President Barack Obama has introduced a concept into the U.S. health-care debate that "no one should go bankrupt because they got sick."

Most Canadians listen to this rhetoric and smile, secure in the knowledge that for them this issue was solved a long time ago. But for some Canadians this platitude is as relevant as it is to their American cousins. They are going broke in the land of universal health care because someone in their family is sick.

My family and I moved to the United States a year ago, following employment opportunities that promptly vanished like spring flowers in the blizzard of the financial system meltdown.

Left precariously clinging to tenuous health-care insurance, we received an involuntary crash course in the very insecurities of being American that fuel the current U.S. health-care debate. Yet financially, when we balance our chequebook every month, we feel we are more secure and less likely to fail than we were before we left Canada.

How can this be? Well, we have a daughter with autism, a disorder that now strikes at least one in 100 children, seemingly at random. It cannot be tested for or prevented. Autism can prevent children from learning how to communicate, to socialize, to control their own body movements and functions.

Behavioural therapy is the only proven and effective treatment. In Canada, this therapy is provided by a patchwork quilt of provincial programs, all of which are resource constrained.

Rationing of care is the result. In Ontario, where we used to live, children proceed unpredictably from wait list to therapy, sometimes never actually receiving any help at all. Once they reach school age, they are dumped into a system that actually prevents their trained therapists from helping them to learn by barring them from the school building.

In this situation, many Canadian parents empty pocketbooks, mortgage houses and exhaust the kindness of relatives in a scramble to personally provide the behavioural therapy that helps to unlock the minds of their children from their uncooperative bodies. A disproportionate number live below the poverty line. Some go bankrupt.

It is hardly a glowing example of the universal care Canadians so smugly proclaim to their American cousins.

But wait. Now we are the American cousins. What a difference this makes. Before school started, our daughter received a complete program of scientifically validated behavioural therapy, arranged by the state of Pennsylvania, with no mentions of wait lists, benchmarked cut-offs or payment. Now in kindergarten, she receives in-school services and support from therapists with the same training as those who are barred from schools in Ontario.

How can these outcomes be so different for the same child when the clinical diagnosis used as a basis for the provisioning of services is precisely the same? I believe the answer lies in the very basis of our two societies.

Canada is founded on principles of peace, order and good government.

In Ontario, this translates into a benchmarks program that will withdraw therapeutic services from children with autism who do not show a sufficiently timely response to therapy. It is apparently a bureaucratic issue of the proper management of government spending.

If presented with a young Helen Keller, one wonders whether Ontario government-provided therapy services would be withdrawn. Would Keller ever have achieved her eureka moment if, instead of persistently holding Keller's hand under the pump, her therapist had been told to move on to another child with a more visible return on therapeutic investment?

The recent media coming-out party of Carly Fleischmann, who showed mixed indications of therapeutic progress for almost 10 years before flowering into a fearsomely articulate advocate for autistic children, is a local and compelling embodiment of the argument that this management-efficiency approach to providing autism services is misguided.

Counterintuitively, things are different in the United States. A nation founded upon the principles of life, liberty and the pursuit of happiness brings a persistent faith in the individual to the question of how to provide for autistic children. A simple trip of a moving truck has transformed the status of our daughter from that of an inconvenient provincial liability to that of a valued citizen with the right to demand assistance in her essential pursuit of happiness.

In Pennsylvania, her very existence demands that supports be provided, with the full force of the law and court system standing behind her.

These differences in the approach to the treatment of autistic children between our two nations call out the fact that the Canadian system is not the perfectly formed jewel it is often made out to be in comparison with the American system.

Families with children with autism should not go bankrupt. But in Ontario and other Canadian provinces, many do.

By allowing such bankruptcies to occur, policy at both the federal and provincial level reveals a hole in the safety net large enough for entire families to fall through.

It is a hole that America apparently started to patch up some time ago. Canadians have some work to do on their own safety net where it concerns helping and supporting children with autism and their families. There is no time like the present for that work to get started.





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Malcolm Stanley advises telecommunications companies on product and service strategies. He currently lives with his family near Philadelphia.

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