From an interview with Pamela Herd, a public policy professor at Georgetown University and the co-author of Administrative Burdens: Policymaking by Other Means, conducted by Sean Illing for Vox:
... Pamela Herd
... Most of our social welfare policies are designed in such a way where they’re a lot more concerned about preventing people who aren’t eligible from accessing benefits than ensuring that those who are eligible actually receive them. We’re fixated on fraud and abuse, which is extremely low in social welfare programs — something like 1 to 2 percent of cases. And even then, it’s not what people mean when they think of “fraud and abuse.” It’s mostly people making mistakes because they didn’t understand eligibility rules.
The problem with this unjustified obsession with fraud and abuse is that it means 20 to 30 percent of people are unable to access these programs even when they’re clearly eligible for them, because they’ve created all these administrative burdens designed to target people they don’t want on the programs. So it’s a huge disconnect in terms of trying to meet the broader goals of these programs. ...
I want to push a little on this point because I don’t think a lot of people who claim to be concerned about fraud and abuse are really concerned about fraud and abuse. As far as I can tell, this is about trumping us these accusations in order to undermine programs they fundamentally don’t believe in, just as a lot of Republicans disingenuously complain about voting fraud as a cover for depressing voting numbers.Pamela Herd
You’re right about that. Partly, this is a way conservatives justify the use of administrative burdens. They make these sorts of arguments all the time, whether it’s about voting or social welfare programs. The pretense is always about preventing fraud and abuse. But think about a program like SNAP, or food stamps. The goal of that program was to prevent hunger, was to ensure people had adequate nutrition. If you think about that goal and you realize the way that you’re running that program means that 20 percent of people eligible for that benefit aren’t getting that help that they really need, then you’re fundamentally undermining these programmatic goals. You’re allowing all those people to go hungry. ...Sean Illing
What are the simplest, most effective things we could do to improve this process right now for people in need?Pamela Herd
There are technocratic things like requiring state governments and the federal government to quantify how many people who are eligible for benefits aren’t getting them. Right now they’re required to report on fraud and abuse, but they should also be required to report how many people they’re failing to reach. This would be a good start....
9 comments:
To a degree, particularly with regard to supplemental security income, which I think most perceive as a handout for so-called "welfare queens." But the disability insurance and retirement benefits have a key distinction that most social welfare program lack. Namely, they're available to everyone, regardless of financial means, albeit with some degree of redistribution of the retirement benefit to accommodate those whose careers paid lower wages. In other words, everyone buys in, and everyone gets something back. And that, I think, is why both programs are vastly more popular than, say, food stamps.
@9:04 AM
Also why I want to pound my fist into the wall every time I hear politicians talking about all the great things the government could do, then immediately following it up with "but it should be means tested."
I have trouble sleeping when I have to deny a case that does not have the documentation required to prove eligibility for benefits, wondering if that person is actually potentially eligible. Come at me, but if you hate the disability programs, don't apply for it. There are other citizens who need them.
I'm glad that someone recognized this issue. I've always considered my self liberal but was always frustrated with the administrative burdens that I had to deal with to provide service. Going into management made it worse. Many people dislike big government because of these burdens to the point of voting against their own self interests. Unfortunately I feel many people get promoted because they zealously enforce these burdens to the detriment of the public.
@10:09
Hey, at least you experience frustration. I can think of a few ALJs who I doubt feel the same way.
Regardless, I would note it is extremely common to hear from self-represented claimants, after being denied by an ALJ, that they were not aware of what evidence was required or even aware of what "disabled" actually means. I think educating claimants from the start as to what the standards are could in fact end some claims at the initial phase, maybe even before a determination has been made, which would save a great deal of time for everyone involved.
I have practiced in this field since 1979. I have handled at least 6,500 hearings. I have known many ALJs, some good and some bad. The bad ones that evidence and twist it. They find that a 64 year old man is not disabled because he can lift 50 pounds with one arm and 10 pounds with the other arm. The bad ALJs use the RFCs of convenience of those over 55 years old, i.e., medium work.
On the other hand, there are some good ALJs. One of them I have known for approximately 35 years. He was first appointed as a Magistrate Judge in Federal Court. I am pretty sure that he did not know much about Social Security Law when he was appointed. I was one of the few attorneys in my area handling Social Security cases in the Federal Courts. I would like to think my briefs were instructional to him.
Later he became an ALJ. After he was an ALJ for about a year he told me the following: "I think my job is to determine if people are disabled as opposed to finding them not disabled." Accordingly, from time to time the ALJ will send claimants for additional more specialized consultative examinations. Many claimants cannot afford specialists or comprehensive Psychological examinations. Many cases are determined favorably through such post-hearing workup. Only about 30% of the ALJs I see will even consider post-hearing examinations. The rest are only interested in seeing "if there is enough evidence to make a decision."
Many years ago I took a case to the Circuit Court of Appeals. The client was illiterate and was not represented at her hearing. The ALJ who handled the hearing walked over her. The hearing lasted 14 minutes. The Circuit Court made the following statement: "The absence of evidence is not evidence." I still use that catch phrase today, 40 years later.
There are also a lot of ALJs in the middle. It is interesting to me that after many ALJs retire we become friends. I have a number of outside activities, including Bar Association committees and sporting events etc. I have run into at least four former ALJs in those activities. We have become friends. I guess ALJs are people also.
If fulfilling programmatic goals is what SSA should be doing then the worst sin it would strive to avoid would be not approving claims which should have been approved. That has not received much priority recently. Consider that SSA does own-motion review of many more favorable ALJ decisions than it does of unfavorable decisions. The focus is on exclusion, not inclusion. Most recent changes and proposals from SSA would make the disability rules more complex and difficult. Consequently fewer people with disabilities can prove their claims, regardless of whether they can actually work.
"I have trouble sleeping when I have to deny a case that does not have the documentation required to prove eligibility for benefits, wondering if that person is actually potentially eligible."
Bless you sir. SSA should only hire adjudicators with that degree of concern. What I can tell you from representing many underprivileged people applying for the program is that it can devastate their lives and their families when they are denied despite being unable to work. I see it regularly and it is not pretty. Many get more sick and some die prematurely. The current trend towards making the program more complex, difficult and exclusionary will only cause more tragedies.
The problem here is that a medical/vocational decision is made into a legal one. Most cases that make it to ALJ's are not the easy black/white decision, but the greyer ones. Often they are full of conflicting evidence or a lack of "objectional medical evidence." Not, necessarily, due to the lack of trying, but rather to the nature of the disease, syndrome, etc. that causes the symptoms that result in disability. No objective test can detect pain, which is the most debilitating symptom. Migraines, abdominal pain, joint pain, etc. are not discernable by tests and often correlate poorly with x-rays, MRIs and CT scans. Epilepsy occasionally won't show up in EEGs.
I have a LOT of experience with doctors. Enough to tell you that many don't listen too well to their patients and will often tell the patient one thing and write something else in their notes. If you tell them 10 things, maybe three or four will make into the notes. They are very confident of their conclusions, then wonder why you keep moving up the next appointment. They often question why the treatment isn't working for you (Are you not taking the medication? Are you doing the exercises?) instead of questioning the diagnosis or treatment plan. And if the treatments fail, "It must be you." You may have been dealing with something with persistent symptoms for 20 years... But, the doctor "KNOWS" more about your condition than you do. Helping a patient to get disability represents (to them) a failure of doctors and medicine to help their patients. Many have the mentality that, "Well, there must be something else we can try..." and, "There must be SOMETHING you COULD do..."
So, IF an ALJ views disability determination as "Is this person disabled?" Meaning, can this person ACTUALLY perform and maintain a full-time job, of any kind? Then, the evidence could, in a given case, support the approval of benefits. The same evidence, with an alternate ALJ, could be used to deny the same case. Especially, if the ALJ looks at it ONLY as a legal case. "Did the claimant PROVE their case?" I would wager that vast majority of cases could "legally" be denied and upheld in Federal Court if interpreted in the strictest legal sense. "Substantial evidence" allows ANY opinion, notes, etc. to be used to deny a case the the ALJ WANTS to. This means, in effect, you have to prove your case BEYOND a reasonable doubt. This is often not even theoretically possible with certain conditions and not practical with many others. Some Circuits will remand cases that there is at least SOME evidence to support, while others will not. I think the PREPONDERANCE of the evidence would be a better standard. Even then, you would deny some who can't work while approving some who could. Part of the problem is the word, "COULD." As in, a syndrome, disease, et. "That COULD" explain the person's symptoms. "Could" could be read very narrowly or very broadly. Medical conditions have a wide range of symptoms and limitations, some of which are very common and others that are much rarer. So, if you look at "COULD" as usually or often, you get a different result than if you consider the one half of one percent. Doctors often don't know or appreciate the rarer outcomes... Yet, we expect an ALJ, in a limited time with a limited knowledge of a given condition, to be able to? The end result is that ALJs and Federal Judges make tge decisions that they WANT to make in most cases. I am sure that they, like doctors, think they are making "the right" decisions... But at what cost when wrong? My cousin had a headache that persisted for weeks. She made several trips to the clinic, ER, etc. After 2-3 months, someone FINALLY took her seriously. She had a brain tumor... and died about 2 years later. IF she would have been taken seriously from the beginning, maybe she would still be alive. There's just no way to know.
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