May 8, 2009

Room For Debate?

Some excerpts from the Room for Debate blog at the New York Times:
From "The Editors":
The 2010 budget unveiled on Thursday by the Obama administration estimates that the government can generate huge savings if it devotes more resources to eliminating fraud, abuse and waste in Medicare, Medicaid and the Social Security disability insurance program. ...

In the Social Security program alone, the White House proposes to spend $4.3 billion over five years to fight fraud associated with disability claims — a problem, officials say, that stems from lack of oversight. Federal spending on disability insurance leaped 65 percent from 2001 to 2007, “yet the number of full medical reviews, one type of review for evaluating claims for eligibility for continuing disability payments, fell from 840,000 in 2001 to 190,000 in 2007, according to the Social Security Administration,” as The Wall Street Journal reported this week.

From Jennifer L. Erkulwater, an associate professor of political science at the University of Richmond, and the author of “Disability Rights and the American Social Safety Net”:

Before we go looking for miscreants cheating the disability programs, it is important to realize that the growth in the Supplemental Security Income and Disability Insurance programs is perfectly understandable given bipartisan policy changes made two decades ago and current limits on what the Social Security Administration can do to ferret out fraud.

Between 1984 and 1990, Congress and the S.S.A. loosened the disability requirements, especially for children and people suffering from mental disorders. The agency also agreed that it would no longer cut off recipients it thought were “no longer disabled” unless it could show that their medical condition had improved, something that is exceedingly difficult to do. As part of welfare reform in 1996, Republicans in Congress did manage to tighten disability standards somewhat.

From Gary Burtless, a former Labor Department economist who now works at the Brookings Institution:

The federal government can certainly reduce the disability rolls and the cost of the disability program by conducting more frequent and tough-minded reviews of recipients’ disability status. There will be collateral damage, however. The reviews will impose real hardship on some disabled workers whose cases are reviewed.

It makes sense to conduct the reviews, but it would be sensible to focus reviews on workers with medical conditions that are most likely to improve. Resources should also be concentrated in parts of the country where statistics suggest that error rates are highest.

From Morley White, an Administrative Law Judge in Cleveland:
... I do not believe that there is as much fraud as the press and the public believe ...

I have advocated for a long time that the government needs to have its own representative in these hearings. I do not advocate making the hearings adversarial, but that government attorneys act as an ombudsman, charged with the duty of getting the pertinent facts.
Nice debate. "The Editors" know little, Gary Burtless knows nothing, Professor Erkulwater presents an argument that ignores the clear evidence that disability policy during the Reagan years was an aberrational nightmare rather than a Golden Age and Judge White, who actually has good knowledge about Social Security disability, decides to use his space to promote a hopeless cause that has little to do with the subject at hand.

Update: The Times has added two additional pieces to this "debate." One is from a disability examiner in North Carolina. His piece seems to have been edited into near complete incoherence. I am sorry for the author, because he might have had something useful to contribute. The other piece is from what I will refer to as a "disability denier," that is someone who feels that everyone can work. "Disability deniers" believe that the only reason that people are "disabled" is because of societal discrimination. With enough government funds, especially funds given to people like the "disability deniers", almost everyone on Social Security could be returned to productive employment. "Disability deniers" seem to believe that almost everyone who is disabled is in a wheelchair. Hey, a wheelchair is used as a symbol for disability, isn't it? Yes, I exaggerate the man's position, but not by much. The "disability deniers" are responsible for the Ticket to Work fiasco. Of course, their position would be that Ticket to Work failed because it was not given an adequate test, that more money for research is desperately needed. Baloney. The credulous usually believe that the "disability deniers" are important experts. I would really like to sit some of these "disability deniers" down with a roomful of Social Security disability recipients so that they could hear about the effects of chronic pain, chronic fatigue and chronic mental instability on ability to work. They might learn that people in wheelchairs are only a small fraction of the disabled population and that issues affecting them have little to do with the lives of most disabled people.


Anonymous said...

ALJ White's suggestion is far from irrelevant. When you have a few ALJs churning out 2500 decisions a year with a 90 percent approval rate, you know people are getting on the rolls who shouldn't be there. Having a government rep at the hearing would temper the enthusiasm of these folks and/or help identify cases that need own motion review by the Appeals Council. Preventive medicine, in other words.

Anonymous said...

So I guess you are the only one with all the answers?

Nancy Ortiz said...

You know, our blogger *may* know a great deal more from a practical standpoint than many observers. He certainly knows more that I do, despite my SSA experience. What I note is the ALJ's remark that fraud is overstated. I agree because in 32 years of DIB claims work I have seen only one really clearcut case of fraud--it was a doozy. A referral from the CA Insurance Commission regarding a class A con-man with video by our IG's agents, medical testimony, etc. The ALJ loved this guy because the con man was a Vet (sure he was!) and so was the somewhat dotty ALJ. Put him back on. Oh well.

Any other ALJ would not have reinstated him. Our bad guy went back to LA where he is apparently back in the slip/and/fall business and doing quite well. Problem--1)dotty ALJs. 2)Fraud is an intent crime and it's hard to prove. This guy was never tried by a jury, and in CA would probably have gotten off. The Carter Administration tried CDR's and quit. Suicides don't make good headlines. So did Reagan. But, in the 80's, people didn't seem to care either about suicides or the homeless people being cut off created. Now, I don't know.

I notice they're still going to do work CDR's which make more sense. However, Obama is giving cover to Congress which won't touch this with a stick. The idea of defined periods of disabililty together with permanent payouts on the WC model is one everybody hates. Gee! Wonder why? But, the idea you're gonna save gobs of bucks by doing CDR's and collecting the resulting OP's is just plain meschugennah.

Anonymous said...

So it seems once again that the only changes in the disability process that you agree with are those that put more money in the pockets of claimant representatives.

Be honest about it for once. What you really want is a system in which a great many claims are filed and denied by the DDSs, then appealed to the ALJs, where you want high allowance rates so you can grab you slice of the pie.

Any other considerations (such as reducing program costs, thereby saving taxpayer dollars) are always mocked by you.

You will support more staff in the DDSs (so they can run more cases through the process) and you will support more ALJs (so more cases can be heard and allowed), but you won't support any tightening of the rules or any other form of efficiencies. You rail against "backlogs," which seems like a concern about program efficiency, but which is really a cover for your real agenda: push more cases through the process faster so you can get a bigger piece of the action.

Nancy Ortiz said...

If A#3 is addressing me, I answer that only the claimants have the right to determine who should file. And, the process itself has never been perfect, nor will it ever be. Consequently, to pay claimant's representatives is necessary. As to the moans of those who regard payroll taxes and benefit payments as the only barriers between them and limitless weath, I have nothing to say.

However, I note a completely unreasonable prejudice against both the claimants and their representatives is fairly commonplace. The payroll taxes are the same no matter how much SSA pays out in benefits. Income taxes are not affected. And, lawyers who have to wait two or three years for their small fees are scarcely a menace to society or the grasping, greedy fee ogres some suppose them.

As to the definition of disability, it would be unwise to assume that I or anyone else writing here endorses or accepts every jot and tittle of the definition of disability or definable medical conditions listed in the act. I could sing you quite a long song about the insanity of the definition of "personality disorders" and their inclusion in the act. But, that is not your complaint. You may think, as many do, that every nickle of the Trust Funds paid out comes directly out of your own resources. It doesn't hurt you one bit, you know. It would be good to reexamine your thinking on this matter. For more information on Social Security and its financing, take a look at Angry, a blog coming from UC Berkeley from academics and economists. It is quite enlightening from many perspectives