Maybe The Right Wing Should Just Lie Low For A Bit

     From Michael Hiltzik writing for the Los Angeles Times:

The anti-deficit lobbying organization "Fix the Debt" staged a question-and-answer chat on Twitter Thursday. Its goal presumably was to reach America's smartphone-savvy youth with its message that Social Security and Medicare payments to their grandparents are going to land them in the poorhouse a few decades from now. 

It's fair to say that "Fix the Debt" got more than it bargained for. Twitterers from all over responded to the invitation with pointed, tactless and downright impolite questions. Many of them aimed to discern how paring social insurance benefits for the elderly and infirm will make society stronger, which is the core of the organization's worldview. Those so inclined can still post their thoughts at #fixthedebtqa.

Among the choicer comments: "Can you explain why anyone chooses to be born poor? Why should the rest of us be responsible for their flawed decision-making?" (That's from Twitter user @jefftiedrich.)

A couple of good roundups of the dialogue thus far can be found at the Washington Post's knowmore site and at Liberaland.

     The tweets at knowmore site and  Liberaland really are funny.

More Money For Social Security's Administrative Budget? No ACA Role For SSA Is Certain

     Below is language from the bill set to be passed tonight (yes, it's certain to pass) to resolve the government shutdown-debt ceiling crisis:

Of the amounts made available by section 101 for ‘‘Social Security Administration, Limitation on  Expenses’’ for the cost associated with continuing disability reviews under titles II and XVI of the Social Security Act and for the cost associated with conducting redeterminations of eligibility under title XVI of the Social Security Act, $273,000,000 is provided to meet the terms of section 251(b)(2)(B)(ii)(III) of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and $469,639,000 is additional new budget authority specified for purposes of section 251(b)(2)(B) of such Act.

     So what does this mean? I won't pretend to know but I like the sound of "additional new budget authority." However, interpreting this is difficult. Generally, an "authorization" doesn't actually give an agency money. It just allows a later "appropriation" which actually gives the agency the money. Social Security, however, is a special case. Social Security technically never receives an appropriation since the money comes out of the trust funds. Social Security has a "limitation on administrative expenditures" -- the LAE. I don't know what the language means but I just can't see a point in giving Social Security a meaningless "authorization" in this bill.
     By the way, I had speculated earlier that the media reports that this bill would include a new income verification requirement for insurance premium subsidies under the Affordable Care Act (ACA or Obamacare, if you insist) might mean a role for Social Security in administering the ACA. A stringent income verification requirement might require Social Security's resources but Social Security won't have a role since the income verification requirement in the bill to be passed tonight is essentially meaningless. The Department of Health and Human Services (DHHS) plans to use commercial databases for income verification. That doesn't sound too workable to me. We've seen the problems with Social Security's Death Master File, for instance, which is about as accurate as a big database can be, but which still contains enough errors to cause serious problems for those wrongly declared dead. However, for better or worse, the income verification process under the ACA is DHHS' baby. Social Security isn't involved, at least not so far.

     Update: The bill has now passed the House and will shortly be signed by the President.

Who Is Most To Blame For The Government Shutdown?

Free Web poll for your Web site - freepolls.com

OGC Employees Recalled To Work

     I'm hearing that most of Social Security's Office of General Counsel (OGC) has been recalled to work. There's every reason to expect that the government shutdown will be completely over by midnight.

One Social Security Employee's Shutdown Story

     CNN reports an a Social Security employee affected by the government shutdown. Dramatic? No, but multiply it by tens of thousands and it's a big deal.

Shutdown Will Soon Be Over

     In case you haven't heard the news, the Republicans lost the government shutdown, big time. I don't want to say the Democrats won but the Democrats won. All federal employees should plan on being back at work Thursday. Republicans should put the idea of using a government shutdown or debt ceiling crisis out of their minds FOREVER.
     Update: For those who don't understand why I'm saying the shutdown will be over after today, read Jonathan Chait. This is a done deal. Everyone but two Senators and 30 or so House Republicans want this over pronto. The few who want this crisis to continue can't prevail or even delay the inevitable much longer.

ICU Stays Associated With Cognitive Impairment

    From the New England Journal of Medicine:

Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months.

An ALJ With A Plan

     Social Security Administrative Law Judge (ALJ) Paul Armstrong has a plan to save Social Security's disability programs that the Washington Examiner has seen fit to publish. Here are the highlights:

• Time limited benefits for some people found disabled.
• Have someone representing the government at Social Security hearings on disability claims.
• More continuing disability reviews.
• " Raise the retirement age used in determining disability payments in tandem with the rest of America."
• Move SSI to the states.

     By the way, ALJ Armstrong has a history of approving Social Security disability claims at a low rate.

SSA To Have Role In "Obamacare" Income Verification??

     News reports say that one element of an agreement to resolve the government shutdown will be a more extensive income verification process for the insurance subsidies that are a key part of the Affordable Care Act (ACA). To this point, the plan has been to rely upon "available electronic data sources" to verify income. The plan has been that Social Security would not have a role in this process. There are no details at this point on the more extensive income verification process planned for the ACA. I would guess that those states that have established their own health insurance exchanges under the ACA will be asked to do this but they may balk. More importantly, most states have not established their own health care exchanges.

     If we're not going to rely just upon "available electronic data sources" to verify income and if the federal government is going to do it in most states, how will the federal government do it? It seems to me that you would need an agency that has extensive experience in income verification and which has an extensive network of field offices. It's just rank speculation on my part but that description seems to fit the Social Security Administration and no one else.

In Fairness To Eric Conn

     This wouldn't excuse Eric Conn, if the allegations against him are true, but does this sound familiar?

• Non-physician disability examiner whose salary is paid by Social Security completes a residual functional capacity (RFC) form. The disability examiner knows that if the claim is denied, whether rightly or wrongly that it is unlikely to be reviewed any further but that if it's allowed, it's going to be reviewed at two different levels. If the reviewers disagree with the allowance, the case is returned to the examiner. Too many returns and the examiner's job is at risk.
• Disability examiner gives the RFC form to a physician whose salary is paid by Social Security.
• The physician receives so many completed RFC forms from disability examiners that he or she has no realistic way of actually reviewing all the medical evidence in each of the cases.
• The physician signs the RFC form after a cursory review of the medical evidence or no review.
• Under Social Security Ruling 96-6p, Social Security's Administrative Law Judges (ALJ) are required to consider the RFC forms generated in this manner because they come from "highly qualified physicians and psychologists who are experts in the evaluation of the medical issues in disability claims."

     What is described above is pretty much the norm. I don't think there's any excuse for what Conn is alleged to have done, but how different is it from what Social Security does regularly? And Social Security demands that the "medical opinions" produced in this way be carefully considered. Does Social Security's Office of Inspector General (OIG) want to investigate? Does anyone in Congress want to hold a hearing?