Thursday, February 25, 2010

Politics and Reality

Here in Canada there has been some push from parents to adopt a "National Strategy for Autism", including a group of people who want to guarantee autism treatments in the Canada Health Act.  For those who are unaware, the Canada Health Act is federal legislation in Canada that sets minimal standards for health care.  Although the federal government does not have the constitutional jurisdiction to do this, they enforce the legislation by fining provinces who do not comply (i.e., withholding transfer dollars).  This generally seems to work and upholds the illusion that Canada's health care system is the same no matter where you go within the country.

With all due respect to my fellow parents in the autism trenches, making this change will do diddly squat for any of us.  It is simply not true that medical care is the same in one province as it is in another.  Waiting times for procedures vary widely across the nation and even across provinces.  Or look at optometry.  Once this service was covered in Ontario for everyone.  Now it's till you're 19, unless you have a specific condition, and then it is covered.  In Saskatchewan it's till you're 18, but if you are receiving other assistance from the government it is covered.  In Manitoba you get an eye exam if you are over 65 every two years; in Ontario it's annually.

The reality is that mandating that provincial governments fund treatments says nothing of how much is covered or how long you have to wait for those services.

In Ontario, autism funding goes through the ministry of youth and child services.  If it is mandated that autism is funded by medicare, that program will move to health.  And it would stay exactly the same.  The flaw is in timely access, and putting something in the Canada Health Act will never change that.  We see this everyday with existing services.

For those who think the federal government should fund autism treatments, consider this:
  1. All governments get their real money through taxes.
  2. You pay taxes to both levels of government.
  3. Asking the federal government to fund autism treatments is just pushing soap around the tub, you are still paying for it.
  4. Any province can opt-out of any national program and continue to do things their own way - the federal government cannot ensure national standards in health.  Any wording in the Canada Health Act would be so vague every province would already meet the criteria.
  5. The only way the federal government can effectively intervene is to directly fund the treatments via money to parents, tax incentives, or transfers to agencies using its spending powers, something unlikely given our current political climate.
The primary problem is one of spending priorities.  In other words, it's money.  How much should governments spend on autism treatments?  Federal or provincial, it's still the same question. 

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