What To Do About The Death Master File?

     The National Academy of Public Administration (NAPA) has produced a lengthy Report to Congress on Sources and Access to State Death Data. This is a role that Social Security, by default, has assumed for the federal government and, indeed, for many businesses. It's a role that Social Security has never been comfortable with and which others have criticized. 

    NAPA has come up with five possible ways to address this issue: 

• the status quo (what SSA does currently)
• designating an agency as the distributor of state death data
• a non-governmental data clearinghouse
• designating an agency as the federal repository of death data
• federal agencies contracting directly with individual states 

    NAPA regards the last two options as not feasible. 

    I'm  betting we end up with no change in the status quo. Social Security acknowledges that there are problems with its Death Master File but it's unlikely that anyone else would do better. There's certainly no other agency that wants this chore.

    By the way, this is a much better report than you usually see from a Beltway Bandit.

Workshop On Covid And Social Security Disability

      From the National Academies of Sciences, Engineering, and Medicine:

REGISTER HERE

Monday, March 21, 2022 | 10:30am - 4:00pm ET

Tuesday, March 22, 2022 | 10:30am - 3:30pm ET

A planning committee of the National Academies of Sciences, Engineering, and Medicine will hold a public workshop to explore the long-term and potentially disabling health effects stemming from COVID-19 infection and how they might impact survivors’ ability to work.

This two-day virtual workshop, sponsored by the U.S. Social Security Administration, will bring together invited experts to discuss a range of topic a

reas including:

• Overview of long COVID, characteristics of the population affected, and research initiatives underway
• Postacute sequelae of SARS-COV-2 infection and implications for recovery
• Experiences of long COVID patients and their caregivers
• Long-term impairments from COVID-19 and effects on work-related functioning
• Best practices to improve recovery and potential future advancements in knowledge

The workshop agenda and list of confirmed speakers will be posted to this page soon.

     By the way, my impression over the years has been that the National Academies are less a scholarly organization and more a Beltway Bandit, set up to attract lavish consulting contracts from government agencies. They always produce lengthy reports that say nothing of consequence and which contain the vaguest imaginable recommendations, except that there's always a definite recommendation for more "research", presumably done by them. I've never seen a report from a Beltway Bandit that had the slightest impact on actual operations at Social Security. Hiring them is what you do when you think you're supposed to do something but you really don't want to do anything other than kick the can down the road.

     It doesn't take any grant of money from Social Security for me to tell you the state of knowledge at this point. There hasn't been enough time elapsed to get a really good idea of the long term impacts of Covid. While there are suggestions that Covid will lead to disability claims, either directly or indirectly, there hasn't been more than a trickle of such claims filed at Social Security so far. No one knows what that means. I'll be amazed if we learn anything more specific that that at this workshop.

SSA To Pay $12.4 Million For Early Intervention

     From a contracting notice recently posted by the Social Security Administration:

Contract Award Dollar Amount:

$12,378,342.00...

Contractor Awardee:

MATHEMATICA POLICY RESEARCH, INC.
1100 1ST STREET NE
12TH FLOOR
WASHINGTON

DC
200024221
USA 

Synopsis: ... 

Single Award Cost Plus Fixed Fee 5-year Contract for Retaining Employment & Talent After Injury/Illness Network (RETAIN) Evaluation - This is a joint project between SSA, the Department of Labor (DOL), and several states. The purpose of the contract is to evaluate the impact of the various interventions implemented under cooperative agreements between the states and the DOL.

     I hope this study shows that early intervention works but let me list just a few of the reasons I don't think it will work very well:

• Most people who become disabled are disabled by degenerative conditions, like diabetes or osteoarthritis. These conditions just get worse with time. Rehabilitating people with this sort of problem isn't realistic. As soon as you get them able to do a new job, their condition has worsened to the point they can't do it.
• Pain is a huge factor in producing disability.  No intervention can take away the pain. If pain prevents one type of work, it's almost certain to prevent other types of work.
• Mental illness is a major cause of disability. It’s not so amenable to intervention that  helps to preserve the ability to work.
• People with below average cognitive abilities are dramatically over-represented among the population of people who apply for Social Security disabilities. That's because their limited intellectual abilities limit them to simpler, more physically demanding work to begin with and make it almost impossible for them to switch to other less demanding work. 
• This whole concept is based upon a misunderstanding of who applies for Social Security disability benefits and why they apply. Those who support this think that most disability is due to trauma and that if you can just help people figure out what they can do despite their injuries and give them a mobility scooter or whatever that they can go back to work. The thing is that the 12 month duration of disability requirement in the definition of disability that is written into the Social Security Act means that folks who are disabled by trauma either go back to their old jobs or figure out something else they can do on their own or with the help of programs that already exist well before 12 months have passed. I don't know that there's anything new that can be offered to help people in this situation. If you wanted to do something useful, you could better fund state vocational rehabilitation agencies. Besides, it's such a small component of disability that it doesn't matter that much anyway.
• In any case, as far as I'm concerned, Mathematica is nothing more than a Beltway Bandit. They get lots and lots of government contracting money but nothing they do ever helps anyone.

NAS To Get $20.5 Million Contract

     From a contracting notice published by Social Security:

The Social Security Administration (SSA) intends to issue a sole source contract with cost reimbursement task orders ... to the National Academy of Sciences (NAS) for a period of 5 years beginning on or around September 30, 2018. The NAS will set up Committees of medical, vocational, and other experts having expertise in fields such as, internal medicine, pediatrics, oncology, otolaryngology, ophthalmology, endocrinology, physical medicine and rehabilitation, occupational therapy, physical therapy, orthopedic surgery, industrial and organizational psychology, psychiatry, developmental-behavioral pediatrics, neurology, cardiology, vocational rehabilitation, health care case management, social sciences, education and health care and workplace economics. The Standing Committee will continue work necessary to maintain an essential capability for theoretical analyses of research, relevant evidence and clinical practices in physical medicine, psychiatry, and rehabilitation medicine.

... The size standard is $20.5M....

     The National Academy of Sciences is not a governmental agency. It's a private non-profit that largely functions as a beltway bandit seeking out this sort of contract.

What Were They Thinking?

     I can't get over the fact that at a time when there are frequently lines of people waiting to be served at Social Security field offices and many people who try to call the agency end up hanging up in frustration because they have been on hold for so long that the Social Security Administration thought it appropriate to spend good money on a study to answer the burning question, "Can you tell how disabled someone is just by looking at how frequently they're treated at a hospital?"

     Honestly, someone ought to be fired over this. Perhaps everyone at Social Security central offices ought to be required to spend some time working on their agency's front line. 

Warning: Beltway Bandits At Work!

     From a press release:

A new report from the National Academies of Sciences, Engineering, and Medicine examines to what extent and in which ways health care utilization—such as in-patient hospitalizations, emergency department use, and hospital readmission—reflects disease severity, disability, and ability to perform gainful activity. The committee that conducted the study was unable to find an association between health care utilization and disease severity as it relates to the Social Security Administration's (SSA) determination of severe impairment—an impairment or combination of impairments severe enough to prevent a person from performing any gainful activity regardless of age, education, or work experience. 

     The Social Security Administration paid these beltway bandits to tell us that there's no direct relationship between the number of hospital visits and the degree of disability! Anybody involved with disability determination could have told you that for free. I have clients with 300 page files who are obvious allowances. I have other clients with 2,000+ page files who have weak cases. Disability determination isn't about counting the number of pages of medical records any more than counting the number of hospital visits. The idea that there would be such a simplistic relationship is absurd on its face.

     There's a real beltway bandit touch to this report. Even though the Social Security Administration paid for this worthless study, the National Academies wants $50 for a copy of the report. 

     By the way, if you did pony up the $50, I will bet you that there will be one unambiguous recommendation in the report -- more research. As I've said before, when someone goes to work for a beltway bandit, they must be told on their very first day of work, whenever you write a report, no matter what else it says, it must always give a firm recommendation for more research.

Should More Consideration Be Given To Assistive Devices In Determining Disability?

     The Governmental Accountability Office (GAO) recommended in 2012 that Social Security look into whether it should consider more fully assistive devices in disability determination. Social Security commissioned a report by the National Academies of Sciences, Engineering and Medicine on the subject. The bottom line is that they recommended against making any change. They also recommended more research but Beltway Bandits always recommend more research. It was a naive recommendation from GAO to begin with, the sort of thing that makes sense mostly to someone who doesn't know how disability determination works at Social Security.

Another Expensive Report Destined To Gather Dust

     Several researchers at Mathematica has done a study for Social Security on Employment Experiences of Young Adults and High Earners Who Receive Social Security Disability Benefits: Findings from Semistructed Interviews. The report is 131 pages. It certainly cost Social Security tens of thousands of dollars, maybe hundreds of thousands. There's nothing wrong with the report. I'm sure the researchers did a competent job. It's just that it's worthless. It repeats what everyone who's looked at the situation already knew. In the end, they recommend that Social Security offer case managers or community liaisons to assist claimants who want to return to work and, of course, they recommend more research. I think that new employees of Beltway Bandits like Mathematica must learn on their first day at work that every report they produce must include a self-serving recommendation for more research.
     Social Security doesn't have the money for case managers. The agency does have enough money to waste on this sort of pointless research, however. Even though it's worthless, the research is relatively inexpensive compared to what it would cost to actually do something worthwhile.  Paying Mathematica for a useless report allows Social Security to pretend that it's doing something about returning disability recipients to work. 

     I don't want to be too critical of Social Security. Nothing they would do if they had the money would make that much difference anyway but they don't have the money to do anything other than pay Beltway Bandits for useless reports.

Institute Of Medicine Reports Forthcoming

     The newsletter of the National Organization of Social Security Claimants Representatives (NOSSCR), which is not available online, reports that the Institute of Medicine (IOM), a division of the National Academies of Sciences, is working on three "consensus reports" for Social Security which may be coming out later this year. These will deal with:

• Psychological testing, including symptom validity testing;
• Mental impairments in children, especially autism spectrum disorder and attention deficit hyperactivity disorder; and
• Speech and language disorders in children.

     Whatever else it may be, the IOM in this instance is basically a beltway bandit, receiving large sums of money for reports that are always so tentative and hedged that they're useless. I wonder what they'll tell Social Security about symptom validity testing. Social Security has been resistant to using it because of questions about its validity. My understanding is that this sort of testing would only apply to claimants with brain damage or intellectual deficiency. Since the agency is approving so few with either of these problems, I doubt that using symptom validity testing would matter much anyway.

BOND Survey

     From a recent Social Security Emergency Message:

The Social Security Administration has asked Abt Associates and Mathematica Policy Research (the surveyors) to conduct a survey to learn about the work experiences of people receiving Social Security Disability (SSDI) benefits. The survey is part of SSA’s Benefit Offset National Demonstration (BOND). From January 1, 2013 to December 31, 2015, the surveyors will contact approximately 22,600 SSDI participants. Some of these beneficiaries will be BOND participants and some will not. The surveyors will ask them about their and their family members’ work, health and education status, and about their attitudes toward work and their health. They will also ask whether they have worked with a benefits counselor recently.

The surveyors will ask the beneficiaries to complete a survey. The survey responses will provide information on SSDI beneficiaries’ attitudes and efforts toward work.

Beneficiary participation in the survey is voluntary. The survey will take approximately 50 minutes to complete. Participants will receive a $25 incentive payment for participation. Participation will not affect receipt of benefits from SSA.

     By the way, Social Security's "Emergency Messages" seldom deal with actual emergencies. It's just a medium for conveying information to the field.

How Much Did This Study Cost?

     From Vocational Factors in the Social Security Disability Determination Process:A Literature Review by David Mann and Jeannette de Richemond of the Mathematica Center for Studying Disability Policy:

At the request of the Social Security Administration (SSA), Mathematica Policy Research conducted a literature review to inform policy discussion about how the disability determination process for the Social Security Disability Insurance and Supplemental Security Income program s incorporates consideration of the vocational factors —that is, age, education, and work experience. Specifically, we sought to identify and evaluate existing literature, reports, and studies that could directly support evidence -based conclusions about the following research question: to what extent do age, education, and work experience affect a person’s ability to perform work he or she has not performed before, independent of all other factors, such as health, impairments and limitations, motivation, or general labor market conditions? This research question, developed in consultation with SSA, is narrow in scope and reflects both statutory language about the vocational factors and how SSA currently incorporates them into the disability determination process. 

Our principal finding is that no rigorous evidence directly supports how the disability determination process currently uses vocational factors or how the disability determination process could change their future use. Although we found extensive documentation of relationships between the vocational factors and the extent to which people actually work or perform work-related activities, the documentation does not distinguish between the effects of the vocational factors on the ability to perform new work and the many other potential causes of the observed relationships. We identified only two articles that contained information tangentially relevant to the research question.

     I have three thoughts on looking at this report:

1. Duh. I could have told you this for free. Lots of people working for Social Security could have told you this for free. It's not like this subject has never come up before.
2. So either the Social Security Administration is looking for some justification for adjusting how it treats age, education and work experience in determining disability or someone is pressuring Social Security to hunt for some justification for doing this. I'll bet the latter.
3. I wonder how much these "Beltway Bandits" charged Social Security for this priceless research. By the way, guess what? Even though their research is spectacularly unhelpful, these researchers recommended additional research! I've never read one of these "Beltway Bandit" reports that didn't contain a self-serving recommendation for more research. I'll bet that the first topic covered when Mathematica trains new researchers is that it is company policy that all reports must include a recommendation for additional research.

Want To Save Some Real Money At Social Security?

     Even researchers at Mathematica, Social Security's prime contractor for the Ticket to Work program, could find "no consistent evidence of impacts [of Ticket to Work mailings] on the number of months in which beneficiaries did not receive benefits because of work, or on other outcomes." The researchers try to blame the failure of Ticket to Work on the recession.

Once You Assume That Social Security's Workforce Will Be Cut In Half, This Is How You Pretend The Work Will Get Done

     From Government Executive:

... The National Academy of Public Administration -- a congressionally chartered organization -- worked with SSA to make 29 recommendations on how the agency should modernize and reform itself by 2025. Chief among the suggestions was to more aggressively embrace new technology to deliver services to Social Security recipients, and to move away from in-person customer support in favor of “virtual channels” such as phone, online and videoconferencing options. ...

“With a shrinking workforce, the agency cannot afford to continue to operate in this [old] way,” the panelists wrote. “Furthermore, as more work is automated, it becomes less necessary to maintain the current structure.”

While NAPA did not make any specific estimates of potential job cuts -- Project Director Roger Kodat said it was “too early to make that judgment” -- the union representing SSA employees said the results would be drastic. The American Federation of Government Employees estimated if fully implemented, the recommendations made in the report would result in 30,000 job cuts and the elimination of all 1,250 SSA field offices. ...

Translating Consultant Speak To English

Does This Tell Us Anything Useful?

     The abstract of a Working Paper issued by Yonathan Ben-Shalom and Arif A. Mamun of Mathematica Policy Research, a big contractor for Social Security:

We follow a sample of working-age Social Security Disability Insurance (DI) program beneficiaries for five years after their first benefit award to learn how certain factors help or hinder achievement of four return-to-work milestones: (1) enrollment for employment services provided by a state vocational rehabilitation agency or employment network, (2) start of trial work period (TWP), (3) completion of TWP, and (4) suspension or termination of benefits because of work. We find that younger beneficiaries are more likely than older beneficiaries to achieve the milestones and that substantial variation exists across impairment types. In addition, black beneficiaries and beneficiaries with higher levels of education have a greater probability of achieving the milestones, everything else equal. Also, such achievement is more probable if state unemployment is low at the time of the award. The probability of achieving the milestones is reduced by having a higher DI benefit amount at award, an award decision made at a higher adjudicative level, and by receiving Supplemental Security Income or Medicare benefits at the time of DI award. Finally, we find large variation in the relationships between state of residence and return-to-work outcomes and between award month and return-to-work outcomes. We attribute these variations to unobserved factors at the state level, policy changes over time, and trends in unobserved beneficiary characteristics.

SSAB Forum

     The Social Security Advisory Board (SSAB) has scheduled a "Forum" for March 8 on "Social Security Disability: Time For Reform." There is some diversity of viewpoint among those scheduled to speak but there's a definite tilt to the program. Here are some of the points of view represented with the names of the speakers representing these points of view in parentheses:

• Something must be done because a lot more people are drawing Social Security disability benefits now. This is because it's less difficult to get on these disability benefits than when Ronald Reagan was President. (Duggan, Daly, Autor)
• Too many people draw Social Security disability benefits because the benefits are too generous.(Duggan, Autor)
• The Americans with Disabilities Act (ADA) makes it easier for disabled people to work and that should make it less difficult for people to get off Social Security disability benefits. (Claypool, Imparato, Blanck)
• Social Security is the reason why more disabled people aren't working. (Maestas, Smith, McDonald, Autor, Stapleton)
• If Social Security gave disabled people more encouragement and assistment, they'd go back to work. (Smith, Davey, McDonald, Mazerski, Autor, Stapleton, Smalligan)

     I'm sure that I'm oversimplifying the views of these people. I'm also sure that each of them in their own way wants to help disabled people. (I will say that David Autor is really full of it and has no business speaking publicly about these issues. He simply doesn't know what he's talking about.) 

     I think it's appropriate to give a shorthand response to each of these expressed views, the sort of responses that are unlikely to be expressed at the SSAB "Forum."

• It certainly is less difficult for people to get on Social Security disability benefits than when Ronald Reagan was President. However, you have to understand that Social Security disability during the Reagan Administration was an aberration. It was less difficult to get on those benefits before the Reagan Administration and it quickly became less difficult to obtain those benefits as the Reagan Administration wore on and the return to prior practices was even more pronounced after Reagan left office. This was because the changes made during the early part of the Reagan Administration evoked a vigorous political response. The Reagan changes were quickly rolled back. Even though there have been plenty of changes since Reagan left office, it has remained less difficult to get the benefits. Anyone who advocates a return to Reagan era policies is naive. Those policies would evoke the same reaction in 2013 as they did in 1983. The Reagan days were as far from a golden age for Social Security disability policy as you can get.
• Disability benefits too high? Really? Generally, Social Security disability benefits are less than half what recipients were earning. They're far less in most cases than disability benefits under employer based long term disability plans. 
• The ADA makes it easier for disabled people to work? The evidence is that the ADA had little effect on the number of disabled people who are employed. In fact, some scholars have argued that the ADA reduced the employment of the disabled!
• I don't see how one can argue that the availability of Social Security disability benefits discourages people from working when we have clear evidence that only 27% of those who apply for and are denied Social Security disability benefits are working four years later. Being denied benefits isn't enough to get these people back to work even though those who are denied are, on the whole, less disabled than those drawing disability benefits. The evidence is unambiguous that very few of those drawing Social Security disability benefits will return to work even if they are removed from benefits.
• The illusion that with a little more encouragement disabled people will fly off the disability rolls and back to work has been persistent for decades. This illusion has led to the following work incentives: Trial Work Period, Extended Period of Eligibility, Expedited Reinstatement, Ticket to Work and the Vocational Rehabilitation exception, just to mention the Title II provisions. There's another complicated mess of Title XVI work incentives. None of this is working to any significant extent. If none of this works, why would anyone expect a new work incentive to work? I can think of one good reason why some of the speakers would promote work incentives. Some of them work for Ticket to Work contractors. Not only do they want to keep the contracts their employers have, even though they're a waste of money; they want to get more contracts. Ticket to Work is an unjustifiable waste of money. Any attempt to go further down the rehabilitation road will just waste more money.

First Report On Youth Transition Demonstration: A Complete Waste Of Money

     From a report by Mathematica Policy Research, a Social Security contractor (emphasis added):

The Youth Transition Demonstration (YTD) is a large-scale demonstration and evaluation sponsored by the Social Security Administration (SSA) to improve understanding of how to help youth with disabilities reach their full economic potential. In particular, SSA is interested in testing promising approaches for helping young people with disabilities become more self-sufficient and less reliant on disability benefits. The YTD conceptual framework, which was based on best practices in facilitating youth transition, specified that the six projects that participated in the evaluation provide employment services (emphasizing paid competitive employment), benefits counseling, links to services available in the community, and other assistance to youth with disabilities and their families. Additionally, the youth who received those services were eligible for SSA waivers of certain benefit program rules, which allowed them to retain more of their disability benefits and health insurance while they worked for pay. ...

In this report, we present first-year evaluation findings for the Career Transition Program (CTP), which served high school juniors and seniors, and youth who had recently exited school, in Montgomery County, Maryland. ...

CTP was well implemented, conformed to the YTD conceptual framework, and provided youth with services to help them graduate from high school, obtain employment, and matriculate into postsecondary education programs. The process analysis showed that CTP enrolled 89 percent of eligible youth in the program and provided services to virtually all of the enrollees. On average, enrollees received 28 hours of services, 36 percent of which were directly related to employment, such as job development. Another 42 percent of service hours were for case management to resolve barriers to employment and education. The impact analysis showed that youth who had been given the opportunity to participate in CTP were more likely to have used employment-promoting services than youth in a randomly selected control group. Nevertheless, we found no impacts of the program on employment during the year following the entry of youth into the evaluation. Neither did we find impacts on income, expectations, or a composite measure of school enrollment or high school completion. We conclude that CTP was no more or less effective than the programs and services available to control group members at improving these outcomes during the follow-up year.

Child Disability Contractor Sought

     Social Security is seeking a contractor to do the following over a 36 month time period:

• Examine how SSI [Supplemental Security Income] disability cash payments for children affect children and their families.
• Compare national trends in diagnosing mental disorders (including, but not limited to, ADHD [Attention Deficit Hyperactivity Disorder], autism, bipolar illness, depression, and learning disorders) and speech/language disorders in children to trends in the SSI disability program for children.
• Investigate the use of prescription medications for children with mental disorders.
• Identify whether the receipt of SSI payments creates an unintended culture of dependence, particularly among adolescent recipients.
• Evaluate the effect of SSA's [Social Security Administration's] "treating source" rule.

     The request for proposals goes on to say that the contractor chosen will:

• Examine and evaluate the rise in the number of children on SSI, and compare to the national diagnostic trends in children with mental disorders (including, but not limited to, ADHD, autism, bipolar illness, depression, learning disorders) and speech/language disorders.
• Identify factors (such as national poverty levels, access to health care, destigmatizing mental illness, changes in special education programs) that correlate with, or cause a, rise in the number of children on SSI with mental disorders and speech/language disorders.
• Identify the appropriate and effective treatment protocols for mental disorders and speech/language disorders in children, and determine to what extent the treatment for these disorders in SSI children is consistent with national treatment trends.
• Identify which mental disorders and speech/language disorders are amenable to treatment and subject to improving with age.
• Investigate the treatment of mental disorders for children on SSI.
• Are medications prescribed improperly for this population?
• Are physicians under pressure (explicit or implicit) to "help families make their case for" SSI payments?
• Evaluate whether SSA's medical source/treating source rules leave the SSI disability program for children vulnerable to manipulation or abuse.
• Evaluate to what extent, if any, the receipt of SSI cash payments creates a "culture of dependence" among children with disabilities and their families.
• Determine the relationship, if any, between a child's receipt of SSI cash payments and future school and work success.

     And Social Security wants the contractor to:

Organize outreach conferences with transcription services to provide a neutral ground for debate and analysis of emerging issues related to the evaluation of disability in children, such as the diagnosis and treatment of mental disorders and speech/language disorders, and assessment of functional limitations, identified during the contract's period of performance (as approved by SSA) to be held in the Baltimore or Washington, D.C., metropolitan area.

People Have Short Memories

Take a look at this report from the "Center for Studying Disability Policy" which recommends "work-support" programs as a way to reduce the burdens on Social Security's disability trust fund. (One word of warning, the Center's website caused my browser -- Firefox -- to freeze up. Could there be a metaphor here?) Three types of programs are recommended in the report:

• Earnings Support Insurance: New temporary program that would provide cash and employment supports funded by payroll taxes.
• Universal Short-Term Private Disability Insurance: Required short-term insurance provided by private insurers and funded through mandated employer and employee premiums.
• Experience Rating: A new formula used to determine the allocation of SSDI payroll taxes to employers, based on SSDI use by former employees.

I understand these ideas are receiving attention in Washington.

I put the name "Center for Studying Disability Policy" in quotations because it is not exactly what you might think. The "Center for Studying Disability Policy" appears to be a wholly owned subsidiary of Mathematica Policy Research which was at one time a major contractor with Social Security. What sort of contract did Mathematica have with Social Security? Oh, a contract to support disabled youth making the transition to employment, a contract which Social Security's Office of Inspector General  says cost Social Security over $44 million and which generated "little tangible benefit." I think that Mathematica wants to get back on that gravy train.

So, Mathematica is recommending another trip down the same path that proved unsuccessful in the past and people in Washington are listening. People have short memories. How many times has Social Security pored money down the rat hole of encouraging the disabled to return to work? Which of these efforts has demonstrated any viability whatsoever? These schemes are always promoted by Beltway Bandits whose only real interest is in getting contracts.

The problem remains what it has always been. If you require people to be half dead or fully crazy to get disability benefits, what makes you think that ANY program will show any significant success in returning them to work? If you want great success in returning people to work, make it vastly easier to get on Social Security disability benefits. Otherwise, you are just wasting money on research that is doomed to failure. 

Policymakers need to drop their illusions about who gets Social Security disability benefits in this country. They are NOT, in the main:

• People who have suffered some traumatic injury that will get better with time
• People whose only impairment is some injury or disease which has put them in a wheelchair but which leaves them able-bodied otherwise. 

They ARE, in the main, people who suffer from one or more of the following:

• Chronic, progressive disease, meaning they not only do not get better with time; they get worse
• Chronic, severe pain which is not going to get better over time
• Chronic, severe mental illness that is unlikely to get significantly better over time

If policymakers would understand who is actually on Social Security disability benefits, they would understand just how futile it would be to fall for Mathematica's scheme.

IOM Studies

The Institutes of Medicine (IOM) at the behest of Social Security has reviewed the disability listings on cardiovascular disorders and HIV-AIDS.

Let me give you a quick summary of the cardiovascular report: "Blah, blah, blah ... Whatever else you do, you MUST, MUST, MUST give us more money for research." The crack team of researchers recommended that Social Security consider making use of exercise testing in evaluating ischemic heart disease. In case you are not familiar with Social Security's cardiovascular listings, they have made extensive use of exercise testing in evaluating ischemic heart disease for decades.

The HIV-AIDS report is better. IOM recommends that "SSA should use CD4 count as an indicator of disability. Specifically, CD4 > 50 cells/mm3 is an indicator that a claimant’s HIV infection is disabling."