people since the dawn of time; the expertise coming out of labs isn’t the only source of wisdom on how to help them lead good lives.
Your first mistake is to use US prices as if that's what the care actually costs.
20+ hours of anything is costly if you are paying the therapists appropriately. The issue is that their work is 1:1 and doesn't scale easily.
And?
Doesn't change the fact that US prices are orders of magnitude out of proportion. You simply can't use it as a yardstick.
Now, if you're looking at the plain amount of material, manufacturing, infrastructure, and labour required, then you're making sense.
But it seems you're making the argument that too many people cost more to care for than they are "worth" in terms of economics, and would be too great a burden on the productivity of the healthy for a universal healthcare system to function.
But that's not even close to true. Universal healthcare is essentially an attempt at triage on national scale. To apply resources where they do the most good.
In comparison, commercial market healthcare is just less efficient across the board. A universal system is able to provide more care for more people at less cost, even if it isn't able to do so for everyone in every situation.
No-one is claiming universal healthcare systems save everyone and care for every ailment, every time. The argument is that it's simply the smarter way to use the resources a country has.
So, you totally hit the nail on the head. I couldn't agree more: It is about maximizing resources for overall good. It is just that some groups may not see a qualitative difference in care.
I'm just doing some simple deductive reasoning. If a person who suffers from a disability receives life changing care and are able to rejoin the workforce you have taken someone who would otherwise cost tax payers and have added an income stream to the tax pool. Similarly you may provide care to people who aren't necessarily disabled but have no means to get a life changing diagnosis and medication which allows them to complete higher education.
For every person you take out of the prison system and put into the workforce you are freeing up resources while also creating resources.
Man, I wish the hundreds of thousands of dollars of care we got positioned my kids into the workforce. Our reality is that all that while the care did help and make their lives much better - it won't translate into productivity or self sufficiency. 🙁 I am super worried that will practically mean a universal healthcare system in the US limits disability care because it isn't deemed as having a good enough ROI.
Thats irrelevant. Your children will still receive care no matter what.
My kids are real life examples demonstrating that huge investment, while good for the individuals, does not reduce the cost or burden of them to society later in their life. And that very concept could risk society's willingness to pay for any disabled person's full care under universal healthcare.
You are making lots of false assumptions and I will assume it's intentional.
No, it is from unfortunate personal experience. Special needs families get the short end of the stick in a lot of ways - ours included. Feel free to IM me about it if you want specific anecdotes. After killing myself to get my kids what they need (navigating insurance denials, waiting lists for specialists, underfunded and confusing government programs, lack of childcare, hitting out of pocket maximums year after year, and taking jobs that leave me exhausted and with little family time to pay for it all), I have a huge defense mechanism for anything that sounds like it can quickly and easily solve this kind of situation - because I've been repeatedly shown it is a pipe dream. It doesn't mean UHC isn't a noble cause or the right way to go. But the reality is that it probably won't be much of a qualitative change for families like ours. And it is hard to hear that our experiences and fears are not valid.
I hear where you're coming from. I can't even begin to imagine how tired you are after all these hardships. The fact that you're still writing civil replies to the other person is commendable.
I would like to respectfully say that universal healthcare would have eliminated the need to navigate insurance denials and out of pocket maximums. If we add a more robust social safety net to the equation, you may also not have to worry about childcare and having to stretch yourself thin with work... Would eliminating these battles really not have brought qualitative changes (for the better) for your family?
Thanks for saying that. 🙂
EDIT: I responded in a way that was not helpful below and I've fixed it now...
I would tear off my right arm to have a robust enough safety net to take care of my kids adequately (and thanks to UHC in that situation, I would live thru it!).
This may come across as naïve, but I also wonder if the excision of all those "essential" layers of needless bureaucracy, might not free up some resources at a societal level to allow a more complete or holistic physical and mental health care system to emerge. After all we need to figure out something for the eye watering numbers of people who are employed directly or indirectly by the Insurance industries to do with their new found free time.
Hell, couple UHS with large scale tax reform and we might find that there are advantages at all levels of society to providing for people whatever their needs might be.
But then maybe I am a pathetic utopist who just needs to realise that Capitalism is simply the perfect structure for us all to live under.
You're the one making a lot of assumptions based on what was originally a shower thought. It's a nice thought but it's completely and utterly incorrect in reality.
This isn't an assumption, it's a data point that contradicts your hypothetical theory.
The fundamental flaw in your thinking is your assumption that treating mental illness and disabilities will result in the person becoming a productive member of society. This is occasionally true, but much more commonly, the treatment serves to alleviate the more severe symptoms of the condition, without actually curing or fixing the condition.
Healthcare is primarily about minimizing the damage and suffering caused by various physical and mental ailments. It can't magically transform people into something they're not.
How would a universal healthcare system exclude people?
I'm talking about net benefits. Obviously not everyone can be made whole but sorry for not explaining that in a showerthought.
As an autistic person my primary struggles are productivity and self sufficiency. What factors in their life got better if not those things?
My kids don't have full language capabilities, they struggle with fixations (which means learning has to be customized to their fixations or it won't happen), and they don't have enough situational awareness to be safe.
So, therapies are helpful in getting them enough language to have basic needs met (and minimize behavior issues), practicing doing things they don't prefer for short bursts and learning things like how to behave in a parking lot. We may never get to productivity or self sufficiency - we are focused on staying alive.