Mr. Graham:
I just read your August op-ed piece in the Philadelphia Business Journal regarding Pennsylvania's proposed autism mandate. I then visited your organization's website and saw this first paragraph in the "About" section:

"Now more than ever, it is vital that our policy responses are guided by the principles that best preserve the essence of America – its entrepreneurial spirit, belief in the dignity of individuals, and vigilant defense of liberty."

I help run a private program for children with autism. I believe the "entrepreneurial spirit" and "belief in the dignity of individuals" are terms that describe what we've accomplished with our kids very well. So well that many of our kids have made substantive gains, and a few graduated to regular education programs with very little support. As a life-long conservative, I have appropriated these same ideals - and that is precisely why I came up with the idea that would become HB 1150.

The "About" page also reads:
"Individuals are the real decision makers when it comes to their schools, health care, and environment."
If this is true, why create diagnostic exclusions that serve as barriers to individuals who want to make the vitally important decisions that affect the future wellbeing of loved ones diagnosed with autism?

Is it too much to ask a conservative think tank to do its homework? With two separate cost-benefit analyses completed in two states in the past 10 years, with three jurisdictions with autism insurance mandates - all more aggressive than Pennsylvania's - costing out at 1/2% to 1% in rate impact, with a per capita lifetime cost to taxpayers of $3.2 million if left untreated, and with a 20 year old therapeutic approach with no less than 10 comparison studies and hundreds upon hundreds of single-case experimental design studies published in peer-reviewed journals indicating that much of the $3.2 million dollar incremental per capita cost is an avoidable cost, I find it perplexing that anyone with access to such data could reach the conclusion that affording kids access to the health care they need is a bad thing.

Perhaps you did do your homework. Perhaps you've seen data I haven't. Perhaps I am completely off-base and should be corrected. If this happens to be the case, I want to know where I've gone wrong.

If you did not do your homework or seen data I haven't, and if I am not off-base, then I think a retraction of your op-ed piece is in order so that it does not impede a child sometime in the future from achieving his or her potential.

James N. Bouder, MPA
Chief Operating Officer
The Vista Foundation
1249 Cocoa Avenue
Hershey, PA 17033
717.835.0310
FAX: 717.835.0314
jbouder@thevistaschool.org

Mr. Bouder:

Thanks very much for taking the time to read my op-ed in the Philadelphia Business Journal, taking the effort to respond, and inviting me to clarify my position.

My op-ed neither challenges the research you cite nor does it “reach the conclusion that affording kids access to the health care they need is a bad thing.” In the first instance, as a general health policy analyst, I would hesitate to challenge the conclusions of those who specialize in autism. In the second instance, I expressed disappointment that, if autism advocates were so confident of their claims, they did not ask taxpayers to shoulder the burden instead of imposing a hidden cost on one industry and its customers. Your message, indicating that the treatment in question saves taxpayers money in the long run, confirms this perspective, and suggests that advocates were unwilling to subject the increased costs to “daylight”. Indeed, your e-mail message, which expresses anxiety that my op-ed might have some influence (unlikely given the legislative action), appears to be in the same vein.

Your case seems very convincing, and you are undoubtedly more aware than I that everyone who earns his or her livelihood from enlisting government power to command resources from private parties who do not voluntarily contribute to “the cause” can marshal equally impressive testimony. Furthermore, state legislators are laymen who are usually not able to critically assess expert claims. This tempts them to socialize costs, especially if they can hide them like your bill achieves. This has resulted in dozens of insurance mandates in every state. If each of them adds up to 0.5% or 1% of costs, it is easy to conclude that private health insurance is one third or so more expensive than it would be if insurers and beneficiaries were free to contract benefits voluntarily.

I regret that time does not permit me to engage deeper into dialogue with you, but I wish you and all those associated with your school continuing success in your valuable mission of educating autistic children.

Yours sincerely,

John R. Graham