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?

Scare Tactics Work -- To Some Extent

     From a press release:

Only 31 percent of American adults believe that Social Security will still be around when they retire, according to a new survey from FindLaw.com. ...

Not surprisingly, faith in Social Security rises as people get older. Only 11 percent of people between the ages of 18 and 24 expect Social Security to still be around when they retire, But even among middle-aged people, less than one-third expect to receive Social Security checks.

18-24 yrs.	11%
25-34 yrs.	18%
35-44 yrs.	24%
45-54 yrs.	29%
55+ yrs.	64%

     This shows that right wing efforts to scare people about the future of Social Security work, to some extent, but Social Security isn't going away. It won't even be changed in any significant way.

New Condition For Raising Debt Limit: Raise Social Security Retirement Age?

     I have a hard time believing this but BuzzFeed reports that Senator Rand Paul is saying that the retirement age for Social Security should be raised and that Republicans will make this a condition for raising the debt ceiling. Paul is thought to be a candidate for President in 2016. This sounds more like a report from The Onion.

Conn's Troubles Not Playing Well In Kentucky

     The Lexington Herald-Leader is calling for the Kentucky Bar Association to take action against embattled attorney Eric Conn, arguing that the recent accusation that he colluded with a Social Security Administrative Law Judge is not the first time that Conn has been in trouble. He had already agreed to stop practicing before the Court of Veterans Appeals because of professional misconduct charge. Also, Conn was recently convicted of illegal campaign finance contributions.

     What I don't understand is why Social Security hasn't already suspended Conn from representing Social Security claimants -- if there is the substantial evidence against Conn indicated by at the Senate hearing last week. There is a process to take away Conn's ability to represent Social Security claimants. It can be done in a few months. Social Security wouldn't have to prove bribery. Even if it the bribery happened, it probably won't be proven unless one of the parties decides to confess. The charge of manufacturing physician opinions would be enough to stop Conn from representing Social Security claimants -- if it can be proven. Charges don't have to be proven beyond a reasonable doubt. Has Social Security just been slow to act? Has the evidence of manufacturing physician opinions just come forward? Is the evidence not as strong as it was made to appear at the Senate hearing?