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NPR -- Addressing the Wrong Question About Disabilities

The real problem is not why so many people get disability benefits, but why so many people are disabled. This gives rise to important questions about our health system and the healthiness of our workplaces.
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Several recent NPR stories reported by Chana Joffe-Walt that originated on This American Life perpetuate stereotypes and misconceptions about disability and the country's main safety net programs that support people with disabilities. Many of these stories' mistakes and insinuations have been pointed out and refuted in other blogs this week. These include comprehensive facts from the Center on Budget and Policy Priorities, a Media Matters fact check, strong protest from the Paralyzed Veterans of America to the stories' skepticism about mental and other disabilities that cannot be seen, and a letter from over 100 groups that work on behalf of people with disabilities.

Ira Glass of This American Life issued a statement defending the reporter's fact-checking of the piece, denying factual errors, and standing by the story. That statement, in turn, was rebutted by Shawn Fremstad of the Center for Economic Policy Research.

Although the blogs convincingly establish that the NPR stories make a number of errors about the disability programs, what is more disturbing to me is the tone of the reporting and the reporter's cynical message that something is fishy with these programs. Joffe-Walt never outright claims that a significant number of the people who receive disability benefits are not in fact disabled, but reading and especially listening to the This American Life piece make it unmistakable that this is what she wishes to convey. Her stated "news" from her research is that the growth in disability benefits recipients reveals a hidden feature of our economy -- that there are no jobs for lots of people with less than high school education in our economy. That's a fair and useful point. But she clearly also conveys that she thinks there is something wrong with the disability programs, because people who tell her they would try to work if they could find a job instead are able to qualify for disability.

Joffe-Walt says the disability definition is "squishy," especially with respect to impairments that are not readily visible, because "you can end up with one person with high blood pressure who is labeled disabled and another who is not." She apparently did not dig enough to find out that core inquiries in the disability determination process, which may be answered only by medical experts, are about the "severity" of impairments and the impact they have, when combined with all of the person's impairments, on his or her ability to function in the workplace. High blood pressure, in particular, is explicitly blocked from being the basis for disability all by itself. Thus, two people with high blood pressure of different severity, in the presence of different additional medical impairments, can easily fall on different sides of the disability line. Nothing "squishy" about it, once you understand it.

Joffe-Walt questions the good faith of all 14 million Americans "on disability." She never notes how stringent the disability requirements are, or that only about 40 percent of applicants succeed in establishing disability. Although at times she concedes that many people getting disability benefits are actually medically unable to work, she also says that "going on disability," which offers recipients small cash benefits and health coverage but also keeps them poor for the rest of their lives, is a "deal 14 million Americans have signed up for." That conclusion assumes that, for most of recipients, "going on disability" was some sort of choice. But people who are disabled do not have a real choice. Their only "choice" is whether to apply for available subsistence income or to have no income at all.

The main problem I have with the piece is its paper-thin penetration of a deep problem. Joffe-Walt never examines the issues through what should be an obvious lens -- what if virtually all of the people receiving disability benefits are actually disabled or medically unable to work? The real problem is not why so many people get disability benefits, but why so many people are disabled. If you spend any length of time in low-income communities, it becomes increasingly clear that there are lots of walking wounded, a reservoir of people who medically qualify for disability benefits but who have not been able to apply or navigate the system to get assistance.

Examining the issues through that lens gives rise to important questions about our health system and the healthiness of our workplaces (in addition to Joffe-Walt's good point about the changing nature of the American job market). The one doctor Joffe-Walt could find in the Alabama county she visited apparently carries on a heroic practice. Yet one wonders how much preventive care, how much early diagnosis and treatment of conditions to keep them from becoming acute, how much well-child care, how much prenatal care is going on in that crowded practice, where so much of interaction involves assessing the disabling impact of impairments people already have. In the larger picture, there are important questions about the impact that a lack of health insurance, and its attendant lack of a regular relationship with a doctor, have on the working ability of the 50 million uninsured Americans.

There is a huge debate raging in this country about vigorously implementing the Affordable Care Act, which has aggressive strategies to reform the health care system and insure most of the uninsured, all of which can bring down the number of people with disabilities. And we have the spectacle -- in Alabama and elsewhere -- of governors and legislators rejecting those reforms on ideological and political grounds. Joffe-Walt's piece, unbeknownst to her, is a very poignant reminder of who and what those politicians are sacrificing on the altar of their political ambitions.

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