The President does not believe that Social Security is a driver of our near-term deficit problems or is currently in crisis. But he supports bipartisan efforts to strengthen Social Security for the long haul, because its long-term challenges are better addressed sooner than later to ensure that it remains the rock-solid benefit for older Americans that it has been for past generations. The President in the State of the Union laid out his principles for Social Security reform which he believes should form the basis for bipartisan negotiations that could proceed in parallel to deficit negotiations:
- Strengthen retirement security for the low-income and vulnerable; maintain robust disability and survivors’ benefits.
- No privatization or weakening of the Social Security system; reform must strengthen Social Security and restore long-term solvency.
- No current beneficiary should see the basic benefit reduced; nor will we accept an approach that slashes benefits for future generations.
Apr 13, 2011
President On Social Security
From a White House summary of President Obama's speech today:
Lawsuit Alleges ALJ Bias In Queens, NY
From the New York Times:
The Queens office that hears appeals of Social Security disability cases is well known to lawyers, judges and many other New Yorkers as an inhospitable place to seek benefits. ...
Now, a class-action lawsuit filed on Tuesday in Federal District Court in Brooklyn says that five of the eight Queens judges are not just difficult, but also biased against the applicants — many of whom are poor or immigrants — and have systematically denied benefits to the disabled by making legal and factual errors. ...
The five judges named in the suit are David Z. Nisnewitz, Michael D. Cofresi, Seymour Fier, Marilyn P. Hoppenfeld and Hazel C. Strauss. ...
The Times’s analysis found that the rejection rate for the entire Queens office, 50.9 percent, was the highest in New York State, and far higher than in other New York City boroughs; in the current fiscal year, Manhattan has an average denial rate of 37 percent, the Bronx 33 percent, and Brooklyn 14.5 percent.
Apr 12, 2011
House Democrats Worried
A group of House Democrats apparently fear that the President will propose Social Security reductions on Wednesday, since they have sent the President a letter warning him not to cut Social Security or risk losing their support.
Bold Republican Plan
The Republican Study Committee, which includes most Republican in the House of Representatives, has issued a report calling for Supplemental Security Income (SSI) to end, with block grants to the states being substituted -- and the block grants would be at the 2007 spending level. The report also calls for a 25.6% reduction in discretionary spending, allowing Medicare beneficiaries to opt out, raising the Medicare age to 67, ending Medicaid and substituting block grants to the states, and raising full retirement age for Social Security to 70, with everyone who is currently under 60 being affected.
If this is the Republican platform for 2012, voters will definitely have a choice.
If this is the Republican platform for 2012, voters will definitely have a choice.
President To Propose Ending FICA Cap
From the Los Angeles Times:
President Obama will call for shrinking the nation's long-term deficits by raising taxes on wealthier Americans and requiring them to pay more into Social Security, drawing a barbed contrast with a Republican plan to save money by deeply slashing Medicare, Medicaid and other domestic spending. ...
Obama would end tax breaks for households earning more than $250,000 a year, trim Pentagon spending, lift a cap on the amount of income that is assessed for Social Security, and save on Medicare and Medicaid through alterations to healthcare delivery, administration officials said. He will speak about 1:30 p.m. Eastern time on the campus of George Washington University.
Final Appropriations Numbers For Social Security
The House Appropriations Committee has finally posted numbers on the cuts for various agencies under the final continuing resolution that will fund agencies through the rest of the fiscal year (FY). These numbers show no specific cut for the Social Security Administration other than a 0.2% cut being imposed across the board on all civilian agencies.
If I understand correctly, this means that Social Security's operating budget for the rest of the fiscal year will be the same as for the last fiscal year, less 0.2%, which would be about a $23 million reduction, at a time when Social Security's workloads are increasing dramatically. The Republican appropriations bill would have reduced Social Security's funding by $125 million from FY 2010, not counting recissions in funds already appropriated for construction of a new national computer center. The President's bill would have given Social Security almost a billion dollars more than FY 2010.
The bottom line is that under this level of funding, Social Security can probably avoid furloughing employees -- and I would guess that to have been the only goal shared by Democrats and Republicans -- but backlogs will grow and service will deteriorate. I am curious to know whether any overtime will be possible for the rest of FY 2011. Social Security has been getting a lot of its workload accomplished using overtime. No overtime would be very bad news for Social Security. Also, we need to know to what extent Social Security will have to freeze hiring for the rest of FY 2011.
Funding for Social Security's new national computer center is more precarious than anyone, including Republicans, would like. That money will have to be painfully squeezed out of the budget each year until it is finished.
Update: That 0.2% reduction in funding must not have been applied exactly evenly. According to the actual bill, Social Security's reduction was $26 million, not $23 million. More importantly, $75 million in funds previously appropriated to Social Security for information technology, telecommunications hardware and software infrastructure was rescinded. This is on top of the $200 million in rescissions for the national computer center. We already knew about that one.
This is going to be a mess to manage. Social Security is on a path towards administrative collapse.
If I understand correctly, this means that Social Security's operating budget for the rest of the fiscal year will be the same as for the last fiscal year, less 0.2%, which would be about a $23 million reduction, at a time when Social Security's workloads are increasing dramatically. The Republican appropriations bill would have reduced Social Security's funding by $125 million from FY 2010, not counting recissions in funds already appropriated for construction of a new national computer center. The President's bill would have given Social Security almost a billion dollars more than FY 2010.
The bottom line is that under this level of funding, Social Security can probably avoid furloughing employees -- and I would guess that to have been the only goal shared by Democrats and Republicans -- but backlogs will grow and service will deteriorate. I am curious to know whether any overtime will be possible for the rest of FY 2011. Social Security has been getting a lot of its workload accomplished using overtime. No overtime would be very bad news for Social Security. Also, we need to know to what extent Social Security will have to freeze hiring for the rest of FY 2011.
Funding for Social Security's new national computer center is more precarious than anyone, including Republicans, would like. That money will have to be painfully squeezed out of the budget each year until it is finished.
Update: That 0.2% reduction in funding must not have been applied exactly evenly. According to the actual bill, Social Security's reduction was $26 million, not $23 million. More importantly, $75 million in funds previously appropriated to Social Security for information technology, telecommunications hardware and software infrastructure was rescinded. This is on top of the $200 million in rescissions for the national computer center. We already knew about that one.
This is going to be a mess to manage. Social Security is on a path towards administrative collapse.
Proposed Change In Evidence Collection Regulations
From a notice of proposed rule-making posted by the Social Security Administration in today's Federal Register (footnote omitted):
We propose to modify the requirement to recontact your medical source(s) first when we need to resolve an inconsistency or insufficiency in the evidence he or she provided....
Sometimes the evidence we receive from your treating physician, psychologist, or other medical source is inadequate for us to determine whether you are disabled; that is, we either do not have sufficient evidence to determine whether you are disabled or if after weighing the evidence we determine we cannot reach a conclusion about whether you are disabled. Our current regulations describe what actions we will take in these situations. Currently, we will first recontact your medical source to determine whether the additional information we need is readily
available, unless we know from past experience that the source either cannot or will not provide the necessary findings. We will seek additional evidence or clarification from your medical source when the report from your medical source contains a conflict or ambiguity that must be resolved, does not contain all the necessary information, or does not appear to be based on medically acceptable clinical and laboratory diagnostic techniques....
[W]e propose to modify the requirement in Sec. Sec. 404.1512(e) and 416.912(e) that we first recontact your medical source(s) when we need to resolve an inconsistency or insufficiency in the evidence he or she provided. Under our proposed rule, after we have made every reasonable effort to help you get medical reports from your medical sources, we will determine the best way to resolve the
inconsistency or insufficiency. We will do that by taking one or more of several actions, including recontacting your medical source(s) when we need to resolve an inconsistency or insufficiency in the evidence he or she provided. ...
Apr 11, 2011
My Surgery
It snowed on Christmas Day in Raleigh. It wasn't your classic White Christmas since the snowfall did not start until late on Christmas afternoon but it was the closest this Southern boy has ever come to a White Christmas. On the day after Christmas, I went out for a walk in the newly fallen snow. It was wonderful. Few cars had passed. The snow was ankle deep and soft, giving excellent traction. I have been walking regularly for exercise for years and that was as good as a walk could get. I remember passing by a neighbor who was shoveling her driveway. I called out with the standard Southern advice for snow -- "Don't bother shoveling! It'll melt!"
By the next day, December 27, much of that snow had melted. I decided to go out and walk again, which was a terrible mistake. I got about two blocks from my house before I slipped and fell on ice. I fell straight back landing flatly on my shoulders. My immediate reaction on hitting the icy asphalt was relief that the impact did not hurt. Unfortunately, I quickly realized that I was in no pain because I could feel nothing below my neck. I could also move nothing below my neck. As bad as that sounds, it does not quite convey how dire things seemed. I looked to my left and saw something close by that I could not immediately identify. I soon realized that what I saw was my left arm stretched out at shoulder level. I had thought it was by my side. The left arm that I was looking at did not even seem to be part of me.
I called for help. My neighbors were ensconced in their warm houses and could not hear me. It took a few minutes before someone drove up. In those few minutes, I started feeling pain in my shoulders. Sensations of the cold, cold pavement that I was lying upon were entering my buttocks and legs. I began to wiggle my fingers and toes. I was even able to think about trying to get up but quickly realized that I could not get up on my own and that any attempt to do so would be insane.
I have been asked many times how long the quadriplegia lasted. I have told people that it may have been two to six minutes but that I was certainly not looking at my watch and that my perception of time was probably skewed by what I was experiencing.
An ambulance finally arrived. I was placed on a body board and taken to the emergency room. A technician tried to check my temperature on arrival at the emergency room. The thermometer did not register. He muttered that it must be broken and got another one. It did not register either. He got a third thermometer which finally registered. I was not told what it showed but the technician immediately got some warm blankets and put them over me.
Many x-rays and MRIs were done. They showed one thing which I already knew, that I did not have a head injury. They also showed to my surprise that I did not have any shoulder injuries even though as time passed at the emergency room, my shoulders hurt more and more. The MRIs of my cervical spine showed much pre-existing arthritis, spondylosis to be technical, that was constricting my spinal cord although there was no appearance of acute spinal stenosis, that is, pinching of the spinal cord.
I was regaining sensation and movement the entire time that I was in the emergency room -- about nine hours. By the time I was released from the emergency room, I was in a lot of shoulder pain, I had pain in my rubbery arms and legs, I was exhausted, thirsty and hungry but I was able to button my shirt and tie my shoes, which was extremely encouraging. I still felt terribly, terribly cold.
I was told to make an appointment with a neurosurgeon, which I did. The neurosurgeon looked at the MRIs and said that he could see no damage to my spinal cord but said that it took time before spinal cord damage shows up on MRIs. He said that my cervical spine looked to be tight around my spinal cord but not tight enough to require surgery. Still, he implied that I might need spinal surgery in the near future, saying that my spinal cord first needed time to heal. He ordered a course of oral steroids, which he thought should have been given to me at the emergency room, and physical therapy. The steroids helped a lot but the benefit ended soon after they stopped. The physical therapy helped me keep up my strength and range of motion.
Things began to settle down. I had pain, numbness and weakness in both shoulders, both arms and both legs. My symptoms were patchy and variable. None of it was acute. It was just that the symptoms covered so much of my body.
I was supposed to go back to my neurosurgeon on April 14. By early April, I called to ask that my appointment be moved up because my symptoms were rapidly accelerating. It took some time to get in to my neurosurgeon's office. In the meantime, new MRIs were ordered. When I finally got to my neurosurgeon's office, I was told that he had been called out of town due to some unspecified emergency and would not be back for two weeks but that I could see his physician's assistant (PA). The PA had an odd look on his face when he came in the room. He did an extremely hurried exam and seemed to expect every abnormality he found and he found a lot. He showed me the MRIs which he had looked at before examining me. My spondylosis had accelerated. Also, and even more important, I now had a badly herniated disk at C3-4. My spinal cord was obviously compressed at c3-4 to the point that it was perhaps one-quarter of the diameter above and below that point. The pinched portion of the spinal cord looked nearly white on the MRI. The PA told me that was dangerous. He informed me that I could not wait until my neurosurgeon returned to town, that I must see another neurosurgeon as soon as possible.
I saw another neurosurgeon the next day. He recommended that I have a C3-4 anterior cervical diskectomy and fusion (ACDF) and soon. He told me that I also have significant problems at C7 and to some extent at C4-6 but he felt those did not require surgery now and might never require surgery.
I had the C3-4 ACDF surgery last Friday. I was home by Saturday afternoon. My throat is awfully sore. Having an anterior fusion means the surgeon goes in through the front of the neck, having to navigate around the trachea, esophagus and larynx which do not appreciate being disturbed, any more than the cervical vertebrae appreciate having screws drilled into them to support a titanium plate.
My neurologic symptoms are fluctuating but I have seen much improvement. No one can say where I will finally end up but I am confident that I will be much better than I have been since December 27. In any case, but for the surgery I would have been in a wheelchair or worse within a few months.
I had never heard of a fall producing a temporary paralysis. I have found out since that while rare this is far from unknown. This sort of thing is most commonly seen in football. This is a major reason for the current rule requiring that tackles be made with the head up since tackles with the head down put a player at greater risk for spinal cord injury. Remember that I never thought that I had injured my head in the fall? That was because I had instinctively flexed my neck forward so the back of my head would not strike the pavement. That may have saved me from a terrible head injury but it also put me at greater risk for a spinal cord injury.
I have heard a couple of theories about how this sort of temporary paralysis happens. One theory is that the violent slamming of the spinal cord damages the myelin that surrounds nerves much like the insulation that surrounds electrical wires. Another theory is that the violent slamming temporarily disrupts the blood supply to the spinal cord. No one knows.
To readers who wonder why my symptoms did not correspond to the nerve root dermatomes, they are so familiar with, I had and have myelopathy, not radiculopathy; damage to the the spinal cord itself rather than to one or two individual nerves branching off from the spinal cord. Dermatomes are irrelevant when one is talking about myelopathy. You just do not see much myelopathy in Social Security disability determination.
Let me relate one final point that may seem minor to others but which I find fascinating. For more than a year before my fall, I had been complaining to my family doctor of coldness in my hands and feet. He had no idea why this was happening nor any solution for the problem. This coldness got much worse after the fall. By my hospitalization for surgery, it was difficult for nurses to draw blood or establish an IV line since the blood was hardly flowing to the skin of my arms. While I was in the recovery room after surgery I could feel the warm blood coming back into my feet. Soon after I got to my hospital room, I could feel warmth coming back to my hands. It fluctuates some but the blood circulation to my hands and feet has changed dramatically since the surgery. Getting a blood sample or establishing a new IV line became easy. I related this to the neurosurgeon. He did not seem surprised. He had already been told of the difficulty drawing blood and establishing IV lines. He figured that the blood circulation problem was a subtle sign of the spinal cord compression that existed even before my fall.
By the next day, December 27, much of that snow had melted. I decided to go out and walk again, which was a terrible mistake. I got about two blocks from my house before I slipped and fell on ice. I fell straight back landing flatly on my shoulders. My immediate reaction on hitting the icy asphalt was relief that the impact did not hurt. Unfortunately, I quickly realized that I was in no pain because I could feel nothing below my neck. I could also move nothing below my neck. As bad as that sounds, it does not quite convey how dire things seemed. I looked to my left and saw something close by that I could not immediately identify. I soon realized that what I saw was my left arm stretched out at shoulder level. I had thought it was by my side. The left arm that I was looking at did not even seem to be part of me.
I called for help. My neighbors were ensconced in their warm houses and could not hear me. It took a few minutes before someone drove up. In those few minutes, I started feeling pain in my shoulders. Sensations of the cold, cold pavement that I was lying upon were entering my buttocks and legs. I began to wiggle my fingers and toes. I was even able to think about trying to get up but quickly realized that I could not get up on my own and that any attempt to do so would be insane.
I have been asked many times how long the quadriplegia lasted. I have told people that it may have been two to six minutes but that I was certainly not looking at my watch and that my perception of time was probably skewed by what I was experiencing.
An ambulance finally arrived. I was placed on a body board and taken to the emergency room. A technician tried to check my temperature on arrival at the emergency room. The thermometer did not register. He muttered that it must be broken and got another one. It did not register either. He got a third thermometer which finally registered. I was not told what it showed but the technician immediately got some warm blankets and put them over me.
Many x-rays and MRIs were done. They showed one thing which I already knew, that I did not have a head injury. They also showed to my surprise that I did not have any shoulder injuries even though as time passed at the emergency room, my shoulders hurt more and more. The MRIs of my cervical spine showed much pre-existing arthritis, spondylosis to be technical, that was constricting my spinal cord although there was no appearance of acute spinal stenosis, that is, pinching of the spinal cord.
I was regaining sensation and movement the entire time that I was in the emergency room -- about nine hours. By the time I was released from the emergency room, I was in a lot of shoulder pain, I had pain in my rubbery arms and legs, I was exhausted, thirsty and hungry but I was able to button my shirt and tie my shoes, which was extremely encouraging. I still felt terribly, terribly cold.
I was told to make an appointment with a neurosurgeon, which I did. The neurosurgeon looked at the MRIs and said that he could see no damage to my spinal cord but said that it took time before spinal cord damage shows up on MRIs. He said that my cervical spine looked to be tight around my spinal cord but not tight enough to require surgery. Still, he implied that I might need spinal surgery in the near future, saying that my spinal cord first needed time to heal. He ordered a course of oral steroids, which he thought should have been given to me at the emergency room, and physical therapy. The steroids helped a lot but the benefit ended soon after they stopped. The physical therapy helped me keep up my strength and range of motion.
Things began to settle down. I had pain, numbness and weakness in both shoulders, both arms and both legs. My symptoms were patchy and variable. None of it was acute. It was just that the symptoms covered so much of my body.
I was supposed to go back to my neurosurgeon on April 14. By early April, I called to ask that my appointment be moved up because my symptoms were rapidly accelerating. It took some time to get in to my neurosurgeon's office. In the meantime, new MRIs were ordered. When I finally got to my neurosurgeon's office, I was told that he had been called out of town due to some unspecified emergency and would not be back for two weeks but that I could see his physician's assistant (PA). The PA had an odd look on his face when he came in the room. He did an extremely hurried exam and seemed to expect every abnormality he found and he found a lot. He showed me the MRIs which he had looked at before examining me. My spondylosis had accelerated. Also, and even more important, I now had a badly herniated disk at C3-4. My spinal cord was obviously compressed at c3-4 to the point that it was perhaps one-quarter of the diameter above and below that point. The pinched portion of the spinal cord looked nearly white on the MRI. The PA told me that was dangerous. He informed me that I could not wait until my neurosurgeon returned to town, that I must see another neurosurgeon as soon as possible.
I saw another neurosurgeon the next day. He recommended that I have a C3-4 anterior cervical diskectomy and fusion (ACDF) and soon. He told me that I also have significant problems at C7 and to some extent at C4-6 but he felt those did not require surgery now and might never require surgery.
I had the C3-4 ACDF surgery last Friday. I was home by Saturday afternoon. My throat is awfully sore. Having an anterior fusion means the surgeon goes in through the front of the neck, having to navigate around the trachea, esophagus and larynx which do not appreciate being disturbed, any more than the cervical vertebrae appreciate having screws drilled into them to support a titanium plate.
My neurologic symptoms are fluctuating but I have seen much improvement. No one can say where I will finally end up but I am confident that I will be much better than I have been since December 27. In any case, but for the surgery I would have been in a wheelchair or worse within a few months.
I had never heard of a fall producing a temporary paralysis. I have found out since that while rare this is far from unknown. This sort of thing is most commonly seen in football. This is a major reason for the current rule requiring that tackles be made with the head up since tackles with the head down put a player at greater risk for spinal cord injury. Remember that I never thought that I had injured my head in the fall? That was because I had instinctively flexed my neck forward so the back of my head would not strike the pavement. That may have saved me from a terrible head injury but it also put me at greater risk for a spinal cord injury.
I have heard a couple of theories about how this sort of temporary paralysis happens. One theory is that the violent slamming of the spinal cord damages the myelin that surrounds nerves much like the insulation that surrounds electrical wires. Another theory is that the violent slamming temporarily disrupts the blood supply to the spinal cord. No one knows.
To readers who wonder why my symptoms did not correspond to the nerve root dermatomes, they are so familiar with, I had and have myelopathy, not radiculopathy; damage to the the spinal cord itself rather than to one or two individual nerves branching off from the spinal cord. Dermatomes are irrelevant when one is talking about myelopathy. You just do not see much myelopathy in Social Security disability determination.
Let me relate one final point that may seem minor to others but which I find fascinating. For more than a year before my fall, I had been complaining to my family doctor of coldness in my hands and feet. He had no idea why this was happening nor any solution for the problem. This coldness got much worse after the fall. By my hospitalization for surgery, it was difficult for nurses to draw blood or establish an IV line since the blood was hardly flowing to the skin of my arms. While I was in the recovery room after surgery I could feel the warm blood coming back into my feet. Soon after I got to my hospital room, I could feel warmth coming back to my hands. It fluctuates some but the blood circulation to my hands and feet has changed dramatically since the surgery. Getting a blood sample or establishing a new IV line became easy. I related this to the neurosurgeon. He did not seem surprised. He had already been told of the difficulty drawing blood and establishing IV lines. He figured that the blood circulation problem was a subtle sign of the spinal cord compression that existed even before my fall.
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