What's Wrong With "Disability"? Part 1

Unfit For Work: The startling rise of Disability in America

Chana Jaffe-Walt, National Public Radio

I finally listened to this "This American Life" story on trends in Social Security Disability programs, and the series of shorter "All Things Considered" stories that basically repeat the same points in bite-sized pieces. My first reaction is that these programs aren't as terrible as I thought they would be. They include some valid observations. The problem is what the stories leave out.

Here are the main stories' main assertions:

* Starting in the 1990s, and continuing to today, the number of people on Social Security Disability programs has gone dramatically, despite factors that should have reduced the rate or at least made the rise less steep. So, something is clearly going on here!

* Without accusing anyone of outright fraud, the stories imply that lots of people on disability aren't really disabled, or if disabled, are in theory able to work.

* The stories suggest that most of these are people who can no longer do physical labor, and are not educated or socialized to make other kinds of work … "sit down" work or brain work … realistic for them.

* Since welfare reform in the '90s put a lifetime limit on benefits, disability has become a support system of last resort for people who for educational or social reasons can't find or keep jobs in today's economy ... whether or not they have bona fide disabilities.

* Some people other than the beneficiaries make money promoting this practice. Lawyers make money getting people on disability. States and counties shift welfare costs to the feds by getting people on disability. Private contractors are paid for every person they get enrolled in disability.

* On top of all this, people on disability are afraid to try working because working is less secure and certain, and they think working will cause them to lose their benefits. Some poor families depend on kids' disability benefits, and have mixed feelings about them doing well in school and eventually getting jobs.

* The program mostly blames a poorly designed system, not individuals. It's mostly sympathetic towards the individuals they profiled, even the ones who may in some way be "faking". At worst they are portrayed as uneducated, ignorant, and sad, not as evil or greedy.

That's what these radio programs are saying, as best I can tell.

Here is what I think the program got right:

* Having a disability and not being able to work are not the same thing, even though the disability program is based on the idea that disabled means unable to work. That does create a lot of contradictions and situations that can seem fishy or fraudulent.

* There are structural, systemic incentives for counties, states, social workers, doctors, and lawyers to put people on disability who maybe shouldn't be. Counties and states pay for welfare. The federal government pays for disability. So, states and counties have a financial incentive to get long-term unemployed people on disability. Meanwhile, they can continue taking credit for falling welfare rolls.

* A 50 year old logger with a high school diploma … or less … can't realistically expect to get a desk job in an office after they develop a back injury. The same goes for a nurse's assistant in a nursing home or someone who worked in a closed auto plant and just happens also to have diabetes. They may or may not be "disabled", but the definitely face major barriers to self sufficiency.

* I liked that they portrayed the issue as less an outrage than a dilemma.

What is missing from the story?

* There is no mention of Social Security Work Incentives and the Ticket To Work program. Social Security has components and programs designed to help people on disability get jobs and become more self-sufficient. That includes being able to work for pay and have benefits reduced somewhat, but not cut off. Most people can keep their Medicaid or Medicare, too. So, the disincentives are more perceived than real.

* There is nothing in the story about Vocational Rehabilitation, a program in every state specifically designed to help people with disabilities get jobs. True, their success rates are often disappointing, but they do exist and they can help counteract this trend.

* The story didn't mention a possibly similar set of incentives for public schools to put low-performing kids into Special Education. However, this probably calls for a whole separate show.

* There weren't enough reminders that some disabilities are invisible to others, but are quite real. People in the stories often said things like, "He doesn't look disabled". Just because someone doesn't "look disabled" doesn't mean they don't have disabilities.

* They don't talk to anyone with unambiguous, "classic" disabilities, like wheelchair users, people with cognitive impairments, blind, deaf, etc. They don't look at all at people with disabilities who do work, or are working hard to become employed. 

* They don't talk to any disability advocates, activists, or counselors in the nonprofit sphere. The story focuses in an unflattering way on the lawyers, the private-sector contractors, and somewhat on the doctors, but again, its as if there's nobody else in the disability world who might have honorable motives or a different perspective on "what's going on" with disability.

* It is also possible, and used to be very, very common, for people with really genuine disabilities to be improperly denied benefits, so some of the higher rate may be a appropriate correction. 

What concerns me most is that if someone goes into the story with a sympathetic and curious mindset, they are likely to come out of it interested in some sensible reforms. But, if they go in convinced already that disability is full of cheaters, malingerers, and con artists, they'll probably come out thinking the story has confirmed those views, too.

In my next post on this subject, I'll try to give some ideas about how to address this problem, if it even is a problem.