Jan 23, 2015

Skepticism Towards Recipients Of Government Assistance Clouds Judgment On Disability

     From an op ed piece in the L.A Times by Rourke O'Brien, postdoctoral fellow in population health at Harvard University:
[W]e must not let the rhetoric of fraud, abuse and “welfare queens” that accompanied the end of welfare as we know it in the 1990s frame the conversation [on the future of Social Security disability].
Americans generally are skeptical of individuals who receive government benefits, biased to think that they are undeserving. It may be our unyielding belief in everyone's ability to bootstrap his or her way to success through hard work or just the way we esteem self-sufficiency. In the context of cash welfare, research shows that this bias leads us to assume all benefit recipients are lazy. In the context of disability — where benefits are predicated on the existence of a qualifying health condition — our skepticism toward recipients of government assistance may influence the way we evaluate their health.
And new evidence suggests that it does just that.
As part of a nationally representative survey I conducted, about 1,000 individuals were asked to read several vignettes, each describing an individual with a health condition such as chronic back pain, depression or symptoms consistent with attention deficit hyperactivity disorder (for children).
Respondents were then asked to rate the severity of each condition and the degree to which they considered it “disabling.” Before reading the vignettes, the respondents had been randomly assigned to either a treatment or control group. After reading instructions for the study, those in the treatment group read an additional sentence noting that
individuals with disabilities may be eligible for government benefits.
The result? Respondents primed with a reference to government assistance were less likely to consider the health conditions described as severe or disabling relative to the control group. Just hinting at the existence of government assistance was enough to change their evaluation of health conditions. What's more, in follow-up questions, respondents in the treatment group were more likely to blame the individual for her health condition. ...
In efforts to paint some of those applying for disability benefits as undeserving, we tend to question both the severity and the legitimacy of the qualifying health condition. We tell ourselves they don't deserve assistance because the condition just isn't that bad, and regardless, they are to blame for their health problems anyway.


Anonymous said...

Well, in the case of smokers/COPD and obesity...even the most favorable ALJ's have a problem with that combo.

Anonymous said...

There is a fundamental problem with the survey/question.

Yes, I agree that we all tend to have bias. But let's phrase the survey differently...

Give a scenario and then ask "Do you think this person is disabled, meaning that they are unable to do ANY job?"

Anonymous said...

"Give a scenario and then ask "Do you think this person is disabled, meaning that they are unable to do ANY job?""

Except for the problem that's "any job" not the definition of disability even for people with COPD and obesity.

Anonymous said...


It's an interesting question. Should ALJ's be entitled to find claimants not credible because of what might be either a long-term lifestyle choice or legal addiction (e.g. over-eating or smoking) contributed to their disability? If so, where do you draw the line? How about a person who worked too hard in stressful situations which exacerbated a heart condition or other medical impairment?

My opinion is that engaging in that kind of credibility determination is a bad idea because it bases findings on ALJ's personal biases about particular activities instead of the law. COPD is an especially bad example because it is an incurable disease. Stopping smoking only slows its progress and smoking is often a powerful addiction.

Dan Smith said...


Don't obfuscate the COPD/smoking question by pretending that such cases are disposed of based on "the ALJ's personal biases...instead of the law". There's obviously at least some "law" behind such considerations: namely SSR 82-59.

Sympathetic to claimants' predicaments though I may be, i know i'm not the only claimant rep that doesnt want to see the rolls of this disability program filled with individuals engaging in actions that only exacerbate their disability, let alone using their benefits to subsidize that very behaviour.

Anonymous said...

Mr. Smith,

I believe you are quite wrong.
There is law indeed


and it clearly supports claimants who may be addicted to nicotine with severe or end stage COPD and any other disease. Failure to follow prescribed treatment is a rare and legally tenuous way for an ALJ to deny an appeal, or assert his bias for that matter.

Dan Smith said...

Unimpressed without an acquiescence ruling

Anonymous said...

Thoughts on this Charles?


Anonymous said...

@ 2:48

Oh wow, a what appears to be unpublished decision from a lowly magistrate in a circuit far, far away from me. Yawn.

Also, that case applied to the very tenuous and never used denial due (solely!) to failure to follow Rx'd Tx. Are you really trying to say that case implies using smoking as a credibility factor period is improper??

Anonymous said...

I have to respectfully disagree with Dan and Anon 5:02, even though I am against smoking and tobacco companies.

People with disabilities have the right to spend on what they want, just like everyone else, as long as what they are buying is legal.
When an adjudicator starts thinking, "I'm gonna deny so he can't buy cigarettes," he has strayed from the question of whether the person is disabled, and infringed on a fundamental American right, e.g. to choose how we handle our own affairs and spend our money (even if the choice in question is a bad one).

Many long-term smokers are addicted and cannot quit. Finding someone not credible for failing to stop something they are not able to stop is, to put it bluntly, cruel and illogical.

It's also ineffective. If you think that denying a nicotine addict disability benefits is going to keep them from smoking, you don't understand addiction. Ironically, by denying their claims, you will often deprive them of access to healthcare providers whose help they would need to quit smoking.

Anonymous said...

5:02 here

you're in "denied due to failure to follow..." mode still. The last part of my comment implied that using smoking, etc. as credibility factors is totally appropriate. The biggest way I see it used is when a claimant alleges he or she cannot afford their medications or treatment as an excuse for their lack of treatment or med compliance.

When I see all their meds are on the $4 list and that they smoke a pack a day (a purchase that, at least without an illegal interim act, cannot be done with assistance benefits like SNAP), I question the veracity of their allegation of inability to pay.

Also, while denying outright solely because they continue to smoke against Dr's orders is a bridge too far, I think it is fair game to say their continued smoking exacerbates their symptoms and limitations more than they would be with compliance. I make that same argument for med noncompliance and failure to follow up (when no good reason is offered for the noncomp or failure).

Anonymous said...

11:45 here again

I would agree with you but for the fact that nicotine addiction is a compulsion for many. Some people truly cannot stop and yes, would even do without proper food or medicine due to the strength of the compulsion. The smoker with COPD example is especially sad; the person knows for a fact it is killing them but still cannot stop, leaving little doubt that the compulsion is so strong they no longer have much choice.

An essential link in the logical chain of your argument is that the addicted smoker has a genuine choice between buying tobacco and getting proper food and medicine. By definition, that choice does not exist for a true addict. Their addiction compels them to get the tobacco.

Dan Smith said...


I agree that the issue of "genuine choice" forms the crux of the disagreement here. And since it wouldn't be productive to argue it further given our perspectives, let's tie this back to the original point of this post: public skepticism on the receipt of disability benefits. Is there any situation more damaging to public perceptions of disability than the (arguably overstated) contradiction of people with respiratory impairments claiming disability while still smoking? Whose perspective is Joe Taxpayer more likely to have when he sees his supposedly disabled neighbor constantly lighting them up?

Millions of Americans depend on this program for their basic needs, without any even arguable means of recovering enough to be able to work. The more we as advocates try to strecth that definition to encompass even more marginal cases, the more we jeopardize the integrity of the entire program, which is constantly under attack from certain groups for purely political purposes. At least IMO, this smoking/COPD is one place i'd draw the line.