You can see why the Ford government wants to make changes to the province’s autism program: get a handle on expenses and introduce some cost-certainty into the mix.

Likewise, you can also see why the government wants to frame this as a win, claiming it’s dealing with a backlog of some 23,000 kids waiting for treatment.

The latter is something of a pipedream, and the backlash may make it impossible to stick with current budget forecasts.

Changes to Ontario’s autism program may in fact reduce the waitlist, but critics note that comes at the expense of those already undergoing therapy, essentially divvying up a pie many say is already too small. The plan would put a cap on per-person spending, which provides some known quantities to the government, but which transfers more of the burden to the families involved.

When it comes to policies involving people’s children, the government is in a no-win situation. Dealing with things in a ham-handed fashion was optional, however.

Given that therapy costs can be upwards of $80,000 a year for children with severe autism, there’s no way the province can foot the entire bill for full-service treatment – there are some 100,000 Ontarians with autism spectrum disorder, and even just accounting for the 23,000 children on the waiting list, the math is hard to overcome. Clearly, tradeoffs have to be made.

What the government can do without any reservations is be more forthright about the situation. Minister of Children, Community, and Social Services Lisa MacLeod has been at the centre of controversy involving allegations of coercing those in the field to endorse the government plan and concerns that the changes could spill over into the school system. Neither she nor Doug Ford is handling the public relations snafu with particular grace.

At the root of the issue, however, is the undeniable divide between the cost of healthcare – the province has much bigger fish to fry on that front – and the demand for services.

Healthcare is the province’s single-largest expenditure, with the 2018 budget setting aside $61.3 billion, or 38.7 per cent of the $158.5 billion total.

The government has tried to slow the pace of spending increases, disingenuously called cuts by those with a vested interest in taking more.

To date, there have been no real cuts, however. Over many years, health care costs rose six or seven per cent annually. In more recent budgets, the government has tried to keep that in the two per cent range, still double the inflation rate some years.

Prior to Ford’s arrival, the Liberal budgets offered the usual vague language about efficiencies and new funding models, but few details. The fact is, health care spending has been outstripping inflation and economic growth for years, an unsustainable situation.

Whatever the provincial government comes up with next, however, will only be tinkering at the margins.

Despite some bluster, Doug Ford has no stomach for the conversation that’s really needed. Some will argue that the system shouldn’t be rationing services like that, perhaps deciding who lives and who dies. Fact is, however, that we already do that. There are waiting lists, it can take ages to see specialists and patients are prioritized based on their conditions.

Unable to make basic cuts, the government is certainly not going to consider, let alone make the tough decisions. Much easier to keep on spending, putting off the issue until the crunch comes … ideally long after someone else is in office.

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