Apr 21, 2017

Why So Much Disability In Rural Areas?

     I'm not sure exactly what The Center for Michigan is but they have posted a long piece about the high rate of disability in poor regions of the state. You wonder if they, unlike the Washington Post, have their numbers right.
     As I've said before, the high rate of disability in poor rural areas is nothing new. It's been a prominent fact for me since I started in the private practice of law in 1979. It's where my clients are clustered. As I've also posted, I see nothing surprising in this. Younger, healthier, smarter, better educated individuals leave poor rural areas to find jobs in urban areas. The population left behind is on average older, sicker, less smart and less well educated. These are all factors that lead to higher rates of disability. People who live in poor rural areas have poor access to health care. Poor access to health care also predisposes to disability.
     The subtext of pieces such as this is that these people aren't really disabled; they're just poor. And all these poor people who aren't sick getting on Social Security disability just shows how lax the standards are. The solution, of course, is to tighten up on disability and enact policies which "grow" the economy. Of course, the best way to "grow" the economy is to cut taxes on the wealthiest Americans. I think virtually everyone actually involved in the Social Security disability process knows it's quite difficult to get on Social Security but that's not what people are hearing.
     By the way, pieces like this don't simply arise out of a reporter's curiosity. Whenever you see David Autor quoted, you can bet that a Washington think tank supported by Koch brothers money planted the piece. All these pieces seem like they come out of a cookie cutter which is why I sort of expect that the stats quoted might be wrong.


Dot.gov said...

(1) People _move_home_ back to rural area when unable to work, with lower living costs, living with relatives and parents, even if local welfare and medical care less available. Common added excuses: Better environment for children; To care for elderly relatives; Always planned to move back down South .

Anonymous said...

Autor and Duggan have been pushing the lie that the reason SS disability "exploded" is due to changes from the DBRA of 1984 changing the rules with particular regard to mental impairments.

Chief Actuary Goss has refuted their lie many times explaining that the main reasons for the increase were demographic (increasing age of baby boomers and the increased numbers of women in the workplace) but the lie continues, zombielike, in articles such as this and going back to the NPR piece and the recent Washington Post stories.

My question to Autor and Duggan has always been, if the change was so significant in 1984, then why did it take 20 years for the numbers to rise. The changes in 1984 were trivial and play no part in the increased numbers, now in decline.

Anonymous said...

It isn't just moving home to live a cheaper life.
The rural south has a lot of people driving a 12 or 15 year old vehicle 15-20 miles one way to work a $9 to $12.50 an hour job. When it is time to go to the doctor, turn around drive past home 5 miles in the other direction.

Their first 45 minutes on the job are just to pay for that day's gas when the prices are really high as they were not that long ago.

Taking off work to see the doctor automatically deducts 1:15 off their work day before counting the time in the waiting room and time with the doctor (more likely APN).

The brutal truth is that someone making $90,000 a year is going to do everything they can to stay at work if they have health issues. Even if they have private long-term disability insurance they are going to give up $30,000 in income if they become disabled and more like $60,000 if they don't have private coverage.

If you are making $25,000 you lose income applying for disability but your costs to earn that $25,000 also go away.

The incentive to avoid filing until there is absolutely no option is minimal for the rural working poor.

If I were unfortunate enough to be in a situation facing disability, I'm going to blow through my saved vacation leave and exercise my FMLA rights to the maximum to stave it off hoping against hope I don't have to go down that path. A person making much less than I do has a different business decision to make.

Until rural counties have wage distributions like urban counties, rural counties will have a higher per capita disability rate.

Anonymous said...

Let's not forget the definition of rural is also a mess. There are at least 15 different definitions for rural inside federal programs. Even the Ag Department has contradicting definitions of rural depending on the program for which you are applying. VA, Education, HHS (the infamous Rural-Urban Commuting Area Codes RUCA) and Census Bureau all use different numbers. What does this have to do with the conversation you ask? Everything!

Funding and program access are based on the definition of rural. So if you drive 10 minutes outside the county seat and hit nothing but corn fields and cows doesn't mean you are in a rural area. This impacts funding for health services, transportation, education, job training and on and on and on.

It is impossible to make a federal rural definition, difficult to make even a state wide definition as some counties may have an urbanized portion and a truly rural area with widely ranging economic forces and ranges.

I found the ideas put forth by 11:00 poster to be rather interesting and it does ring of the truth I have seen in some areas I have worked in.

Anonymous said...

The rural poor here were exposed to DDT and other pesticides and chemicals which are slow to come off the market. They worked 12 hours a day in different horrible weather. Some of the diets weren't the best. Wow, when they hit their 50's they weren't very healthy! And when all your past relevant work was heavy, you might even meet the stringent standards for disability.

Anonymous said...

The biggest problem with the disability program seems to be the ALJ's at social security who are lazy and don't do their jobs. Until they are held accountable and fired for not doing their jobs the system will never work properly.

Anonymous said...

The Ayn Rand followers believe that anyone receiving disability payments is a "parasite". They love larger numbers of homeless people. Their main fears are 1) What if everybody moves to Malibu? and 2) What if I have to pay taxes?

Anonymous said...

Special interests who want to cut Social Security purchased the services some academics to write flawed articles to put a faux layer of respectability on their agenda. It's sad when mainstream media quotes them as if they should be taken seriously. Even a half-hearted attempt at research would turn up the information making it clear that they are a joke.

Anonymous said...

Bravo 3:51!

Anonymous said...

This article is a bit deceptive in that it is referring to percentage of population in these areas rather than the number of individuals on disability. These are extremely low density population areas. Therefore, any disabled individual will have a large impact on the percentage of the population on disability. In reality we are not talking about that many people.

For example, the articles cites Roscommon County (pop. 24,014), Montmorency County (pop. 9,350) and Lake County (pop. 11,386). The entire Upper Peninsula of Michigan (15 counties) only has a population of 311,361. Compare this to Wayne County (pop. 1,775,000), Oakland County (pop. 1,232,000), Macomb County (pop. 854,769), and Kent County (pop. 621,700) and you can see that the areas this article is talking about do not contain much of Michigan's population. There just aren't that many people in these counties. There are probably more people on SSDI in Wayne County than the entirety of Northern Michigan.

Further, Michigan has "reformed" its Workers' Compensation system. This started with a Michigan Supreme Court Decisions in 1999, and was completed with legislative amendments to the WC statue in 2011.

The effect of this has been to lower WC benefits and to make it more difficulty to prove that medical conditions are related to employment. Many people who should be receiving WC benefits are denied under these new rules and then have to go on SSD. The State of Michigan has effectively made a policy choice to shift costs from private WC insurers to the taxpayers at large.

Anonymous said...

Anon 11:00 You have a pretty good point.

There is a financial reason why poorer people file for disability. It's not that the poor people ARE not disabled. It's that the worker making more money has more incentive NOT to file for disability.

As most reps will attest, it is getting harder to get SSD/SSI benefits. But most of my clients rarely make above $50-70K per year. Most make below $50K.

But this does not mean they are not disabled just more desperate financially.