Jul 23, 2012

GAO Report Wonders Why Computers Can't Determine Disability; Also, SSA Says Final Mental Impairment Listings To Come Out This Year (I'm Dubious) And Problems With The OIS Project

     The Government Accountability Office (GAO) has issued a report on Modernizing SSA [Social Security Administration] Disability Programs. GAO wants Social Security to take "modern views of disability." GAO thinks that "modern views of disability" would include (with my comments in brackets and italicized):
  • Incorporating criteria in the Listings of Impairments that would specify the extent to which certain impairments limit functional ability [You're naive, GAO. SSA already has residual functional capacity guidelines used at the initial and reconsideration levels. They can't put them in the Listings. They can't publish them. They don't want them in writing. They deny they exist. This is because they cannot justify them. But they do exist. They're disseminated and enforced through the quality assurance program.]
  • Finding ways of measuring functional ability [Right. Just as soon as someone manages to invent a machine that measures pain or depression.]
  • Developing "a computerized tool to assist adjudicators in evaluating how various impairments affect an individual’s function and ability to work."[GAO is saying that since computers can do such wonderful things they must surely be able to determine residual functional capacity better than individuals. You guys at GAO have never read a Social Security disability file, have you?]
  • Understand that "Modern concepts focus on an individual’s functional abilities in the workplace environment, including consideration of the presence or lack of assistance, for example, per the requirements for reasonable accommodation by the Americans with Disabilities Act of 1990." [Social Security has rejected the reasonable accommodation route. You're not getting around this without legislation. Even if legislation were passed, I don't think anyone can say how SSA could incorporate reasonable accommodation into disability determination. Even though the ADA was high-minded, it was terrible vague. It's been interpreted nearly out of existence by the Supreme Court. In the real world, the ADA has meant little. Also, if you put reasonable accommodation into the Social Security Act, you might have to amend the ADA to make it really mean something and we know that business interests would fight that tooth and nail.]
     The report contains the statement that "SSA issued a notice of proposed rulemaking to revise its listings of mental disorders in 2010 and has told us that it plans to finalize this comprehensive revision by the end of 2012 ..." We shall see. It's late July  and Social Security still hasn't submitted this to the Office of Management and Budget (OMB) for approval. Once they do, it will take OMB three months or so to study it and it's far from clear that OMB sees eye to eye with Commissioner Astrue on this. Maybe they think they can get the mental impairment Listings approved and published after the election but I have a hard time seeing OMB approving any final rule on this with Michael Astrue's term as Commissioner about to expire unless the new Listing is exceedingly non-controversial. If the final rule was to be exceedingly non-controversial, I think it would have already happened. I think this one will still be on the desk when the next Commissioner arrives sometime next year.
     The report also indicates that Social Security is having problems coming up with a sufficient budget to pursue its Occupational Information System (OIS) project. The project is being delayed due to lack of personnel. The full extent of the problem is unclear since Social Security seems to have little idea how much the full program is going to cost. According to the report:
Without any estimate for the cost of producing the OIS, SSA risks designing a system that would not be a viable or affordable option to complete. Additionally, without maintenance cost estimates, SSA is at risk of designing a system that would be too costly to maintain on a regular basis resulting in outdated information.
     GAO says that Social Security could face "broader challenges" to its OIS project but that SSA "has not done a formal risk analysis of these challenges." According to GAO, these risks include:
  • SSA’s lack of expertise with designing an OIS
  • Cost of maintaining an OIS
  • SSA's history of difficulty managing large, multiyear projects
     OMB should mention but does not the even bigger issue of the legal defensibility of whatever the OIS project produces. Social Security seems to be a bit nervous about this issue. I think they should be extremely nervous about this issue. How does it look if SSA spends several years and a few hundred million dollars on the OIS project and it all goes up in smoke in federal court? Can anyone say there is no risk of that happening? Can anyone quantify that risk? Can anyone predict the fallout if that happens?


Anonymous said...

GAO has never made a serious effort to understand the Disability program, and thus their reports have been--and continue to be--superficial and largely worthless.

Anonymous said...

While SSA technology is certainly not exceptional, technology is not the main issue in my view. Manpower is the problem. End of story.