Hundreds marched on Queen’s Park yesterday to protest proposed cuts to Autism funding.

Stories and signage suggest that many protesters had children with severe illness. Paediatric disease moves us, as it should.

Compassion for autistic children fuelled the march but was that the only motivation?

Autism

Rates of autism continue to rise.

In 2017,  1 in 42 boys and 1 in 189 girls in the USA had autism.  Whereas in 1966, experts estimated the rate at 1:2500, probably severe cases only.

In 1987, the DSM expanded autism criteria to identify more subtle patients. And in 2006, the American Academy of Paediatrics advised to screen all children between 18-24 months of age for autism.

Last year, one study reported that between 1 in 65 to 1 in 88 children have the condition.

A former president of the Royal College of Psychiatrists in the UK caused a fracas when he said that parents seek a diagnosis of autism as an excuse for bad parenting.  Parental failure created the autism epidemic.

The Royal College of Psychiatry quickly denounced the article. Autism was not over-diagnosed.

Secondary Gain

Everyone benefits from a diagnosis of Autism. Continue reading “Autism, Secondary Gain, and Rationing”

Imagine your first car. Your paper route pays for gas. Your parents pay for insurance. Without parental co-funding, you would be riding your bicycle.

Every country in the world, except Canada, uses some element of private funding to keep its medical system on the road.

Every country pays for doctors and hospitals using a mix of tax dollars, through government, and private money, through insurance or cash payments. Most developed countries outperform Canada.

Obsessed With Australia

Medicare activists use Australia in almost every presentation, article, and conversation about healthcare. Australia is their poster child for how private funding fails.

Here is the argument:

Australian medicare lags behind Canadian medicare.

Australia allows private funding.

Therefore, Canadian medicare would deteriorate with private funding.

It is a bit like saying: Cancer can cause baldness. Jack is bald. Therefore, Jack has cancer.

But the argument often emphasizes a change in performance also: Continue reading “Obsessed With Australia — Private Funding For Healthcare”

Cream skimming triggers many doctors and all single-payer activists. It might be one of the most hated, uncollegial behaviours in medicine.

No one likes a colleague who takes all the easy patients and leaves the hard ones.

No one likes the idea of for-profit hospitals skimming all the easy cases and leaving the hardest ones for the public hospitals.

Why Cream Skimming?

Cream skimming exists because some patients are hard and others easy, even though each patient often carries the same fee. On top of that, some easy medical problems carry higher fees than harder ones.

For example, a toddler with a tiny laceration generates a visit fee plus a suture fee. It takes a few minutes to fix. Toddler leaves with a sucker in one hand, a wave in the other, and a huge smile on her face.

A weak and dizzy 80 year old with 6 non-English-speaking relatives often generates the same visit fee as the toddler, minus the suture fee. No smiles, suckers or happy parents.

It happens in all specialities. Cream exists: Some patients carry less risk, pay more, and require fewer brain cells to see.

Path to Incompetence

Committed cream skimmers cannot exist for long. No one became muscular by doing easy things. Easy guarantees mediocrity at best.

Cream skimming is the path to flabbiness in medicine. Doctors get mad at  colleagues who “scoop all the easy patients.”

Doctors think that cream skimmers get ahead. Continue reading “Cream Skimming — Do We Need a Trigger Warning?”