This WSJ article illustrates the type of analysis that we should all expect to have to understand as coverage for ABA moves into the mainstream of private insurance coverage and then, theoretically, becomes the responsibility of some national health insurance plan to cover.
Will Congress and state legislatures be as willing to bear the burden of the costs of 1:1 ABA, for example, as they are to institute the loss-spreading accomplished by private insurance coverage statutes? Here in NJ, the state legislature has examined the cost to the state in terms of increased costs for state insurance programs. Of interest to this part of the debate, there is this sentence:
The OLS notes that it may be reasonable to assume that long term societal benefits are generated from providing the treatment mandated by the bill because there is a higher probability that children who receive treatment will be able to integrate into society and thereby reduce future social and economic costs. While there may be societal benefits over time, the costs of this bill would be incurred by the SHBP/SEHBP and other insurers.
This allocation of resources, from tax revenues (or private insurers) through service providers and then back to society as a whole is the sort of judgment we expect legislatures to make, with a general societal preference for making good long-term decisions (which is why we allow our municipalities to raise money for capital projects but dislike unbalanced budgets over the short term).
We, as a community, need to develop a deeper appreciation for the value, not the cost, of the services we provide for our children and adults with ASD and for those services we ask others to support. Those families who use services other than ABA will likely need to press for more evidence of efficacy. Even if parents satisfy themselves on efficacy enough to choose some intervention/treatment method, they will have to expect that third-party providers, whether insurance companies or state/federal health agencies, will look for more explicit and defensible calculations of value.
In the end, we will all be better off with more information about benefits delivered by the interventions we choose. Legitimate scientists care more about good process and reproducible/reliable results than in being “right” about a hypothesis. We should all aspire to that goal when it comes to choosing and defending interventions and treatments.