Jun 6, 2017
Jun 5, 2017
Can We Talk About Real Problems?
There have been many, many media pieces on the Trump budget proposals that promise big cuts in the number of people drawing Social Security disability benefits. Here's one from CBS and another from Bloomberg.
The thing that gets me is that the Trump budget proposals on Social Security disability are unlikely to have an effect upon the real world. They mostly rely upon vague proposals to return many disability recipients to the workforce. It's not like this hasn't been tried before. The Social Security Act is littered with work incentive after work incentive to the point that almost no one understands how they all work. Certainly, claimants don't understand. The oldest work incentives date back to the 1960s. Everything has been tried. Nothing worked. Nothing will work. The vast majority of Social Security disability recipients are too sick to work and have no realistic hope of getting better. I doubt that any new work incentive could be passed and if it was, it wouldn't work. However, the news media likes to talk about these proposals because they fit into a narrative that the Trump administration is heartless. It may be but these proposals are more a sign of fecklessness than of heartlessness.
Meanwhile, almost no one pays attention to Social Security's operating budget. This has an effect on the here and now. The agency is starving for operating funds. As a result, backlogs increase, telephones don't get answered and wait times at Social Security field offices soar. That gets little attention because it's boring but real people are suffering right now. All of this could be improved dramatically by adding another billion dollars to Social Security's operating budget.
Please, let's pay more attention to the operating budget and Social Security's service delivery problems. They matter. They could be solved so easily.
Jun 4, 2017
Hoagland Approached About Social Security Commissioner But Says "No"
In the course of an article about how slowly the Trump Administration is filling government positions, the Los Angeles Times reports that William Hoagland was approached about becoming Social Security Commissioner but declined. Hoagland didn't want the job because he really wants to cut Social Security, and apparently far more than the disability cuts proposed, but Trump didn't. That tells you something about Trump but it also tells you that Hoagland understands little about the job of Social Security Commissioner. Even if Trump wanted to really cut Social Security, it wouldn't be the job of the Social Security Commissioner to sell the plan. Social Security Commissioners stay out of campaigns to make significant changes to the Social Security Act regardless of the administration. Whenever anyone is nominated for Commissioner, Senators of both parties always demand that he or she promise to stay out of that sort of debate.
Jun 3, 2017
Another Attack On People Suffering From Mental Illness
From the Washington Post:
Bipolar disorder is a very serious mental disorder. Although many people with bipolar can be stabilized with medication to the point that they can work and live fairly normal lives, that is certainly not the case with all. The disability produced by bipolar disorder has nothing to do with where a person lives or what their source of income is. Cutting off the income of people with bipolar disorder doesn't effect any cure. It just causes stress which makes the condition worse.
With one exception, I don't often see two members of the same family as clients either at the same time or at different times. The exception is families where there's a lot of bipolar disorder.
By the way, I don't know if there have been any studies, but I think a fair number of people with bipolar disorder get involved in relationships with other people with bipolar disorder producing children who face a really high risk of bipolar disorder. Why would this happen? Well, I guess you could say "birds of a feather ..." or "misery loves company" or you could say there was a lack of alternatives. Sometimes people meet in a psychiatrist's waiting room or in a psychiatric hospital. For better or worse, love finds a way and that's not always a good thing.
In presenting a family where there's a lot of bipolar disorder, the reporter presented a skewed picture. He would have found it very hard to find a family to illustrate the point he wanted to make, and he definitely had a point he wanted to make, where the genetics of bipolar disorder weren't a major part. Would the reporter have used a family where there was a lot of hemophilia present to make the same point? I think not since he would have known that genetics were the problem, not culture or poverty or living in a rural area. This reporter was almost certainly unaware of how big a role genetics play in bipolar disorder.
The food was nearly gone and the bills were going unpaid, but they still had their pills, and that was what they thought of as the sky brightened and they awoke, one by one. First came Kathy Strait, 55, who withdrew six pills from a miniature backpack and swallowed them. Then emerged her daughter, Franny Tidwell, 32, who rummaged through 29 bottles of medication atop the refrigerator and brought down her own: oxcarbazepine for bipolar disorder, fluoxetine for depression, an opiate for pain. She next reached for two green bottles of Tenex, a medication for hyperactivity, filled two glasses with water and said, “Come here, boys.”
The boys were identical twins William and Dale, 10. They were the fourth generation in this family to receive federal disability checks, and the first to be declared no longer disabled and have them taken away. In days that had grown increasingly tense, as debts mounted and desperation grew to prove that the twins should be on disability, this was always the worst time, before the medication kicked in, when the mobile home was filled with the sounds of children fighting, dogs barking, adults yelling, television volume turned up. ...
Talk of medications, of diagnoses, of monthly checks that never seem to cover every need — these are the constants in households like this one, composed of multiple generations of people living on disability. Little-studied and largely unreported, such families have become familiar in rural communities reshaped by a decades-long surge that swelled the nation’s disability rolls by millions before declining slightly in 2015 as older beneficiaries aged into retirement benefits, according to interviews with social workers, lawyers, school officials, academics and rural residents. ...
“I hesitate to use a term like ‘culture.’ It’s not a specific, measurable metric,” said Kathleen Romig, an analyst with the Center on Budget and Policy Priorities, who studies disability in the United States. “Certain things like toxic stress or nutrition or preterm births or parental depression or genetics” offer a more revealing context for understanding generational disability.
And yet others say it’s about money.
Ruth Horn, director of social services in Buchanan County, Va., which has one of the country’s highest rates of disability, has spent decades working with profoundly poor families. Some parents, she said, don’t encourage their children academically, and even actively discourage them from doing well, because they view disability as a “source of income,” and think failure will help the family receive a check. ...For the record, genetic influences account for 60-85% of the risk for bipolar disorder so it is hardly surprising to find several people with bipolar disorder in the same family. Many who are initially diagnosed with attention deficit disorder in childhood are eventually diagnosed with bipolar disorder.
Bipolar disorder is a very serious mental disorder. Although many people with bipolar can be stabilized with medication to the point that they can work and live fairly normal lives, that is certainly not the case with all. The disability produced by bipolar disorder has nothing to do with where a person lives or what their source of income is. Cutting off the income of people with bipolar disorder doesn't effect any cure. It just causes stress which makes the condition worse.
With one exception, I don't often see two members of the same family as clients either at the same time or at different times. The exception is families where there's a lot of bipolar disorder.
By the way, I don't know if there have been any studies, but I think a fair number of people with bipolar disorder get involved in relationships with other people with bipolar disorder producing children who face a really high risk of bipolar disorder. Why would this happen? Well, I guess you could say "birds of a feather ..." or "misery loves company" or you could say there was a lack of alternatives. Sometimes people meet in a psychiatrist's waiting room or in a psychiatric hospital. For better or worse, love finds a way and that's not always a good thing.
In presenting a family where there's a lot of bipolar disorder, the reporter presented a skewed picture. He would have found it very hard to find a family to illustrate the point he wanted to make, and he definitely had a point he wanted to make, where the genetics of bipolar disorder weren't a major part. Would the reporter have used a family where there was a lot of hemophilia present to make the same point? I think not since he would have known that genetics were the problem, not culture or poverty or living in a rural area. This reporter was almost certainly unaware of how big a role genetics play in bipolar disorder.
Jun 2, 2017
It Has Nothing To Do With "Character"
Someone posted this comment on this blog recently:
Why do people take low end jobs as a Certified Nurse Attendant (CNA), kitchen helper, assembler, construction helper, etc? These jobs are physically demanding, the working conditions aren't so great and the pay is lousy. Why strain your back as a CNA lifting 200 pound patients for little more than minimum wage when you can work in a data processing job that pays better?
The answer is that people take these harder low-paying jobs because they're not able to perform those more desirable jobs. The problems that keep people in physically demanding, low-paying jobs vary from person to person but the two most important reasons are limited cognitive abilities and chronic psychiatric problems. If you're reading this blog, you probably didn't hang out in high school with the kids who barely made it through high school, much less the kids who didn't make it through high school. Those kids became adults who went to work at these physically demanding low-paying jobs. They're almost invisible to most of us who work in offices but they're a significant part of the workforce. They file a lot of disability claims because once they get sick or injured they have little to offer an employer. Having low cognitive abilities or chronic psychiatric problems isn't a sign of lack of character. It's bad luck.
Contrary to the poster, not anyone can work in medical billing and coding or data processing. I don't even know what sort of "social services" work the poster is talking about. To do office jobs you have to have basic computer literacy and the ability to type. You have to be able to learn. You have to be able to work with other people. You have to meet some minimum standards for hygiene and social conduct. Those with low cognitive abilities or chronic mental illness usually have problems with several of these requirements. This may seem incomprehensible if you work in an office and never mingle with poorly educated or chronically mentally ill people but I'm talking about real problems that force people to take low-paying, physically demanding jobs and that make it very difficult for them if they become sick or injured. Talking about these practical problems as if they were merely a matter of "character" is a "let them eat cake" approach. And, no, additional education isn't a solution either. If these folks could have benefited from additional education, in most cases they would already have gotten it. They already have plenty of incentive.
Not everyone can be Stephen Hawking ALS or not, that is a once in a generation mind. On the other hand medical billing and coding, data processing, social services work and countless other positions can and are done by those with disabilities every day. Programs like HBWD (Health Benefits for Workers with Disability) help bridge the gap of healthcare, the highest priority for those with chronic conditions. You can make a difference or make excuses, you cannot legislate character.I think this is worthy of a reply.
Why do people take low end jobs as a Certified Nurse Attendant (CNA), kitchen helper, assembler, construction helper, etc? These jobs are physically demanding, the working conditions aren't so great and the pay is lousy. Why strain your back as a CNA lifting 200 pound patients for little more than minimum wage when you can work in a data processing job that pays better?
The answer is that people take these harder low-paying jobs because they're not able to perform those more desirable jobs. The problems that keep people in physically demanding, low-paying jobs vary from person to person but the two most important reasons are limited cognitive abilities and chronic psychiatric problems. If you're reading this blog, you probably didn't hang out in high school with the kids who barely made it through high school, much less the kids who didn't make it through high school. Those kids became adults who went to work at these physically demanding low-paying jobs. They're almost invisible to most of us who work in offices but they're a significant part of the workforce. They file a lot of disability claims because once they get sick or injured they have little to offer an employer. Having low cognitive abilities or chronic psychiatric problems isn't a sign of lack of character. It's bad luck.
Contrary to the poster, not anyone can work in medical billing and coding or data processing. I don't even know what sort of "social services" work the poster is talking about. To do office jobs you have to have basic computer literacy and the ability to type. You have to be able to learn. You have to be able to work with other people. You have to meet some minimum standards for hygiene and social conduct. Those with low cognitive abilities or chronic mental illness usually have problems with several of these requirements. This may seem incomprehensible if you work in an office and never mingle with poorly educated or chronically mentally ill people but I'm talking about real problems that force people to take low-paying, physically demanding jobs and that make it very difficult for them if they become sick or injured. Talking about these practical problems as if they were merely a matter of "character" is a "let them eat cake" approach. And, no, additional education isn't a solution either. If these folks could have benefited from additional education, in most cases they would already have gotten it. They already have plenty of incentive.
Jun 1, 2017
Have You Ever Been Under So Much Time Pressure That You Took A Shortcut Even Though You Knew It Would Probably End Up Taking Longer?
One of my colleagues wrote a letter to his Congressman about the problem of a Social Security hearing office scheduling hearings without contacting attorney offices first. This is contrary to established agency practices which are posted in the agency's HALLEX manual. His Congressman in turn wrote Social Security which sent back the reply below. Click on each page to view it full size.
If you're not involved in the hearing process, you can regard complaints about this as nothing more than attorney whining, but you'd be wrong. The fact that this is happening is a sign of desperation at the hearing offices. They're under so much pressure to schedule hearings that they're deliberately doing something they know will actually take more time in the end. Social Security attorneys have many clients. It's the only way you can make money in this kind of practice. If hearing offices don't call attorneys before scheduling hearings, inevitably any attorney will have conflicts between scheduled hearings. It takes longer to reschedule hearings than it would to make the phone calls in the first place. We're even seeing cases where hearing offices are refusing to reschedule hearings even after they've been notified that an attorney has a conflict with a previously scheduled hearing. Hearing offices that do this have to know that the Appeals Council will remand 100% of such cases but they're doing it anyway.
As you can see from Social Security's response, there's not enough concern at Social Security's Atlanta Regional Office that they intend to do anything about the problem.
By the way, from the letter, it sounds like the law firm was complaining about the Raleigh hearing office but that's not the problem office. Raleigh is still calling. The law firm was complaining about the North Charleston, SC hearing office that serves the Southeastern corner of North Carolina.
This problem isn't limited to North Carolina. It's not affecting every hearing office but it is affecting many nationwide.
I'm trying to think of an analogy to explain why this is so concerning. Let me try this one. Let's say a police officer pulls over a woman who's going down the road at 90 miles an hour. The officer finds a child in the back seat. The driver explains "I was just trying to get my child to school on time." I think you'd understand that the problem wasn't just the speeding. You'd know that something was clouding the driver's judgment and you'd think that whatever was clouding the driver's judgment was probably even more worrisome than the speeding itself.
I'm trying to think of an analogy to explain why this is so concerning. Let me try this one. Let's say a police officer pulls over a woman who's going down the road at 90 miles an hour. The officer finds a child in the back seat. The driver explains "I was just trying to get my child to school on time." I think you'd understand that the problem wasn't just the speeding. You'd know that something was clouding the driver's judgment and you'd think that whatever was clouding the driver's judgment was probably even more worrisome than the speeding itself.
May 31, 2017
Trying To Put A Big Finger On The Scales Of Justice?
From three nearly identical contracting notices posted by the Social Security Administration:
The SSA Office Disability Policy seeks to: (1) provide additional capacity for medical expertise to the Office of Disability Adjudication and Review (ODAR) and (2) conduct a small scale pilot to determine whether existing Medical Consultants' (MC) in various specialties and Psychiatric Consultants (PC) use at the hearing level will enhance the accuracy and consistency between disability determinations at the initial level and decisions at the hearing level. Towards this end, BPA number SS00-16-4C051 with [H Richard Waranch, Neal Salomon, or Homayoon Moghbeli] to provide MC/PC services in the specialty of psychology, will be modified to permit the contractor to review cases for ODAR in the capacity of a ME, provide a written response and opinions to questions and/or interrogatories, and to give oral testimony subject to cross examination.Enhance consistency? Will there be any pilot to try to get initial level determinations more consistent with ODAR decisions? Is the only change sought at the hearing level?
Can anyone tell me anything about Waranch, Salomon and Meghbeli?
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