Doug Grow -- "Government's largesse exposes small hypocrisy" Response -- Political opportunism reveals moral hypocrisy

I wish I could be so confidently righteous about condemning Doug Grow’s Star Tribune column on the use of state funds to treat autistic kids as are some on the right side of the blogosphere. Yes, I agree that Grow definitely takes the low road, but partisan and vulgar motives don’t necessarily invalidate a person‘s position.

Grow’s column is based on stories in the Star Tribune about controversies surrounding the Minnesota Autism Center. Ron Carey, recently elected chairman of the Republican Party of Minnesota and vice-chairman of the Minnesota Autism Center board of directors has an autistic son that receives treatment through the Center. The Center receives funding from public sources. Behavioral therapy as provided by the Center can run to more than $100,000 year.

“It's so easy to have a philosophy,” writes Grow. “But so hard to live it.”

Yes, living a philosophy is hard and often presents conflicts. Grow’s philosophy reflected in his column would seem to be "C'est la vie" -- principles are not meant to be taken all that seriously -- unless there‘s a political point to be made.

Take the case of Ron Carey, who became chairman of the Republican Party of Minnesota in June because many party activists feared that Gov. Tim (No New Taxes) Pawlenty was becoming too big a spender.

Philosophically, Carey is very conservative on the issue of government spending.

But then there's life. . . .

[I]sn't there a conflict between Carey, the leader of a party so resistant to government spending, and Carey, the parent of a child who benefits from public spending?

I can’t speak for Mr. Carey, but I can speak for myself, and the answer is “Yes, Grow is right -- there is conflict.” And as a conservative that believes in principle, I cannot dismiss that conflict with Grow's flippant “se la vie“ attitude nor counter with the obvious statement that Grow is being an ass. The conflict needs to be addressed, not merely deflected because Grow’s motives are less than honorable. And it can be addressed.

By way of background and full disclosure, I was recently asked (and accepted the invitation) to join the board of the Minnesota Autism Center as part of a reorganization of the Center’s board. Having been an outspoken critic of government spending, that I've joined the board after the issues raised by the Strib were resolved and that I don’t have any personal connection to autism doesn’t exclude me from Grow’s criticism. If Carey is being hypocritical, then so am I.

I take Grow’s column personally. Wrestling with the notion of public funding of the Autism Center was no idle task for me. And I can make all the rationalizations that others have and more.

Grow fails to the mention that the funds follow children served by the Autism Center. Autistic children are “disabled Americans” and qualify for Medical Assistance; Medical Assistance is not provided to the Autism Center or any other service provider that provides treatments for other disabilities. Medical Assistance is made available to families for approved treatments regardless of affliction. This assistance is neither autism specific, nor Minnesota Autism Center specific.

Grow also fails to note that parents make a co-payment to the state when they receive Medical Assistance funds. The co-payment is on a sliding scale based on ability to pay. Although Carey is certainly getting a good value in service for his co-payment dollar, his family‘s co-pay is 12.5 percent of family income. That is on top of the standard tax rate paid by all Minnesotans and does not include what it might cost to raise and care for an autistic child outside of therapy service provided by the Autism Center.

The point is, providing even minimal care for an autistic child can be financially devastating for any family regardless of income level. As noted later, the fact that anybody can be victimized by the consequences of a health issue is one neutral criteria that necessitates government intervention and elevates individual health issues to “public health“ issues.

Nonetheless, at the end of the day, Grow implies that the issue still seems to come down to the state collecting taxes from the many to benefit the few -- what Grow would have people believe is that is a hypocritical position for a fiscal conservative to hold.

So how can I justify serving on the board of the Minnesota Autism Center?

In a perfect world the Minnesota Autism Center would be funded entirely from private sources and donations. It’s not a perfect world, but that is the direction the Center is moving. Grow erroneously states the Autism Center receives about 70 percent of its funding from public sources. That was true in in 2003. The Center’s 2004 990 filing shows government revenue down to 59 percent of total funds as the burden of payments shifts to private insurers.

In fact, Carey sued his own insurance company, joined by the State of Minnesota, in an attempt to force it to cover his son‘s ABA costs, rather than put the burden on taxpayers. As a result, Carey’s insurance company did reimburse the state six figures for treatments paid through Medical Assistance although future therapy will be paid by public funds.

Challenging private insurers is a start to move away from government funding, but it’s still not a perfect world. Conservatives still need to meet Grow’s challenge. “Isn’t there a conflict?” The answer to that challenge is not found questioning Grow’s obvious partisan motives; it’s found by applying conservative principles to the underlying question of when do multiple individual health issues rise to the level of a public health issue that necessitates government intervention and does funding therapy for autistic children meet that standard.

I have long argued in the case of smoking bans that government requires neutral criteria before passing “public health” legislation. Without criteria there is virtually no limit on what government might regulate. The same criteria-based approach, if not the same criteria, can be applied in funding situations as well.

These are the criteria that figured into my decision to accept a position on the Minnesota Autism Center board, and which I believe justify Medical Assistance funding for autism therapy.

First, Medical Assistance pays for therapy received by the child. It is not given to the Minnesota Autism Center to set up its infrastructure and provide operation and cash flow funding. The Center receives funds based on the number of children that voluntarily enter its programs. The Center must be run both efficiently and effectively like any business. If it doesn’t provide service, it won’t draw clients, and it doesn’t receive funding. It can fail.

This criteria is in sharp contrast to many government programs that Grow might favor where funds flow to the provider and there is no correlation between funds and outcome. They are not allowed to fail, no matter how poorly they perform. In fact, as is the case with public education, the worse an organization performs, the more funds it demands and the more funds it receives. The incentive is to fail.

Second, Medical Assistance is not exclusive to the Minnesota Autism Center or to autism. Parents are eligible to treat their autistic children in other programs by other providers. Medical Assistance covers a broad range of childhood disabilities. There is competition for funds, which ensures that the Autism Center provides real service. As far as the Autism Center is concerned, the funds are not an entitlement; they are earned. Ultimate evaluation rests with the Autism Center’s customers -- parents of autistic children.

Third, there is no political partisanship involved in the funding. Although many of the Autism Center’s board members are Republicans, the program targets families, not the Autism Center. Autism targets neither Democrats or Republicans. Therapy does not benefit the children of Democrats of Republicans based on party affiliation.

That contrasts with many government programs that are clearly established for political benefit by serving one party’s or the other’s favored constituency. Here, that is not the case. Anyone can have autism strike his family; anyone can benefit from the program.

Fourth, to Carey’s point that “a dollar spent on therapy saves $10 down the line,” there is a large neighborhood effect, if you will, from Medical Assistance for autistic children. Carey notes (and this is typical for children in therapy) that due to progress resulting from therapy, the cost to taxpayers for his son’s treatment will decrease 80 percent from 2004 to 2006. As a result of therapy, a day will come when his son contributes to the tax base rather than taking from it. That outcome is visible and can be tracked.

Like public education, treating autism has a residual value to society as a whole. Think of it as more intensive public education in the broadest sense of public education -- education in the public interest. As mentioned before, however, unlike public education there is parental choice and the Minnesota Autism Center is ultimately accountable to its customers for the outcomes it achieves or fails to achieve.

Do my rationale completely obliterate Grow’s points? Maybe not, but they do start us down the road on a path for justifying public expenditures in vague areas of government legitimacy like healthcare funding. They do affirm that philosophy and values matter and that even the smallest conflict ought to be addressed. Conservatives do not give up on questions just because they are difficult.

Grow’s comment that “It's so easy to have a philosophy, but so hard to live it,” expresses the false logic that, ergo the philosophy must be wrong or unimportant. It’s that logic that enables people on the left to subscribe to relative values and a rejection of objective truth. Living consistent is difficult, and Grow’s implication is that it simply isn’t worth the effort.

Grow criticizes Carey and by implication me for struggling with the idea of government providing funding to provide therapy for autistic children while his notion of a liberal moral dilemma is an environmentalist driving a pick-up truck. I suggest those two moral conflicts are not quite on the same scale of significance.

Conservatives ought to embrace conflict between philosophy and practice as the opportunity to examine and reaffirm what they believe in. By simply taking umbrage with Grow’s below the belt tactics, conservatives miss that opportunity. Conservatives can do better.

Disclaimer -- This post represents my personal views and my reasons for accepting a position on the board of the Minnesota Autism Center. Neither in total nor in part does this post necessarily represent the views of the Minnesota Autism Center board or any individual member of that board. The views expressed herein are entirely mine.

Category: Autism, Public Health