Everybody is talking about the recent NPR segment of This American Life on disabilities, "Unfit for Work." The findings are startling: the number of people on disability is skyrocketing, even as work becomes increasingly less physical, and sit-down tasks dominate, either in the intellectual domains or in the vastly expanding service sector. Yet despite that reality, there are 14 million people getting monthly checks from the federal government; this program now costs national taxpayers as much as welfare and food stamps combined. Are there that many sick people in America? The reality is, disability is now replacing welfare as the universal entitlement program.
There are several culprits here, some in government. The states love this idea. It moves needy individuals off of welfare rolls (paid by the state), to a new service paid for by Washington. The local budget gets downplayed, and the devil takes the hindmost.
The feds don't mind either, because they get something luscious out of this deal too. Many of these folks are transferring from the unemployment rolls. Since they now have a medical reason for not working, they are no longer unemployed, those numbers drop, the country seems to be improving, and the national administration gets the credit.
Then there are practitioners. Doctors sign off on disability when folks have high blood pressure and diabetes. Just for the record, I have had the former for more than a decade, the latter for a year. I've managed to teach my classes and write some books. Lots of other people manage jobs -- high pressure careers in many cases -- with these conditions as well.
Then there are the lawyers. Disability hearings are setup to be non-adversarial. While the defendant can bring a lawyer, the government has no one; the judge is supposed to sit as impartial arbiter and represent the state. Guess what happens when there is an appeal, in a situation like that? One law firm that specializes in this practice made $68.7 million last year. That's just in fees, and doesn't approach the amount the won.
This sounds like the mother of all frauds. Disability insurance is being used casually, for folks who don't really need it, or deserve it. And if this becomes the source of scandal, it could endanger funding for people with serious disabilities, who really must have this assistance to survive.
While there are problems galore here (the hearings setup is a farce), there are also issues the story missed, as well as examples posted in the NPR story, but overlooked by those seeking another government program to flog.
First, the article makes it sound like getting disability is the easiest thing. Just fill out a form and you're on the dole. Who wouldn't do something that easy?
That's inaccurate. This is a long and arduous process involving quite a few steps, hearings, and substantial screening. It is neither easy nor pleasant, nor is it brief. The appeals process is distorting this, but no one should think it is falling off a log. One recent report referred to it as a "a byzantine, punitive, painful process".
Then there is a far larger problem. The NPR reporter told of an older mill worker who had a stroke. By the time he was ready to go back to work -- and wanted to -- the mill had closed. Quietly, they told him to go on disability.
This points to a larger problem. The grim reality is that while there are non-arduous service jobs, a frightening number of Americans have no access to them, or can't fill them. Remenber that doctor who blithely signed off on patients who seemed like they were able to work? He practices in Hale County, Alabama. One of the first things he asks patients is how much education they have. Because without a college degree all those other jobs are closed to them.
In one story, a woman working in a local fish plant developed back pains from her strenuous job. One of my students worked in this industry, and described how rough it could be. No problem; a job sitting down in a chair with a good back would work fine.
Except there aren't any. A quick examination of the "Help Wanted" ads revealed the following list: Occupational Therapist (college degree required), McDonald's, McDonald's, Truck Driver (heavy lifting), KFC, Registered Nurse, McDonald's. The woman explained that her dream job -- her fantasy in other words -- was working in the Social Security office weeding out cheaters. This was the only job she had ever seen where the person worked sitting down.
So behind some of these figures is a terrible new American reality. My wife, who used to run federal job training programs, explained to me, there's a terrible, incredible mismatch between available jobs and the skills of people looking for work. Yes, there are jobs. But not necessarily the kind that can be taken by folks in any given area. Disability applies if the only jobs available to you involve a physical condition.
Yes, some of these people shouldn't be on disability, but should they be on anything at all? There is another giant moral issue, lurking out there since the dawn of state programs to help the disadvantaged, and never resolved. I am serious about this question.
Some of these people are simply screw-ups. They are not evil, do not hurt people, are not lazy. But they make all the wrong choices, do not function well in our society. Should they die for this shortcoming?
One woman in a book on homelessness put it this way: she piteously, and remorsefully explained that she had messed up everything: chosen the wrong men repeatedly, messed up on jobs. Picked all the wrong opportunities and programs. She had tried, far more than most of us, and always produced snake-eyes. Because of this, she asked, should she be homeless and starve?
This is a query that government programs face every day. When I worked for the Chicago Urban League back in the ugly eighties, the pits was public housing. Filled with drug dealers and violent, even the cops wouldn't go into some of these projects. I once talked with one of the top officials in the Chicago Housing Authority and he described the kinds of decisions he faced: what kind of people are too bad for even places like this? What should happen to them?
What is the bottom rung of the safety net? What is society's obligation? We continually debate these issues, at least on the days we even take notice.