Unfit for work: the startling rise of disability in America

Interesting; I like the doctor's rule of thumb, though I expect he might amend it for degrees that don't tend to get one a job.

abnormal wrote:

 Otherwise there wouldn't be as many law firms advertising as "Social Security Disability Advocates" who simply spend their time challenging the SSA's determination.

Why doesn't that surprise me.

They'd challenge which direction the sun comes up in the morning if they thought there was a buck to be made. I have seen enough of that in the states, with ads that make it sound like you should WANT to get in a car accident.

I guess the other side of this question is what support one can hope to get if one is classified as disabled.

The example given is a (supposedly) normal kid who was on disability but who is now doing well in school - the family has a problem - if the kid does well in school he'll be moved off of the disabled list and the $700 a month he receives will stop - unfortunately that's a significant part of the family's income.

A physician on an American healthcare forum said that at least part of the rise in autism diagnoses was to help families get coverage for a troubled child. The DSM-IV diagnosis of "Autism Spectrum Disorder NOS" (not otherwise specified) is a flexible catch-all for many sorts of problem behaviour.

The rise in diagnoses of mental illness might reflect a reduction in stigma rather than any real increase (impossible to say I concede).

Last week, NPR's This American Life and Planet Money featured "Unfit to Work," a story from reporter Chana Joffe-Walt, which implies that lots of people are receiving Supplemental Security who don’t deserve the help and that children, particularly, are being enrolled at alarming levels, often for questionable disabilities. The right-wing media of course picked up the story and ran with it. Policy wonks furthered it and called for reform.

There's a huge piece missing out of Jaffe-Walt's story as well, that she misses right here, when she's talking about laid-off mill-workers: "I talked to a bunch of mill guys who took this [disability] path—one who shattered the bones in his ankle and leg, one with diabetes, another with a heart attack. When the mill shut down, they all went on disability."

Heart disease, diabetes and a shattered ankle. In the real world, those are called pre-existing conditions. In the real world, the only jobs available to these men are low-wage jobs that don't provide health insurance. Heart disease and diabetes are conditions that require regular trips to the doctor, prescriptions and medical expenses. The cheaper alternative for them, and for a nation with a broken health care system, is to have them receiving $13,000 a year in disability income and regular medical care. Another piece missing from the story is the large population of disability recipients there because of mental impairments and mental illness. Where once they'd have been institutionalized, either in hospitals or prisons, they're now living on their own with the help of disability payments; again, a cheaper alternative for government than housing them.

What the story did that was of service was to put a focus on a dysfunctional economy that has no place in the workforce because they are too old, too sick or otherwise “obsolete.” That should have been the story Jaffe-Walt told, instead of an alarmist, incomplete and mythical picture of another "entitlement" gone out of control.

The cleverly titled story, “Trends with Benefits” is gracefully presented and gets some things right. It depicts with human texture some unpleasant realities facing millions of displaced workers with health difficulties whom our economy has left behind. With the exception of nutrition assistance, our safety-net has failed to keep pace with the Great Recession. Disability assistance has naturally filled the gap. SSI and SSDI expenditures have correspondingly increased. This is an important story.

Still, I fear the misimpressions this piece leaves behind.

“There’s no such thing as a neutral story. But there is such a thing as an honest story.”

How did NPR end up repackaging extreme right-wing talking points into a week-long series claiming to tell the “hidden” truth about disability’s explosive growth in our recession economy? Journalist Chana Joffe-Walt says she spent six months “reporting on the growth of federal disability programs” and trying to “understand what that meant.”  She gets it almost all completely wrong, down to the beautifully-colored graphs.

Since the series aired, experts have rushed to document the facts and urge corrections: the Center for Budget and Policy Priorities here, here, and here; the Center for Economic and Policy Research here and here; the Shriver Center here; law professor James Kwak here; Media Matters here; disability rights activists here; and legal services advocates here. Over 120 organizations have signed on to a call for NPR to retract the series, and to top it off, no less than eight former commissioners of the Social Security Administration wrote an open letter outlining their “significant concerns,” saying they “could not sit on the sidelines and witness this one perspective on the disability programs threaten to pull the rug out from under millions of people with severe disabilities.”

How then, could a reporter, and three different NPR brands spend so much time and effort on something that is so wrong? To start, in all her research and airtime, Joffe-Walt quoted only three experts, and they share one narrow, controversial perspective.

It turns out that Joffe-Walt’s reporting very closely tracks a set of talking points disseminated by a handful of linked think tanks and echoed by astroturf groups.  The same talking points showed up late last year in Nicholas Kristof’s NY Times columns asserting that Kentucky parents were purposely preventing their children from learning in order to preserve their SSI benefits (this was largely debunked, and subject to a critical response by the Times’ Public Editor). A few years ago a story from the Baltimore City Paper hit all the same “surprising” insights that Joffe-Walt did, down to a similar section on obscure companies that help identify people who may qualify for disability assistance.  (And in the mid-90s, there was a startlingly similar media frenzy which led to a staggering number of children losing their benefits before being revealed as based in fantasy and anecdote more than fact.)

There is, of course, a particular agenda at work here: the dismantling of the social safety net.  Policy papers and op-eds like the following, with similarly misleading statistics and examples and calling for “reform” of SSDI and SSI, have been issued by the libertarian Cato Institute, the conservative American Enterprise Institute and Heritage Foundation, as well as the more centrist Center for American Progress and Brookings Institution.  These are consistently based on work by Joffe-Walt’s main sources, the economist team David Autor and Mark Duggan, as well as Mary Daly, another economist she cites later in the series, and Daly’s partner Richard Burkhauser.

Despite what Joffe-Walt claimed, this isn’t hidden or new information: the same actors have been saying the same things for years. They’d like to radically restructure these disability programs, turning them into private insurance products or block granting them to the states along with reduced funding, sometimes questionably recast as “waivers.” And this think tank echo chamber is heavily subsidized by Peter G. Peterson, a billionaire investor who has spent hundreds of millions of dollars to dismantle Medicare, Social Security, and recently the disability programs that are the subject of the NPR series.

Right while Joffe-Walt’s pieces were airing, Washington was poised to weigh these very issues. The dollars Peterson spends to promote deficit fearmongering help manufacture a budget crisis (the fiscal cliff, “Fix the Debt”), but Mitt Romney’s loss signaled popular support for raising revenue from the rich who have paid too little in taxes, and against the logic of austerity.  In a calculus designed to get those tax measures through, Obama again is testing the waters to see if he can get away with proposing a budget that includes some cuts to the social safety net.  While Democratic lawmakers have pushed back, they may be looking for an excuse to give in.  In the midst of these decisions, Joffe-Walt’s piece seeds questions about whether the disability programs are too generous, whether some undefined number of people really don’t need them, whether some cuts to SSDI and SSI might not be so bad.

And, despite the fact that she provided little real evidence for her borrowed thesis, Joffe-Walt’s series immediately went viral. It’s a neat package, and everyone can see what they want in it (a changing economy that should force us to face hard truths, for some, and proof of the freeloading we always suspected, for others). It’s on right-wing TV shows, blogs, websites, newspaper columns, and the websites of the same think tank sites that generated the misleading information in the first place. They all love the series. Next month the think tanks have a conference scheduled on the very topic, funded by Peterson’s foundation, and Joffe-Walt’s reporting will surely be used in Congressional hearings before long. This is what expert propaganda looks like.

She talks to Jahleel, who she says is disabled “in the eyes of the government.”  Based on chatting with him about his favorite school subjects, she says: “Jahleel is a kid you can imagine doing very well for himself. He is delayed. But given the right circumstances and support, it’s easy to believe that over the course of his schooling Jahleel could catch up.” Okay, we’re imagining. She then insinuates that Jahleel’s mom might hold back his improvement, despite wanting him to do well in school, to keep the money coming (she won’t be able to help herself!). This is based on nothing, except possibly more imagining. Joffe-Walt is not a doctor, or a social worker, or a teacher, and unless she is psychic, she is in no position to assess the needs and capabilities of this real boy whose picture and name she uses for her own ends.

But she doesn’t stop there. Instead, she  used Jahleel to expound on “some basic things we’d all agree on”  about the care of our children:

Kids should be encouraged to go to school. Kids should want to do well in school. Parents should want their kids to do well in school. Kids should be confident their parents can provide for them regardless of how they do in school. Kids should become more and more independent as they grow older and hopefully be able to support themselves at around age 18.

Yes, we can all agree on that. Then Joffe-Walt drops the hammer:

The disability program stands in opposition to every one of these aims.

Think about that sweeping declaration. Good people of this country who care about kids like Jahleel, her logic follows, need to change the way this program functions – it means well but is actually hurting our children. Moments like this in the series struck many listeners, sparked their interest and concern, and are a part of why it went viral.

Again, there is one main problem. The disability program does not do any such thing.  Her statement is indefensible.  You could line up over a hundred groups that work with disabled people and a bunch of former Social Security Commissioners to tell you that her conclusion is baseless – and of course that’s exactly what happened once the piece aired (remember those letters?).  In the face of such criticism, This American Life’s Ira Glass proclaimed that every line spoken by Joffe-Walt was fact-checked, leaving you to wonder what this fact-checking involved if it left in place lines like that, so horribly and disastrously wrong.

In order to tell these stories, to actually do real reporting, we need to talk to the people we are talking about.  It’s sadly ironic that a maxim of the disability rights movement is the phrase “nothing about us, without us.”  Instead of those voices, Joffe-Walt’s listeners got a retired Alabama judge, a man who did not himself rule on disability cases, explaining how he could just tell whether a man he ran into on the street was really disabled. This reveals more about attitudes towards disability than it does about disability itself.

A vast array of austerity measures has been introduced by the British Government and many of these impact poor and disabled people. These have included the merging of jobless and disabled benefits and a huge, privatized effort to reassess disability claims so as to rob people of their benefits en masse. A September 26, 2012 article in the British Daily Record reported that the Department of Work and Pensions had admitted that, of those who had by then been cut off disabled benefits, 55 per cent were without work or income, 30 per cent were existing on the jobseekers allowance and a mere 15 per cent were employed. As this unfolds, one British Tory MP has openly called for the introduction of a sub minimum wage for the disabled.

The sheer viciousness of the way the British Government has hounded disabled people can be found in another British media report dealing with people in Scotland living with Motor Neurone Disease (MND). This neurological condition causes loss of ability to walk, speak or even breathe without assistive devices and it leads to death, usually within fourteen months. However, the British Department of Work and Pensions has determined that ‘terminal illness’ will only be defined as conditions that will claim your life within a six month period. If you are expected to live longer than that, you will be required to take ‘fitness to work’ tests and be subject to the infamous ‘bedroom tax’ imposed on April 1 of this year. This has meant MND sufferers have been cut off benefits and lost their housing.

Similar attacks are now being developed in the United States and a glance at media coverage there shows that a veritable campaign is underway to ensure disabled people are targeted. As early as February 12 of last year, we find an online article with Business Insider entitled “The unemployed are now going on disability and it's costing the Government billions.” The idea being put forward is that a stagnant U.S. economy is creating a lot of long term jobless and many of them are avoiding precarious welfare programs by registering claims for disability with an overly lax system. They are not, it is asserted, really disabled but a population of hidden unemployed who need to be flushed out from their dishonest place of refuge and comfort.

This is the context in which the Liberals are planning major changes to social assistance in [Ontario]. They have now held power for a decade and, during this time, have allowed poverty to intensify. In the last period, they have fully embraced the austerity agenda and have begun to fashion their own version of it here in Ontario as their recent Budget demonstrates.

Given this Government's track record and the directions being taken in the UK that I have described, it is an appalling miscalculation to see something positive in the above mentioned Lankin/Sheikh Report. This document does not press for income adequacy for people on ODSP and for barriers to accessing the program to be removed. Rather, it is all about creating a system of disability benefits that judges everything by standards of ‘employability’ with a maximum drive to low waged work as its dominant consideration. They go so far as to advocate the setting up of ‘employer's councils’ to assist in the process.

I have seen hundreds of middle-aged patients who appear healthy enough to hold down a job, yet are receive Medicare and SSD for diagnoses like fibromyalgia, chronic low back pain, post –traumatic stress disorder, multiple sclerosis, and chronic fatigue syndrome, (to mention just a few.) And yet the truly disabled often have a difficult time qualifying for these benefits.

no one from the government will be snooping around the SSDI beneficiary’s home to see evidence of fraud, like washing their car, playing golf, fixing a roof, hauling hay, etc.

I see a lot of healthy young men collecting disability for various reasons, often "severe crippling lower back pain," and when I phone their physicians saying, are you sure about this, they say, "If you think MY PATIENT is faking, call the police." Then they leave the clinic and sell their Oxycontin to their friends waiting outside before riding their bicycles home. It's at the point where many of us who work in health care think more disabled people are scammers than are not. And disability activists should be outraged about all the disability fraud because it means that real disabled people get crap benefits for one, and also, it means that the people who really need assistance get treated like criminals when they try asking for help.

I do think Sineed was not trying to support a pro-austerity agenda here and instead adding information for consideration