Mar 11, 2013

Is More Rehab The Answer?

     The Deseret News of Salt Lake City has a long piece on "How federal disability policy mangles its mission." Here are a few excerpts:
Over the last 20 years, the disability rolls have burgeoned. In 1989, just 2.3 percent of Americans aged 25-64 received SSDI benefits. Today, that number has jumped to nearly 5 percent, or nearly 9 million adults.

That jump was not cheap. In 1990, Social Security spent $20 billion a year on disability. Today, it spends more than $128 billion.
And much of this growth went to often hazy claims that are hard to prove, including mental disorders and back pain. And many are not so much disabled as they are economically bypassed. ...
Like most federal entitlements, the disability program faces an existential crisis, as limited resources stand in the way of ever-expanding expectations.
Later this month, a key Social Security advisory board will meet to fix the disability system by getting fewer false positives that drive up costs and fewer false negatives that chew up lives. ...
When SSDI was enacted in 1956, “an able worker could maintain a job and didn't need assistance from the disability program, but a disabled worker couldn't possibly work, and needed the government to provide income and medical care,” said MIT's [David] Autor.
The 1956 disability law, still in force, treats a disabled worker as an oxymoron. You are either a worker or you are disabled — not both.
That model is now “totally outdated,” Autor said, “partly because work is more sedentary, and medicine can actually help you. But also because attitudes have greatly changed.” The very purpose of the 1990 Americans with Disabilities Act, he notes, is to integrate the disabled worker into the labor force, by compelling employers to be more accommodating.
“Many Americans are willing and able to work,” Autor said, but work limitations under current law “curtail their earning power and raise their health costs.” ...
If the Americans with Disabilities Act was supposed to get more disabled workers into the work force, it seems to have failed. In fact, the sharp spike in disability claims began when the ADA was passed, notes Jennifer Erkulwater, a professor of political science at the University of Richmond in Virginia.
“Everyone thought the ADA was going to open up work to people with disabilities and they would become taxpayers,” Erkulwater said. “In fact, it had the exact opposite effect.”
Erkulwater suspects that the ADA, combined with 1984 policy changes that opened up disability claims for mental and musculoskeletal disorders, drove up claims by destigmatizing disability and encouraging new types of disorders.
     Articles like this can just appear on their own based upon a reporter's investigation. However, they are often planted. I suspect that this and similar articles are being planted by economic interests wishing to preserve and expand the Ticket to Work program. Ticket to Work is a complete failure and waste of money yet the contractors that profit from Ticket to Work want it expanded.

18 comments:

Anonymous said...

For people with "treatable" conditions, maybe required rehab and medical treatment should mandatory. Remove the two year wait for Medicare, require treatment and rehabilitation and get into the work force.

Anonymous said...

For good or for ill, most (not all) of the folks I talk to consider themselves to be permanently disabled and have little or no intention of returning to work. If they are working at SGA levels that cause denials: "I'm just working because I have to make ends meet. I plan to quit working when I get on disability." In my experience, very few ever return to SGA level work. (Those who do, then fail to report it and end up with overpayments when SSA catches up to what they are doing). SSI children are a problem. They are determined to be disabled as children and spend their entire childhood being told that they are. At age 18, when evaluated as adults, they are shocked when they get cessation notices. 'I have always been disabled, nothing has changed. Why am I denied now"? In any case, Rehab as it is currently structured is of limited value. Something like apprenticeships, on-the-job training, re-structured job corps (for all ages) would be more likely to have a better rate of success -- In my lowly opinion. . . .

Anonymous said...

Agreed, I see the same things daily as well. I'm in a high SSI office so most of what I see is the disabled child or the adult claiming mental problems. Very few have ever worked in the first place so giving them a check every month no matter how small feels like hitting the lottery to them. It's a sad state of affairs but no amount of "rehab" will work there.

Anonymous said...

adding to what was said above...

rehab won't work for the typical beneficiary that claims pain and depression. Additionally, no amount of rehab will overcome the lack of education and lack of experience of most SSI claimant's.

As noted above, unless "rehab" means some sort of vocational training it is useless for the typical/most disability beneficiaries.

Anonymous said...

Yet we continue to push CDR's and people are labeled improved despite the fact they have no intention of ever working again as previously stated.

Anonymous said...

CDRs would be a better place to put the money than rehab. Also give the agency some teeth for those who willingly try to cheat the system working and getting disability with real fines, real imprisonment and loss of all state or federal benefits for life due to fraud.

Anonymous said...

I don't disagree, my point was just that you have the polar opposites of claimants expecting never to work again and SSA expecting medical improvement. The end result is part of the reason we have the mess we have today.

Anonymous said...

The only CDR's that ever make a difference in my experience are the SSI age 18 CDR's. A significant percentage of SSI kids attaining age 18 are ceased when they have to meet the adult rules. Regular adult CDR's rarely result in cessations--I have seen no figures, and wonder if such figures are even available. Offices often request CDR workloads from other offices to pad their work units, but there is not much to doing them, and as I said, rarely result in negative outcome to beneficiaries. The whole notion of CDR's saving SSA massive dollars is mostly a myth.

Anonymous said...

if the work of doing an adult CDR isn't much, then I would imagine it wouldn't take ceasing too many adults to make it "worth it." Even with appeals and everything, once ceased, that's saving (what's the average disability benefit, like $1100-$1200 a month?) nearly $15k a year for every year that person is now not receiving benefits.

Anonymous said...

CDRs generally return $9 for every $1 spent doing them. If the agency does not want to or is no longer able to do them, farm the work out to civilians. The basic forms and medical request are basically the same as a Recon or Hearing. Then all SSA has to do is review the Medical Evidence of Record.

Maybe SSA needs to look at farming out more work. The usual response is "we cant do that, its too much personal information." Which is the same information used to file a claim by a third party, or a recon, or Medicare, or Retirement, or get an online copy of Earnings record....

The Army does not build its own land mines. The Air Force does not build its own planes, the Navy does not build its own ships. If civillians can be trusted with creating the weapons of war, I think they can handle getting the medical records and short form completed for a CDR.

Anonymous said...

I think your analogy is faulty... "SSA doesn't make it's own pencils or build its own computers" might be more apt. Also, it's a civilian agency. They're all civilians.

Anonymous said...

Seriously? Their poster-child is a guy walking around Walmart having seizures, that can't safely complete his shift?

How does he get home? Sounds like an unsafe driver if he's operating a motor vehicle.

This opinion article was clearly put in the news section by mistake.

Did Paul Ryan's office help write it?

Anonymous said...

Money "saved" by doing CDR's is money not disbursed from the trust funds, or in the case of SSI, from general revenues. The savings do not accrue to the agency's administrative expense budget, so additional effort by FO's do not result in additional staffing as a result of the savings. It just leaves other work undone. Money appropriated by Congress targeted to CDR's is not used to hire additional staff, it is usually used for overtime to catch up backlogs, including CDR's.

Anonymous said...

How many of you involved in SS would deny this guy an approval for SSDI, and why?

Anonymous said...

denied, he's working at SGA levels...disability benefits are for people that CANNOT work.

Anonymous said...

Rehab and job training are great ideas for an economy that has jobs.
If there were jobs in the USA for our citizens (i.e., not in China ...), then as able bodied people became fully employed and moving up the employment ladder, this would creating opening for the less skilled, and in turn a REAL NEED for getting the less able into the employment market.
It does not work the other way around with programs, preferences and make-work jobs at the bottom having any hope of floating the economy.

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