This essay discusses the way we pay for autism, from a marxist perspective. It goes into economic reasons that certain people are disabled from participation in the economy, some models of redistribution of money, the kinds of incentives that affect behavior in each of those models, the complexities of insurance as a redistribution model, and what to do about it. I’m starting with economics background to frame disability. Even though it is probably too long and thick, I hope you will read it and discover a completely different take on costs of disability than the conventional wisdom.
1. Efficiency and exclusion from the workforce
The very rich and very poor live off the work of others, as do the old and young, all those whose work is undoing the work of others, and all those who are disabled in the quest for employment. Various wealth redistribution systems exist to maintain the imbalances, and those systems constitute the livelihood of the majority; actual economic productivity is relatively uncommon. For every one person doing economically productive work like growing food, installing windows, or teaching children, there are several operating within the economy, but just doing paperwork or fighting over money and attention, the result of which meets no actual human needs. The more efficiently industrial production is accomplished, the more inefficiency we create on purpose to soak up the excess time. So far, we are seeing advanced capitalism playing out as Marx predicted.
There was a time when we could not afford to exclude people from the workforce: people who were too weak to plow fields were still needed for other things, and generally speaking, if you could not do one thing, you could probably do something else. There was no retirement and no adolescence. With gains in efficiency, however, we can now afford to be idle; or looked at another way, we can now afford to exclude the old and young from the workforce. As efficiency marches on, we are not using the gains to better meet the needs of everyone; in fact we just become more competitive and we concentrate the wealth more, creating a large chronic underclass with no means to provide for their own needs.
Advanced capitalism therefore has two opposing effects: increasing efficiency, which tends to exclude an ever greater portion of people from the workforce; and increasing inefficiency which tends to concentrate wealth. Both opposites operate together. For example, in the food production chain, the actual farming, transport and delivery of food becomes more labor efficient over time, and the resulting wealth is distributed in the sense that the people doing that work are all getting paid and the consumer is getting a necessary product for less money over time. But there is also a growing workforce in the areas of food patents, genetic engineering, marketing and legal sectors, who are all working exclusively for the owners of the food production chain in order to increase the owner’s advantage and increase their assets, and has no benefit to others.
Adolescence and retirement were invented concepts at one time, which served the progress of capitalism by ejecting people who were no longer needed for industrial and agricultural production, and at the same time, creating a dependent class with a redistribution system around them. We now have vast budgets for schooling and social security, and whole sectors of the economy dedicated to wealth redistributing and otherwise providing for the young and old, who either may not work or cannot compete against a narrowing class of employable people. I’m not making the case that the old way is better than the new way, or vice versa, but just that a class of people have become recipients who were once contributors.
This historical pattern has not stopped with age-exclusion; capitalism demands that we continually invent new categories of exclusion, expand the pool of people who are non-productive beneficiaries, and build a distribution system for these new categories. I’m looking at disability in this context: a class of non-worker with a distribution system surrounding it to allocate money to that class. Disability is a lot of things, but this essay is only about disability in that particular economic sense.
2. Why am I writing this?
As an autistic person, I’m focusing mainly on the redistribution system we are building today to support the neurologically disabled – including autism, so-called attention deficits and other conditions of the mind that affect interpersonal relations. This dependent class is currently undergoing rapid expansion. This affects me greatly where I am in the economy. In the 20 years I’ve been in the workforce, a lot changed. I was not considered autistic before, under the older definition of autism. Earlier in my career my particular style of social communication was a disability, but not so major, in the sense that people would willingly pay me to do things in the information technology sphere. However, over the course of two decades, autism has expanded to engulf me: the definition changed to include people like me, and at the same time, I’ve been less able to compete in the market. As I write, I’m moving into more dependence on government programs for the disabled. It is important to see this not as any change in my objective value or ability to contribute, since I have actually become more skilled over time. It is rather a change in the economy: a new criterion is being used to filter out people from productive roles. Terms like “autism” probably stay roughly synchronized over time with the set of people who have fallen out of economic favor.
Star Ford 