Welcome to the Cato podcast. I'm Ryan Bourne, Cato's R. Evan Scharf Chair for the

public understanding of economics. Autism diagnoses in the United States have risen sharply over

recent decades, and so has Medicaid spending on therapies

tied to them. But how much of that actually reflects a growth in the number of children with

severe, genuinely disabling autism, and how much reflects looser diagnostic boundaries, distorted

payment incentives, and weak oversight that invite waste and abuse? To discuss this, and whether this is just the tip of the iceberg of medical misdiagnosis

or overdiagnosis more generally, today I'm joined by Jeffrey Singer, a senior fellow

in Cato's Department of Health Policy Studies.

Good morning.

And Adam Omory, making his, I believe his debut on the podcast today, a research fellow at the

Kato Institute Center for Global Liberty and Prosperity. Debutu Kato Podcast. Thanks for having me.

So Adam, let's start with you, given this is your debut. If somebody were to just briefly ask you,

what actually is autism or what is the kind of medical definition

of autism that we're trying to get out? I mean, how would you describe it?

Autism is a rare genetic psychiatric disorder characterized by social impairments, excessive, repetitive behaviors, and now we frame it as

autism spectrum disorder.

We see everything from, in severe cases, nonverbal children or adults who need constant care

to what we would now consider more mild autism spectrum cases, as in high functioning, but exhibits

social difficulties.

So there's been a well-documented increase in autism diagnosis numbers in recent decades,

and that's got plenty of people worried.

In a piece that you wrote for the Washington Post,

...