Ticket To Work Doesn't Work

      From a recent report by the Government Accountability Office (GAO):

Disability beneficiaries participate in the Social Security Administration’s (SSA) Ticket to Work and Self-Sufficiency program (Ticket to Work) by assigning a "ticket" to service providers who, in turn, provide help with employment. SSA compensates the service providers when Ticket to Work participants achieve designated levels of work and earnings. Using SSA data from 2002, when the program began, through 2018, the most recent year available, GAO estimated that 5 years after starting Ticket to Work, participants’ average earnings were $2,451 more per year than that of similar nonparticipants. However, the majority of participants remained unemployed 5 years after starting Ticket to Work. 

Based on GAO’s analysis, the costs of Ticket to Work exceeded the savings in disability benefits to SSA by an estimated $806 million from 2002 through 2015, the most recent year with reliable savings data. Savings accrue when Ticket to Work participants receive lower benefits or leave the disability rolls due to earnings from work. GAO estimates that participants were slightly more likely to leave the rolls (9.7 percent) than nonparticipants who are similar across a range of characteristics such as age, gender, disability type, and education level (8.6 percent). A greater percentage of participants left the disability rolls due to work rather than for other reasons, such as medical improvement ...

GAO estimates that SSA incurred an additional $133 million to $169 million in costs (above the $806 million) from disability benefit overpayments to Ticket to Work participants. Overpayments can occur when beneficiaries who work do not report earnings to SSA or SSA delays in adjusting their benefit amounts. ...

     This report ignores an important reality.  No one makes claimants participate in the Ticket to Work program. Those who do participate are saying they believe they may have some capacity for work, meaning that they have better prospects for returning to work than claimants generally. Comparing the results in this group to claimants generally makes the Ticket to Work results look better than they are. Some of those who volunteered for Ticket to Work would have returned to work with or without Ticket to Work. We can't tell how many were only able to return to work due to Ticket to Work. If there were a control group, it would be some who volunteered for Ticket to Work but were arbitrarily denied Ticket to Work help but there is no such control group because none were turned away.

     Note the ridiculous level of overpayments associated with Ticket to Work even among a group of beneficiaries who told Social Security they planned to return to work. Don't blame claimants for this. Social Security's system for handling reports of return to work just doesn't work. 

     I'll make a modest suggestion. Social Security should almost completely stop relying upon wage reports from claimants because they do a poor job of reporting and Social Security does a worse job of recording what they report. We should define Substantial Gainful Activity on a quarterly basis and base work deductions on quarterly wages reported by employers. This can mostly be done by the computers. Yes, there will be problems with "wages" that are reported for work done earlier (such as sick pay, vacation pay and residual commissions) and yes, there will be problems with self-employment income but we'd be in a much better place than we're in now if those are the only problems we have to deal with.

Press Release On Ticket To Work

A Social Security Administration press release:

The Social Security Administration issued final rules designed to improve the Ticket to Work program. The changes will improve the effectiveness of the Ticket program in assisting beneficiaries with disabilities who want to work.

“These rules outline a new and improved Ticket to Work program and are based on learning from our experiences, listening to input from interested parties, and responding to their suggestions,” said Michael J. Astrue, Commissioner of Social Security. “Beneficiaries with disabilities will have greater flexibility and expanded choices in obtaining the services they need to attain their employment goals.”

The new Ticket to Work program rules:

• Include more beneficiaries under the Program--The population of individuals eligible for a Ticket is expanded to include beneficiaries who are expected to medically improve.

• Increase incentive payments for Employment Networks (ENs)--The new rules modify the EN payment systems to create greater financial incentives for service providers to participate, which will improve beneficiary access to services and expand the pool of quality providers available to serve beneficiaries.

• Increase the value of the Ticket--The rules for Ticket assignment are changed to enable beneficiaries with disabilities to take advantage of a more effective combination of services from both State Vocational Rehabilitation agencies and ENs.

• Synergize efforts--The new rules promote better alignment of the Ticket to Work Program, the Work Incentives Planning and Assistance Program, the Protection and Advocacy for Beneficiaries of Social Security Program, and other Social Security work incentive initiatives.

"Thus far, the results of the Ticket to Work program have been less than everyone expected and clearly less than Congress intended," Commissioner Astrue said. "We need to monitor the results of today’s regulation closely, but it is highly likely that Congress will need to revisit the statute in the next few years in order to achieve the goals that Congress intended."

In preparation for the new Ticket to Work program, Social Security is undertaking a major recruitment effort to increase the number of organizations functioning as ENs. Social Security also is initiating targeted outreach to promote the Program to more beneficiaries and to encourage their participation. In addition, Social Security is presenting at national and state conferences and bringing beneficiaries and ENs together at local Work Incentives Seminars (WISE events) throughout the country.

The Ticket to Work and Work Incentives Improvement Act of 1999 established the Ticket to Work and Self-Sufficiency Program. The purpose of the Ticket to Work program is to expand the universe of service providers available to beneficiaries with disabilities who are seeking vocational rehabilitation, employment and related support services. These service providers are available to assist beneficiaries in obtaining, regaining and maintaining self-supporting employment. Available in all 50 States and the US territories, the Ticket to Work program is an important component in a coordinated series of work incentives and initiatives that are designed to help overcome barriers to employment often experienced by beneficiaries with disabilities.

The final rule can be accessed through the Federal Register online at www.regulations.gov .

Disabled People Who Return To Work Usually Don't Last Long

     From a study by the Center for Studying Disability Policy (footnotes omitted):

Each year, SSA publishes information about work activity among beneficiaries. Those statistics tend to show relatively little beneficiary employment; indeed, only about one percent of beneficiaries each year have had their cash benefits suspended or terminated because of work. However, the statistics do not paint a complete picture of the number who forgo cash benefits for work because they exclude beneficiaries who have worked for a long time and are therefore no longer formally connected to SSA programs. To develop a better idea of how many beneficiaries work, SSA and Mathematica Policy Research developed an indicator for “nonpayment status following suspension or termination for work” (NSTW), based on a complex set of SSA administrative data. This indicator captures all months that beneficiaries have given up cash benefits specifically because of work ...

These statistics show that considerably more beneficiaries are forgoing cash benefits because of work than those reported in SSA’s annual reports. SSA’s published statistics show that fewer than one in 100 beneficiaries in each program have their benefits suspended for work in a typical month. However, our statistics reveal that, during a typical month in 2006, about 2.5 beneficiaries were off cash benefits (with benefits either suspended or terminated) because of work for every 100 receiving a benefit payment ... TTW [Ticket to Work] participants are more likely than other beneficiaries to enter NSTW. In 2006, 3.4 percent of TTW participants had their first NSTW month versus 0.7 percent of nonparticipant beneficiaries. The NSTW indicator also allowed us to assess the incidence of NSTW after Ticket assignment for several years; by the 48th month after assignment, nearly 17 percent of TTW participants had had at least one NSTW month, compared to just under 7 percent after 12 months.

      First, even with the increased return to work numbers this study shows, there still are few disability benefits recipients returning to work. Second, while you can read the chart above as showing that Ticket to Work helps, you can also read it as evidence of selection by Ticket to Work providers or self-selection by beneficiaries. What the chart does show unambiguously is that the vast majority of those on Social Security disability benefits who attempt to return to work don't last long. This study does not confirm the common belief that there are many Social Security disability recipients who have the capacity to return to work if only they're given the right encouragement and help. Even when they really want to and even when they receive a lot of help, few of them succeed in returning to work for the long haul.
     This study is a few months old. There are reasons why you haven't seen Ticket to Work proponents touting it.

SSAB Forum

     The Social Security Advisory Board (SSAB) has scheduled a "Forum" for March 8 on "Social Security Disability: Time For Reform." There is some diversity of viewpoint among those scheduled to speak but there's a definite tilt to the program. Here are some of the points of view represented with the names of the speakers representing these points of view in parentheses:

• Something must be done because a lot more people are drawing Social Security disability benefits now. This is because it's less difficult to get on these disability benefits than when Ronald Reagan was President. (Duggan, Daly, Autor)
• Too many people draw Social Security disability benefits because the benefits are too generous.(Duggan, Autor)
• The Americans with Disabilities Act (ADA) makes it easier for disabled people to work and that should make it less difficult for people to get off Social Security disability benefits. (Claypool, Imparato, Blanck)
• Social Security is the reason why more disabled people aren't working. (Maestas, Smith, McDonald, Autor, Stapleton)
• If Social Security gave disabled people more encouragement and assistment, they'd go back to work. (Smith, Davey, McDonald, Mazerski, Autor, Stapleton, Smalligan)

     I'm sure that I'm oversimplifying the views of these people. I'm also sure that each of them in their own way wants to help disabled people. (I will say that David Autor is really full of it and has no business speaking publicly about these issues. He simply doesn't know what he's talking about.) 

     I think it's appropriate to give a shorthand response to each of these expressed views, the sort of responses that are unlikely to be expressed at the SSAB "Forum."

• It certainly is less difficult for people to get on Social Security disability benefits than when Ronald Reagan was President. However, you have to understand that Social Security disability during the Reagan Administration was an aberration. It was less difficult to get on those benefits before the Reagan Administration and it quickly became less difficult to obtain those benefits as the Reagan Administration wore on and the return to prior practices was even more pronounced after Reagan left office. This was because the changes made during the early part of the Reagan Administration evoked a vigorous political response. The Reagan changes were quickly rolled back. Even though there have been plenty of changes since Reagan left office, it has remained less difficult to get the benefits. Anyone who advocates a return to Reagan era policies is naive. Those policies would evoke the same reaction in 2013 as they did in 1983. The Reagan days were as far from a golden age for Social Security disability policy as you can get.
• Disability benefits too high? Really? Generally, Social Security disability benefits are less than half what recipients were earning. They're far less in most cases than disability benefits under employer based long term disability plans. 
• The ADA makes it easier for disabled people to work? The evidence is that the ADA had little effect on the number of disabled people who are employed. In fact, some scholars have argued that the ADA reduced the employment of the disabled!
• I don't see how one can argue that the availability of Social Security disability benefits discourages people from working when we have clear evidence that only 27% of those who apply for and are denied Social Security disability benefits are working four years later. Being denied benefits isn't enough to get these people back to work even though those who are denied are, on the whole, less disabled than those drawing disability benefits. The evidence is unambiguous that very few of those drawing Social Security disability benefits will return to work even if they are removed from benefits.
• The illusion that with a little more encouragement disabled people will fly off the disability rolls and back to work has been persistent for decades. This illusion has led to the following work incentives: Trial Work Period, Extended Period of Eligibility, Expedited Reinstatement, Ticket to Work and the Vocational Rehabilitation exception, just to mention the Title II provisions. There's another complicated mess of Title XVI work incentives. None of this is working to any significant extent. If none of this works, why would anyone expect a new work incentive to work? I can think of one good reason why some of the speakers would promote work incentives. Some of them work for Ticket to Work contractors. Not only do they want to keep the contracts their employers have, even though they're a waste of money; they want to get more contracts. Ticket to Work is an unjustifiable waste of money. Any attempt to go further down the rehabilitation road will just waste more money.

Ticket To Work -- A Waste Of Money

From the New York Times:

... Social Security offers disability beneficiaries some incentive to ease back into the work force. For nine months after starting a job, they can earn any amount without threatening their benefits. For another three years, if their income falls below $1,000 a month, they can immediately receive full benefits again. And they can keep Medicare coverage for eight and a half years after going back to work, something few beneficiaries may realize.

In 1999, Congress passed a law authorizing the Ticket to Work program, which offers beneficiaries practical help with a job search. Social Security also waives medical reviews for those who participate.

So far, the program has had little success. Out of 12.5 million disabled workers and those who receive benefits for the disabled poor, only 13,656 returned to work over the last two and a half years, with less than a third of them earning enough to drop the benefits....

Officials say they have streamlined and simplified the Ticket to Work program. But even with more awareness, they say not enough people could go back to work to make a difference in the disability trust fund.

“We could make this program exponentially more successful and it wouldn’t be enough to dramatically improve the solvency picture,” said Michael J. Astrue, the commissioner of Social Security. “You do it because work — for people who can work — gives them dignity and improves their economic condition.”

I have a suggestion. Ticket to Work doesn't work. There's no way to make it work. Let's get over our fantasies that there's some way to return large numbers of disabled people to work. Just end Ticket to Work and save the money.

The National Council On Disability Needs To Meet More Disabled People

     I have written recently about the attitudes towards the Social Security disability programs that exist within what I'll call the ADA community, a group of people, many of them in wheelchairs, who are committed to the notion that literally anyone can and should work, regardless of the severity of their disability. They believe that the Americans with Disabilities Act (ADA) changed everything, despite the abundant evidence that it changed almost nothing. The ADA community seems to regard the existence of Social Security disability benefits recipients as a sign of a great failing, by society  They believe that all those recipients should be working and would be working if only something -- they don't know what -- were changed. The ADA community seems to think that every disability is much the same as being in a wheelchair, something that a well-motivated person who has a bit of help should overcome. If you think I'm exaggerating, take a look at these excerpts from an announcement by the National Council on Disability (NCD), an independent federal agency: 

Notice of Funding Opportunity 

NCD-02-12

NCD seeks an individual or entity to undertake a project to analyze the various options for SSDI [Social Security Disability Insurance] and SSI [Supplemental Security Income] reform, including what measures could facilitate people currently receiving SSDI and SSI benefits in being able to work, what measures could decrease the likelihood of needing such benefits, and what financing options exist to extend the life of both programs. ...

Suggested Framework for Research

The National Council on Disability is interested in answering the following questions:

1. What would a fundamental restructuring of the SSI and SSDI system require to align it with the goals of the Americans with Disabilities Act, i.e. eliminate the requirement that an SSDI applicant declare themselves unable to work in order to be eligible for benefits; provide job retention supports to working people with disabilities who are at risk of job loss as a result of their disability; assist people with disabilities who are at risk of job loss because they are not receiving reasonable accommodations.
2. Given the extremely diverse populations served by the SSI and SSDI programs, how might different reform strategies disproportionately impact – either positively or negatively – particular segments of the disability community?
3. Based on the most current evidence-based research, does the Medicaid buy-in opportunity impact work activity?  How should it be modified to promote work opportunities for people with disabilities?
4. To what extent has the Ticket-to-Work initiative been evaluated?  What lessons can be drawn from the challenges the Ticket to Work program has faced in realizing its intended goals?  If sufficient information is available to make a determination, what reforms to the Ticket to Work program are recommended?
5. Did the research reveal any changes to other federal programs that would have a positive impact on the health and effectiveness of the Social Security Programs and work opportunities for SSDI and SSI beneficiaries?
6. Could an incentive mechanism be used to encourage employers to make more efforts to accommodate employees with disabilities and to avoid employees with disabilities going on to SSDI rolls, e.g. an experience rating system whereby employers, whose employees have a lower rate of SSDI retirements, pay lower SSDI payroll taxes?
7. Could an incentive mechanism be developed to encourage states to supplement the SSI program with state funds?
8. Could an incentive mechanism be used to encourage more employers to offer private disability insurance policies that would supplement the SSDI program?
9. Are there other changes to the SSDI or SSI programs that would promote work activity, preserve benefits for those who need them, and secure the fiscal integrity of these programs?

     These proposals come despite the fact that the Congress has again and again fallen for the siren call of the ADA community and stuffed the Social Security disability programs with every imaginable incentive for recipients to return to work, so many incentives that keeping them all straight is a huge challenge. The only thing left is to stop with the incentives and try compulsion -- time limited benefits. That would be an enormous mistake but there is literally nothing left to try if you really believe that all those disability recipients should be put back to work. By this point, the ADA community is a positive menace not only to Social Security disability recipients but to the Social Security Administration and Congress. They are pulling policy making in a potentially calamitous direction.

Ticket To Work Works?

The Ticket to Work program has such an insignificant effect upon the Social Security disability program that it's tempting to think it must be a failure. Social Security estimates in its 2006 Performance Plan that the Ticket to Work program will return only 4,360 disability benefiaries to work in FY 2006. The program is not inexpensive. Maximus Corporation administers the Ticket to Work program on a contract basis for SSA. Maximus' Ticket to Work contracts with SSA for FY 2006 total about $52 million. That is real money. However, when you work it out, the average cost for a job placement under the Ticket to Work program is only $11,697, not including SSA's direct expenses, which are probably minor. That has to be far less than the costs of even a year of cash disability benefits and Medicare. Although the number of claimants being placed is tiny and the whole program is not worth nearly the attention it has received, Ticket to Work is cost effective.

The Attack Pieces Continue

     Here's a Reuters piece attacking the Social Security disability programs as being in part disguised unemployment.  Here are a few excerpts, with some comments by me in brackets and bolded:

• ... Chris Low, chief economist at FTN Financial, said over time, disability will rob roughly $250 billion - or 1.6 percent - from total output each year once the economy returns to full employment, probably within the next five to seven years. This will also widen the budget deficit.
• Duggan and other economists say the major change in the growth rate stems from a series of reforms in the mid-1980s, which changed the focus of screening from medical criteria to working ability. [The golden age that Duggan longs for was actually a brief, bizarre period of extreme harshness that was extraordinarily unpopular and quickly abandoned.]
• "They are not encouraged to go back to work. [Actually, there are encouragement galore to return to work. You just don't know what you're talking about] I have gone to multiple meetings on a program called 'Ticket to Work' and there were only five people who showed up," she said. [The article is so poorly written that I cannot figure out who "she" is. The bigger problem, though, is "she" doesn't consider the possibility that the reason why so few people show up for Ticket to Work is that there are so few people drawing Social Security disability with a potential to return to work.]
• If people do return to work, they could lose benefits such as health insurance, which further discourages some from looking, said Richard Johnson, Director of the Program on Retirement Policy at The Urban Institute in Washington.[No, actually, they are allowed to continue to receive Medicare for a very long time after going back to work. Why is Johnson giving interviews about something he doesn't understand?]
• "If you provide incentives to people to go back to work, they do that," Barry Lundquist, President of The Council for Disability Awareness, a non-profit organization which advises disabled workers.[Lundquist advises disabled workers but doesn't know about the abundant work incentives that already exist? Maybe, they don't go back to work despite the incentives because the definition of disability used by Social Security assures that they're just too sick.]

     The drumbeat of articles along this long don't happen by accident. They are promoted by some entity or entities. The same ill-informed people keep getting quoted again and again. At least, they seem very concerned that work incentives be added to the Social Security disability programs. Adding another work incentive to the long list of work incentives that already exist would mostly be harmless.

We're Doing A Poor Job Of Helping Disabled Young People Make The Transition From School To Work

     From a recent report by the Government Accountability Office (GAO):

The Social Security Administration’s (SSA) primary approach for encouraging employment for transition-age youth (ages 14 to 17) with disabilities who receive Supplemental Security Income (SSI) is work incentives that allow them to keep at least some of their SSI benefits and Medicaid coverage while they work. But few transition-age youth benefit from these incentives. ... The work incentive targeted specifically to younger SSI recipients is the Student Earned Income Exclusion (SEIE), which allows income to be excluded from benefits calculations if a recipient is a student under age 22. However, less than 1.5 percent of all transition-age youth — and generally less than half of those with earnings —benefited from SEIE in 2012 through 2015. ... Data also show that almost no youth benefited from other incentives that allow them to exclude earnings used for specific purposes, such as the Impairment-Related Work Expenses incentive. The effectiveness of SSA-administered work incentives may be further limited because, according to SSA and other officials, youth and their families are often unaware of or do not understand them, and may fear that work will negatively affect their benefits or eligibility. ... 

SSA does not have a systematic way to connect transition-age youth on SSI to state Vocational Rehabilitation (VR) agencies that provide training and employment services under the VR State Grants program administered by the Department of Education (Education). Although youth receiving SSI are generally presumed to be eligible for VR services, GAO found that less than 1 percent had an open VR service record in 2015 in four of the five states from which GAO collected VR data. ...

We recommend that the Acting Commissioner of the Social Security Administration take the following actions: 

1. Analyze the SEIE data to determine why a large proportion of transition- age youth on SSI with reported earnings did not benefit from the SEIE and, if warranted, take actions to ensure that those eligible for the incentive benefit from it. 
2. Analyze options to improve communication about SSA-administered work incentives and the implications of work on SSI benefits, with a goal of increasing understanding of SSI program rules and work incentives among transition-age youth and their families. This should include, but not necessarily be limited to, updating SSAs procedures for staff meeting with SSI applicants, recipients, and their families to regularly and consistently discuss – when applicable—how work incentives can prevent reductions in benefit levels and how work history is considered during eligibility redeterminations. 
3. Work with the Secretary of Education to determine the extent to which youth on SSI are not receiving transition services through schools that can connect them to VR agencies and services. 
4. Explore various options for increasing connections to VR agencies and services , including their potential costs and benefits. One option, among others, could be to expand the Ticket to Work program to include youth.

     The report addresses an important topic. I have a few thoughts on this:

• Transition services are vitally important to disabled youths who are about to leave school. I have seen far too many cases where young people who urgently needed VR had no idea that VR exists. When I see clients in this situation, I tell them and their parents about VR but, of course, most disabled young people never see a Social Security attorney.
• Some years ago, at least in North Carolina, schools worked with VR to identify disabled young people in need of help and made sure they were offered that help. That seemed extremely effective. That's not happening now. (What about other states?) I'm pretty sure the problem is lack of VR funding. I'm not sure why the school systems don't at least give the disabled young people and their families the phone number for VR although as I discuss below state Vocational Rehabilitation may be of only limited value at this point.
• Sheltered workshops are a vital part of vocational rehabilitation for disabled young people trying to make the transition from school to work. Sheltered workshops have almost completely disappeared in North Carolina. I'm pretty sure it's due to lack of funding. (What about other states?)
• What I've seen over the last decade or two is declining effectiveness of North Carolina VR. They seem to be able to do little other than pay for community college courses. Disabled young people trying to make the transition from school to work typically need far more help. (What about other states?)
• Social Security's work incentives are far, far too complicated. That's not the agency's fault. Congress wrote the work incentives, not Social Security, but don't expect simplification to help much. There's plenty of evidence that work incentives have little value.
• Social Security lacks funding to do much to help disabled young people making the transition from school to work. I suppose the agency could send out mailings but they would need additional appropriations to do anything more. I think the money might be better spent elsewhere.
• I think additional funding for VR along with provisions requiring VR to coordinate with school systems would work better than anything the Social Security Administration can do.
• Finally, don't expect miracles. Most disabled children won't work on a regular basis no matter what anyone does. Many people who work at the Office of Disability Adjudication and Review (ODAR) or who represent claimants get the mistaken impression that almost all children receiving SSI benefits have psychiatric or cognitive impairments that are of less than overwhelming severity. That's because that group is vastly over-represented in the population requesting hearings on SSI child disability claims. Most disabled children on SSI have physical problems and most of those problems are so overwhelming that the disability claims are approved quickly. Work is unlikely to ever be in the picture for most of these children. Many of those suffering from psychiatric disability have schizophrenia. While Social Security is denying too many schizophrenics, it's still a fact that most schizophrenia claims are being approved fairly quickly. The vast majority of schizophrenics won't be able to work no matter what anyone does for them.

This Is The Best You Can Come Up With?

This is from the website promoting the Ticket to Work program:

Today we are featuring Terry Anderson, a single mother who celebrated one of the most important anniversaries of her life. She has been cancer-free for four years! As an active person who believes that employment is important to her health and well-being, Terry was anxious to return to work when she began to feel better.

She was also concerned about being “51 in a 20-something workforce.” It had been years since she had to apply and interview for a position. Naturally, she felt out of practice and nervous. Terry sought help from Iowa Workforce Development Center, one of many One-Stop career centers known for the array of employment support services they offer clients in a single location. Through the Ticket program, Iowa Works helped Terry coordinate career preparation and a job hunt. “They offered workshops on interview skills”, she says. “I had my resume refurbished. I learned fresh job-hunting strategies and new computer skills! At first, I was too proud to ask for help. I’m glad that I did.”

     Good for Ms. Anderson but is this the best example that Ticket to Work can come up with?  I don't know what residuals Ms. Anderson has from her cancer but this blurb mentions none. If  her residuals, like those of most cancer survivors, are only of the "different outlook on life" type she should have been cut off Social Security disability benefits at least three years ago. I'm glad she's in remission and I'm glad she got some help in redoing her resume and brushing up on her interview skills but, honestly, it's quite unlikely that the help she got from Ticket to Work was crucial to her return to work. If this is the best proof that can be mustered to show the value of Ticket to Work, it's pretty clear that Ticket to Work doesn't come close to paying for itself.

Ticket To Work Not Working

     From the Washington Free Beacon:

The Social Security Administration has spent $3 billion on programs designed to incentivize disability recipients to go back to work over the past 16 years. So far, less than 3 percent of beneficiaries have signed up, with "no consistent evidence" the program has helped participants find a job. 

The inspector general for the agency released an audit last week calling for Congress to evaluate the "viability" of the programs 

including Ticket to Work and Self-Sufficiency (TTW) and Achieve Self-Support (PASS)."SSA has spent about $3 billion administering two ongoing congressionally mandated return-to-work programs and a time-limited demonstration project designed to determine whether a policy change would help beneficiaries return to work," the inspector general said. "However, these programs and demonstration project enticed a small percentage of disabled individuals to return to work." ...

Since it began in 2000, the TTW program has cost $2.8 billion and enrolled 1.2 million disabled welfare recipients, a participation rate of only 2.6 percent. Those beneficiaries have saved the government approximately $5.9 billion. For each beneficiary served, the government spent $2,300 through the program, as opposed to the average $5,000 benefits forgone. ...

      You might say that this shows that even though TTW is only minimally successful that it still more than pays for itself but the problem is that it is more than possible that the vast majority of those “helped” by TTW would have gone back to work on their own. To what extent are TTW providers helping people who wouldn’t otherwise get back to work and to what extend are TTW providers just profiting from people who don’t need their help? We just don’t know. Any advantage from TTW is, at best, unproven. The problem with all the efforts to get Social Security disability recipients back to work is that they are premised upon a deep seated belief that it’s easy to get on benefits. It’s not. It’s terribly difficult to get on disability benefits. As sick as people have to be to get on Social Security disability benefits, we shouldn’t expect many to go back to work.

Social Security Seeks Ticket To Work Input

     From today's Federal Register:

We are soliciting public input on whether and how we might revise the current Ticket to Work program rules. The Ticket to Work and Work Incentives Improvement Act of 1999 established the Ticket to Work program to allow individuals with disabilities to seek services to obtain and retain employment in order to reduce dependency on cash benefit programs. In creating the program, Congress found that eliminating barriers to work and providing individuals with real choice in obtaining services and technology to find, enter, and maintain employment can greatly improve the short and long-term financial independence and personal well-being of our beneficiaries. We want to explore improving our Ticket to Work program as part of our ongoing effort to help our beneficiaries find and maintain employment that leads to increased independence and enhanced productivity. If we propose specific revisions to our regulations, we will publish a notice of proposed rulemaking (NPRM) in the Federal Register.

When Will They Ever Learn?

     From a "Policy Futures" paper by Kathleen Romig for the Center on Budget and Policy Priorities (CBPP):

The October 2015 budget agreement extended the solvency of the Social Security Disability Insurance (DI) trust fund into 2022 and renewed the Social Security Administration’s (SSA’s) authority to conduct demonstration projects, allowing the agency to test ideas to encourage work among DI beneficiaries and applicants.  This creates an opportunity to build further evidence on the efficacy of various ideas to encourage work among this population. 

New demonstrations will likely produce only limited results, however.  SSA has conducted many work-incentive experiments over the past 25 years, and none has led to a significant number of beneficiaries earning enough to support themselves and leave DI.  This result should not come as a surprise.  DI’s eligibility criteria are strict.  Few DI beneficiaries are able to work.  Still fewer are likely to be able to return to self-supporting work on a sustained basis. ...

TABLE 1

SSA Work-Incentive Experiments Have Shown Only Limited Results
Demonstration	Years	Description	Effects
Benefit Offset National Demonstration (BOND)	2009-2017	Testing a $1-for-$2 benefit offset for earnings above SGA level, with additional work supports for “Phase 2” beneficiaries	Small effects on earnings (Phase 2 only) Increased benefit payments
Accelerated Benefits Demonstration	2004-2011	Provided health care to DI beneficiaries during 24-month waiting period for Medicare, with additional medical and work supports for “AB Plus” beneficiaries	Improved health outcomes Negligible effect on employment For AB Plus, greater use of return-to-work services, but some evidence employment effects are temporary
Mental Health Treatment Study	2003-2011	Provided medical and employment supports to beneficiaries with schizophrenia or affective disorders	Improved employment and earnings Improved mental health status No impact on earnings above SGA No impact on benefits
Benefit Offset: Four-State Pilot	2003-2009	Replaced “cash cliff” with a $1-for-$2 offset for earnings above SGA level, with additional work supports	Small increase in earnings above SGA No effect on mean earnings No effect on employment Effects varied by participant subgroup
Youth Transition Demonstration	2001-2014	Waived SSI income and asset rules, provided state-designed employment and education supports for young DI and SSI beneficiaries	Little to no effect on employment and earnings SSA periodically revisiting outcomes
Ticket to Work	1999-present	Provides vocational rehabilitation and work support from employment networks (Ticket to Work is a change in law, not a demonstration)	Increased use of return-to-work services Little effect on employment Little effect on benefits
State Partnership Initiative	1998-2006	Tested variety of state-designed interventions, including Medicaid waivers and employment services for DI and SSI beneficiaries	Small and mixed effects on employment No effect — or negative effect — on earnings
Project NetWork	1991-1999	Offered intensive outreach, work-incentive waivers, and case management services to DI and SSI applicants and recipients	Small short-term effect on earnings No effect on benefits

National Council on Disability Report

The National Council on Disbility has completed a report on The Social Security Administration's Efforts to Promote Employment for People with Disabilities: New Solutions for Old Problems. The report recommends:

• Better customer service at SSA
• Improve the Ticket to Work program by including claimants whose conditions are expected to improve
• Better benefit planning for Social Security disability recipients who want to return to work
  
• Reduce the number of work related overpayments to claimants
• Eliminate the marriage penalty [for Disabled Adult Children beneficiaries? The report talks about a marriage penalty in SSI, however.]
  
• Change the "cash cliff" to a ramp when disability recipients return to work
  
• Consider rules that would allow SSI recipients to accummulate assets
• Reduce the complexity of the rules affecting return to work
• Make improvements in Medicare to encourage return to work
• Allow traditional Vocational Rehabilitation to participate in Ticket to Work
• Possibly allow Department of Labor Career Centers to receive reimbursement for helping beneficiaries under the Ticket to Work program
• Get the Department of Education more involved in transition planning for disabled young adults who are about to leave school
• Expand the Student Earned Income Exclusion and Program for Achieving Self Support efforts
• Consider the possibility of changing the tax laws to add a disabled person tax credit
• Develop an outreach program to small and mid-sized businesses to encourage more employment of the disabled.
  

Witness List For Social Security Subcommittee Hearing

      Here is the witness list for the September 14 hearing before the House Social Security Subcommittee, with a little information about each witness:

• Richard Burkhauser, Ph.D., Professor, Cornell University, Ithaca, New York, and Adjunct
  Scholar, American Enterprise Institute -- has written a book recommending raising the early retirement age 
• David C. Stapleton, Ph.D., Director, Center for Studying Disability Policy, Mathematica Policy Research -- works for a contractor which is making lots of money off the failed Ticket to Work program. 
• Marty Ford, Director of Public Policy, The Arc of the United States, on behalf of the Consortium for Citizens with Disabilities Social Security Task Force -- an advocate for Social Security disability benefits recipients 
• Daniel Bertoni, Director, Education, Workforce, and Income Security, Government Accountability Office -- Believes that "the criteria the agency uses to make decisions about eligibility for benefits may not sufficiently assess the work capacity of individuals in the 21st century" but cannot give a coherent explanation of what he means. Did a report showing that the Ticket to Work program is a complete failure and then recommended "more oversight" rather than killing off the program. 
• Jill Houghton, Executive Director, US Business Leadership Network -- long history of promoting Ticket to Work.
• Nadine Vogel, Founder and President, Springboard Consulting, Mendham, New Jersey, on behalf of the Society for Human Resource Management -- mother of disabled child who speaks on special needs planning for disabled children 

     I suppose we can take it that the Subcommittee will hear extensively of the wonders of Ticket to Work despite the overwhelming evidence that Ticket to Work is a waste of money. Our representatives in Congress desperately want to hear from people who tell them that large numbers of people drawing Social Security disability benefits can be rehabilitated and returned to work. They are willing to spend great gobs of money pursuing this pipe dream so, of course, people appear who are willing to tell them what they want to hear can be found.

CCD Lays Out Its Agenda

Groups are already laying out their agendas for what they expect to be a Democratic party ascendancy to come next year. The Coalition for Citizens with Disabilities (CCD) is the major umbrella group representing just about all groups of any consequence who advocate on behalf of the disabled. The CCD has issued a Statement of Principles on work incentives and other issues affecting Social Security's disability programs. I am sure that the CCD would be happy to get any of this enacted this year -- and it is possible that a little could be enacted this year -- but mostly this is the CCD agenda for the next Congress and the next President. This deserves close attention. In my opinion, much of this is likely to become law if Democrats capture the White House as well as larger majorities in both Houses of Congress, something which looks likely at the moment.

Here are what I think of as the major points from CCD's statement of principles:

1. No change in Social Security's definition of disability, nor anything designed to force disabled people back to work, such as time limited benefits;
2. An increase in the earnings limits for Supplemental Security Income (SSI);
3. Changing work incentives in Title II of the Social Security Act so that the disabled lose one dollar for each two dollars they earn;
4. An indefinite presumptive disability status for those whose disability benefits end due to return to work;
5. Allowing health insurance expenses to count as Impairment Related Work Expenses;
6. Improving the ability of child SSI recipients to make the transition to work;
7. Eliminating the five month waiting period for Disability Insurance Benefits;
8. Improving Ticket to Work;
9. Improving tracking of earnings for disabled people who return to work to help avoid large overpayments;
10. Eliminating the 24 month waiting period for Medicare;
11. Allow premium fee access to Medicare for beneficiaries who return to work;
12. Allow individuals to get on Disabled Adult Child (DAC) benefits despite some work activity after becoming 22 years of age;
13. Exempt DAC recipients from the family maximum if they live outside the family home;
14. Eliminate the DAC marriage penalty;
15. Improve the minimum benefit;
16. Repeal the seven year prescribed period for disabled widows and widowers; and
    
17. Increase disabled widows benefits

I cannot understand why the CCD does not want to pull the plug on Ticket to Work. It is nothing but a bottomless money pit. Merely sounding like it would be a good idea does not make it a good idea.

I cannot understand why CCD would talk about improving disabled widows and widowers benefits, but not mention ending the actuarial reduction in disabled widows and widowers benefits. Is it possible that CCD does not understand the actuarial reduction? I know that the phrase "actuarial reduction" sounds like it must be something impossibly complicated. Let me make it simple. The younger the disabled widow or widower is when he or she goes on benefits, the less he or she receives in disabled widow or widower benefits. Does it make sense to penalize people for becoming disabled at an earlier age?

The Mirage Of Rehabilitation As A Solution For Disability

The Government Accountability Office (GAO) has just released a study it has done on the effects of Vocational Rehabilitation (VR) on Social Security disability benefits recipients. The results are not encouraging for those who believe that rehabilitation holds dramatic promise for reducing the number of people drawing Social Security disability benefits. VR is clearly of only modest benefit. Once the costs of VR are figured in, it hardly pays for itself, even without considering the often transitory effects of VR.

The only rational response to this study should be to eliminate the Ticket to Work program. Ticket to Work is only of limited value. There are much better ways to spend that money. The program has never been based upon much more than the naive dreams of people who know little about those who receive Social Security disability benefits. The response that has traditionally been given to this dream by those with first hand experience with Social Security disability recipients has been along the lines of: "If you require claimants to be half dead or seriously crazy to get on benefits, why would you expect many of them to go back to work?" It is a simple question, but the proponents of Ticket to Work have never had a good answer for it.

Here is a summary from the GAO report:

• Earnings outcomes were mixed in the year following VR [Vocational Rehabilitation] and also over time. Approximately 40 percent of the over 303,500 SSA disability beneficiaries in our study increased their earnings compared to the year prior to VR services, while 32 percent did not have any earnings and another 28 percent had fewer earnings. In comparison to DI [Disability Insurance Benefits] and concurrent beneficiaries, more SSI beneficiaries—42 percent versus 36 and 39 percent—increased their earnings in the year following VR. Of the disability beneficiaries who exited VR in fiscal year 2000, 33 percent sustained some level of earnings through 2004, although their median earnings decreased by 12 percent over this period.

• Most beneficiaries’ annual earnings remained below annualized SGA [Substantial Gainful Activity, which would be enough earnings to eventually cut off benefits] in the year following VR. Specifically, 88 percent of all disability beneficiaries in our study had annual earnings below annualized SGA in the year following VR. Only a small percentage (5 percent) of beneficiaries from each cohort had annual earnings just below annualized SGA (i.e., earning over 75 percent of, but less than annualized SGA) in the year after VR. However, this does not provide evidence that beneficiaries either were or were not “parking”—i.e., deliberately remaining just below program income limits to retain benefits. Because SSA did not collect monthly earnings for DI beneficiaries during the timeframe of our study, we used annualized earnings for both DI and SSI beneficiaries, thereby limiting our ability to determine the extent of “parking” on a monthly basis.18 For beneficiaries who had earned income in the year after VR, their median annual earnings were $4,476.

• Some beneficiaries in our study earned enough to have their benefits reduced in the year after VR, resulting in decreased DI and SSI program expenses. Benefit reductions from DI and concurrent beneficiaries in our four cohorts who did not receive DI benefits for 1 or more months due to work in the year after VR resulted in an estimated reduction in DI benefit payments of over $106 million. The average annual reduction in DI benefits due to work was $26.6 million. Of the 70,302 SSI and concurrent beneficiaries in our study who had earnings gains from the year before VR to the year after VR, almost 50,000 (71 percent) had a reduction in their SSI benefits. However, we were unable to reliably estimate SSI benefit reductions for SSI and concurrent beneficiaries because SSI benefit amounts can be affected by other factors besides earnings increases (e.g., changes in unearned income, spouse’s income, etc.), and, due to data limitations, we could not isolate the effect of beneficiaries’ earnings increases on their SSI benefit levels.

• For the 2000 and 2001 exit cohorts, 10 percent of beneficiaries were able to leave the rolls at some point by 2005; however, about a quarter of those who left also returned for at least 1 month. While the SSI program saw the most departures, the lower rate of DI and concurrent beneficiaries leaving the rolls may be due to several factors. For example, DI beneficiaries are generally afforded a much longer working period before cash benefits are completely discontinued, and delays in the reporting of beneficiaries’ earnings data to SSA are much more likely to occur for DI beneficiaries. The median annual earned income for all beneficiaries leaving the rolls was $12,027.21 By way of comparison, the average annualized SGA was $9,618, and the average annualized disability benefit was $8,460 for the DI beneficiaries and $4,452 for the SSI beneficiaries in our study in the year after VR.22 Those who returned were off the rolls for an average of 16 months.

Report From SSAB On Disability Benefits

The Social Security Advisory Board has published a report entitled "A Disability System For The 21st Century." The report concerns the Holy Grail of Social Security disability benefits -- rehabilitating far more people so that they can get off Social Security disability benefits or, better yet, never get on benefits in the first place. As in the Arthurian legends, the quest to return the disabled to work is a noble undertaking, but like the quest for the Holy Grail, no one ever seems to find the path that leads to the prize.

So far, the quest for rehabilitation has brought about mandatory referrals of Social Security disability recipients to Vocational Rehabilitation, the Trial Work Period, the Extended Period of Eligibility, the PASS program, the end of the minimum disability benefit, expedited re-entitlement, the Ticket to Work program, etc. None of this has worked to any appreciable extent. There are no examples that I am aware of from other country in which rehabilitation programs have had any significant effect upon Social Security disability programs. Private disability plans have shown what appears to be dramatic success, but once you look closer, it becomes obvious that these plans have only used rehabilitation as a tool to harass disabled people and to cook up justifications for stop benefits, with no meaningful rehabilitation accomplished.

Below, I will give my opinion why these efforts are doomed. What follows immediately are some excerpts from this report:

The Social Security Act equates disability with inability to do any substantial work. This core definition is as old as the program itself. It was adopted at a time when attitudes about the capabilities of people with disabilities were markedly different than they are today. As the Board pointed out in the 2003 report, The Social Security Definition of Disability, the definition was adopted for a program that was limited to individuals approaching retirement age, and the program was explicitly viewed as representing a kind of early retirement. It was adopted by a Congress that could not have foreseen the great advances that would take place over the next fifty years in medical science, adaptive technology, and rehabilitative practice and therapy.

... [I]n the extensive study the Board has undertaken since 2003, the Board has also heard concerns expressed about what it would mean to modify the definition of disability used for Social Security programs. Changing the definition could result in narrowing eligibility in ways that would exclude individuals who have no alternative but to depend upon the benefits those programs provide or could result in broadening eligibility so as to increase the costs of the program and provide benefits to individuals beyond the currently intended scope. We recognize the validity of these concerns. It is our purpose in this report to suggest neither that the existing disability programs should provide coverage more broadly nor that they should be contracted to prevent individuals who are unable to engage in substantial work from receiving their benefits. The problem that we see is in the way in which those programs are, or rather are not, integrated into an overall approach to disability that supports the aspirations of people with disabilities to achieve their maximum potential. Correcting this problem will require a statutory change to define disability in a way that encompasses such an integrated approach. ...

One question that might arise is whether such decreased expenditures or possible savings, or much of them, could be achieved by doing a better job of screening applicants for disability benefits so that those who have the ability to work do not become beneficiaries in the first place. Similarly, will doing a better job of rehabilitating those on the rolls so that they stay on for a shorter period result in large savings? Although these are logical questions, the answer to both is no. Certainly, every effort should be made to make initial eligibility determinations accurately. And, certainly it is worthwhile to try to support and encourage rehabilitation efforts by those who do find themselves on the disability benefit rolls. However, past experience has shown that these approaches are largely ineffective and are likely to remain so. The reason is that by the time an individual applies for disability benefits and, even more so, by the time he or she is actually placed on the benefit rolls, the best opportunity for restoring or retaining the capacity for self-support has already been lost. In the absence of a disability system designed to manage toward self sufficiency, the realistic possibilities of someone with a work limitation remaining productive begin to fade. The process itself tends to make an individual who might have been able to work at an earlier point in time less and less capable of doing so. Attachment to an employer, the maintenance and improvement of skills, the sense of belonging to the workforce, the mindset that work is possible—the loss of all of these factors, combined with the passage of time and with the program requirements that reward inability to work, conspire to transform a person from an “impaired individual” with potential into an individual who, in fact, has come to meet the definition “unable to work.” ...

We believe that it is time to set aside old paradigms and look more broadly at what is possible. Clearly, a shift in public policies is needed to sustain the employment of people with disabilities. It is time to reexamine our national disability programs with a view to investing in human capital — our most valuable asset. A new disability system must incorporate elements that embrace change and:
• provide assistance and support to individuals and strive to maximize employment outcomes to the extent of each individual’s capabilities;
• facilitate a culture shift within society to establish the expectation that individuals with disabilities can and should work to the extent of their capabilities and that society should assist individuals with disabilities in that endeavor;
• recognize and accommodate the dynamic nature of disability and its sometimes cyclical impact on work capacity; and
• facilitate rehabilitation and employment by coordinating and integrating the various sources of assistance and support that are now inconsistently provided by multiple uncoordinated programs.

So why will none of these noble ideas advanced by the SSAB work? First of all because they are incredibly fuzzy. The SSAB says that a new definition of disability is needed, but cannot give any idea what the new definition of disability would look like. They deny that they want to approve or deny more claims, but any change in the definition of disability will inevitably result in a change in who gets approved. If there is no effect upon who gets approved, what is the point in making a change? The SSAB wants more emphasis on rehabilitation, but where is the evidence that more emphasis on rehabilitation will do anything other than waste money? Why would this rehabilitation effort be any more effective than what already exists? The SSAB wants to divert people who want to file claims for Social Security disability benefits into rehabilitation before they even get a chance to file a claim, but how do these people support themselves while they are awaiting the miracles of rehabilitation? The SSAB has noble ambitions but no answers to any of these questions.

The basic problem is that the well-intentioned people writing reports such as this have little idea of who applies for disability benefits. Those who write such reports live in a nice well-educated middle class world where they seldom interact with Social Security disability claimants. When they think of disabled people, they think of automobile accidents and wheelchairs, but automobile accidents and wheelchairs are not nearly as commonly the cause of disability as other health problems, such as schizophrenia and osteoarthritis. The scourge of schizophrenia is invisible to most people in this country and osteoarthritis seldom disables people who work in offices. Disability due to osteoarthritis happens to blue collar workers. People who write reports such as the SSAB has released know few blue collar workers and spend little time thinking about what their lives are like.

Why is rehabilitation such an elusive goal? Most of the disabled people I see professionally present at least one and usually more than one of the following problems, any one of which is likely to make rehabilitation impractical:

1. The claimant has a chronic, progressive disease such as diabetes or osteoartritis. Rehabilitating such a person is like trying to hit a moving target. By the time you get the claimant rehabilitated so that they can work with the limitations they had when they first saw you, they will be sicker and have more limitations, making all the rehabilitation efforts a waste.
2. Many, many Social Security disability claimants suffer from chronic pain. It is impossible to do much work if you are in severe pain or if you have to take narcotic medication for pain on a regular basis. There is no solution on the horizon for this problem. Rehabilitation will not make pain go away.
   
3. Most Social Security disability claimants are older. As we age our adaptability diminishes. This is a problem for which modern medicine and rehabilitation have no solution. Rehabilitation has some hope of working with carefully selected younger people. With people in their 50s, it is almost always hopeless.
4. We do not live in Lake Wobegone. All of the children are not above average and neither are the adults. A high percentage of people filing claims for Social Security disability benefits have IQs in the low average or borderline mentally retarded range. Such folks have little or no ability to benefit from rehabilitation, since they have limited learning ability.
5. In a related vein, many claimants have low educational attainments. Before they can take advantage of any rehabilitation, these claimants need to get a GED, but that can be difficult and time consuming. By the time they do this, they will probably be sicker and they will certainly be older. And, of course, the usual reasons that people fail to get a high school diploma are that they had a low IQ or were already suffering from mental illness when they were in school and those problems usually do not go away.
   
6. Many, many claimants suffer from life long nagging psychiatric problems such as depression, anxiety and personality disorders. These problems were not enough to completely exclude work, but they always made it tough. When the person had good physical health, he or she could work, although usually not too successfully. Once their health declined, they had little to fall back on. Psychiatric treatment is of only modest benefit to such individuals.
   
7. Many Social Security disability recipients suffer from major psychiatric problems, such as bipolar disorder or schizophrenia. Few people who suffer from schizophrenia work on any regular basis. That is just a fact. Many with bipolar disorder do, but there are plenty of others with bipolar who are just unable to work and all the psychiatric treatment and all the rehabilitation in the world will not return these folks to work.

In the end, even though the SSAB members are mostly conservative politically, they make the classic naive liberal mistake of believing in the perfectability of human beings.

Don't You Have To Know Something In Depth Before You Write A Book About It?

     The New York Times piece attacking the Social Security disability program was based upon the writings of David Autor of MIT. Dr. Autor can be heard speaking on a podcast of the Library of Economics and Liberty. Here are a few excerpts from the transcript of that podcast with my comments in brackets and bolded:

Host: If you are disabled and you are not working, and you are getting this benefit, what if you work a little bit? Does the benefit go down, stay the same? Or are you not allowed to work at all because you are disabled?

Autor: So, there is what is called a Substantial Gainful Activity (SGA) threshold, which a couple of years ago was $1000/month. And essentially what it means is that if you earn more than SGA, you are in theory not disabled from the perspective of the Social Security Administration. They typically will reduce your benefits. You may lose your benefits for a month if you work above SGA. If you do it frequently, your benefits will be reviewed and you may lose access to the program. You can be viewed as having recovered. ... So, you have to basically be making money under the table. The thing is not by intention but the program creates a very strong incentive against meaningfully participating in the formal labor market. ... [It appears that Dr. Autor has never heard of the Trial Work Period, the Extended Period of Eligibility or Expedited Reinstatement, all of which are Social Security work incentives, not to mention Ticket to Work or the Vocational Rehabilitation exception to the medical improvement standard. Since his basic point is that there are serious disincentives to return to work, lack of knowledge of the work incentives that do exist is a major issue. There is no evidence that under the table employment by Social Security disability recipients is a significant problem.] ...

Autor: So, the definition of disability used by the SSA [Social Security Administration] adopted by Congress in 1956 is one based on employment more than health. The substance of the definition is that you are unable to engage in substantial gainful activity in the U.S. economy for a reason of health or disability. But what it really means is that you are not able to work; and you have to demonstrate to the SSA that you are unable to work; and the reason you are unable to work has to have something to do with your health. It could be your physical health or your mental health. So, it's a very elastic definition. For example, when the unemployment rate is high, there are very few jobs; you may be unable to work because the type of health limitation you have means that the type of job you would be able to do is not available at present. And that would qualify as a disability. ... [It appears that Dr. Autor has not read the part of the Social Security Act that says "An individual shall be determined to be under a disability only if ... he is not only unable to do his previous work but cannot ... engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work."]

Autor: At present more than half of all awards are for mental disorders and musculoskeletal disorders. Mental disorders are things like nervous disorders, schizophrenia, and musculoskeletal disorders are basically back disorders.

Host: Carpal tunnel.

Guest: Yes. And those disorders are very difficult to verify. So, soft-tissue pain is difficult to prove or disprove; not observable. Obviously if you have a damaged disc in your back, that's observable. Soft tissue pain is not. ... [Musculoskeletal disorders are "basically back disorders?" I think that arthritis in the knees and broken bones and rheumatoid arthritis also qualify as musculoskeletal disorders. Damaged disks are easy to verify but schizophrenia isn't? Does Dr. Autor have any idea how ridiculous a statement that is medically? I'm pretty sure he wouldn't dismiss schizophrenia so quickly if he had any schizophrenics in his family or even in the families of any of his close friends.]

Autor: Even if population health were holding constant, there ought to be fewer and fewer people who are effectively disabled because of course the types of jobs they need to do require less and less physical capability. So, it is indeed quite surprising from that perspective that we should see an epidemic of disability. ... [Autor entirely misses the point that as the physical demands of some types of employment have decreased, the cognitive demands of almost all types of employment have increased, causing more disability for individuals who have cognitive limitations or who suffer chronic mental illness.]

Autor: ... And I believe it was 21 U.S. State Supreme Courts [who] ordered their Social Security Field Offices to stop complying with the continuing disability review process [in the early 1980s when Social Security has terminating the disability benefits of huge numbers of people]... [This is seriously fractured history. State governors ordered Disability Determination Services (DDS's) to stop doing continuing disability reviews for Social Security. A young Arkansas governor by the name of Bill Clinton was the first to do this. This was how he first drew national attention. But I digress. The DDS's are state agencies doing work under contract with Social Security. The state Supreme Courts ordered nothing. No part of any state government ordered Social Security field offices to do anything. If they had, the field offices would have ignored them. To think that State Supreme Courts could order Social Security field offices to do or not to do something is to misunderstand a fundamental principle of constitutional law, the sort of thing that I think that someone with a Ph.D. in public policy should know.]

      I understand that Autor was speaking off the cuff, but come on! There's every appearance that there are serious gaps in Autor's knowledge that go to the core of what he's talking about. Not what you would expect from an MIT economist.

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.