SSDI's Open Enrollment

Bryce Canyon, Utah - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

Two years ago an article appeared on this site which noted the influx of patients admitted for surgery who were young, receiving Medicare benefits, and whose state of health did not correlate with their level of disability. (Did I Missing Something?) Now we are told at the present rate of depletion the SSDI Trust Fund will be defunct within five or six years.

The four predominant federal welfare and insurance programs are in serious trouble, and it is not just the Democrats who initiated them. Credit them for Medicare and Social Security, but SSDI (Social Security Disability Insurance) was enacted during the Eisenhower Administration and SSI (Supplemental Security Income) during Nixon’s tenure. They share something in common: initially all were limited in scope with political assurances of financial prudence, but with time aggressive expansion ensued without regard to financial repercussions.

To review, SSDI is an insurance program funded through Social Security while SSI is a welfare program funded through the general tax fund. To be eligible for SSDI a person’s medical condition must have rendered them unable to work for at least one year or that condition prevents them from working for at least one year in the future or result in death. If after two years of receiving benefits, SSDI recipients are eligible for Medicare. In contrast SSI is a non insurance based program where eligibility is independent of work status, and recipients receive Medicaid benefits.

To understand how far SSDI has drifted from the original intent, it is useful to review its history. According to Professor Edward Berkowitz’s testimony to Congress in 2000, the intent and rules governing SSDI were debated hotly during Roosevelt’s New Deal twenty years before becoming law in 1956. Specifically, lawmakers confronted with economic hardships of the Great Depression were adamant the program was a disability program and not intended for unemployment compensation, otherwise admitting legions of unemployed people into the program would quickly exhaust available financial resources. Consequently, disability was defined as “an impairment of mind or body which continuously renders it impossible for the disabled person to follow any substantial gainful occupation” and was likely to last for “the rest of a person’s life.”

Today’s woeful state of affairs should come as no surprise. Although SSDI eligibility requirements are touted as strict, there is a broad scope of opinion among those who define disability. Last year 46.9% of all SSDI applications were approved with the highest rate of 63% occurring in the 00725 Zip Code in Puerto Rico. Furthermore, the applicant does not need to be injured on the job to receive the average $1070 per month stipend. Enrollment has ballooned to 8.5 million workers - nearly three time the number of twenty years ago. Most claims are not based on severe physical injury or incapacitating medical conditions like Lou Gehrig’s Disease or terminal cancer but nebulous, difficult to quantitate complaints like back pain and depression. With nearly open enrollment and funds rapidly dissipating, one would expect government agencies to monitor recipients to insure they are truly unable to function in the workplace in some capacity - right? Only 1% of SSDI enrollees ever return to work. SSDI has become primarily an unemployment program and a disability program secondarily. It is hardly reassuring that the 6.20% Social Security deduction taken from every paycheck is spent is such a frivolous manner.

The Occupy Wall Streeters are misdirected and protesting in the wrong places. They should hop in their VW vans, make a pilgrimage to Washington, D.C., and pitch their tents on the lawns of the White House and of every Congressman and Senator who spend this country into oblivion. Give them the message that we would be better off, if everyone of them resigned, enrolled in SSDI, and never “helped” us again with their brilliant ideas. In this case it is worth $1070 a month for the rest of their lives just to leave us alone.

Did I Miss Something?

Roman Ruins at Volubulis, Morocco - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

I accelerate down the ramp to enter the freeway. Within ten seconds six vehicles with handicapped license plates roar past me. I remark to my wife, “Does it seem to you there are a disproportionate number of disabled drivers in California?”

Out of curiosity I follow a high horse power pickup truck with a construction company logo off the highway until the driver parks in a disabled parking spot in front of a convenience store. A middle aged man bounds out of the truck and strides toward the store's entrance.

We all know someone who abuses the disability system. Programs intended to help the truly needy frequently become an avenue of deceit for those who manipulate them. Government agencies in charge of these institutions are too big, too lax, and too free with public funds.

Much of my medical training occurred in a Veterans' Hospital. The system was profoundly inefficient, but the veterans received good care primarily due to house staff working a hundred hours per week. Some veterans suffered from medical conditions due to combat wounds. Many suffered from the travails of alcoholism and tobacco abuse. A few were malingerers who received disability compensation for maladies that were either not service connected or for bogus diagnoses stemming from vague symptoms.

Part of our job as internal medicine house staff was to evaluate patients receiving disability. Continued receipt of benefits depended upon these periodic examinations. One clinic day another resident and I examined a robust thirty year old man receiving 50% disability for Reiter's Syndrome, a type of arthritis. As hard as we tried, the diagnosis did not fit the history or physical examination. I asked the patient, “What kind of work do you do?”

“I can't work. The pain is too much to handle.”
“How do you make a living?”

It was the smirk which accompanied the answer that is most memorable. “I'm drinking from the lemonade spring. The VA will pay my way forever.”

We decided to recommend disapproval for disability and thoroughly documented our findings. The next day the head of the hospital called us to his office. We could either withdraw our conclusions or look for another training program.

While working in the operating room at the conclusion of an operation, I look at the information sheet of a seemingly healthy young adult only to find he or she is disabled. There is nothing in the history or physical examination to warrant such a status – no major injury, chronic debilitating disease, or congenital illness. I ask the surgeon, “Did I miss something? This patient is covered by Medicare, but there is no evidence of incapacitating disease.” When the answer surfaces, the problem usually involves stress, back pain, depression, a history of drug abuse, or an old problem which resolved but never received follow up to remove the patient from disability status.

I have a close friend who has suffered from disfiguring joint disease and unremitting pain for over thirty years due to rheumatoid arthritis. He works 70-80 hours a week, has never accepted disability benefits, and pays for those who have these benefits but whose medical problems pale in comparison to his. It is ironic someone who legitimately could qualify for disability benefits pays taxes to support those who should be taking care of him.

To put this ethos of entitlement in perspective, one only needs to look at the “Greatest Generation,” a group hailed by liberals and conservatives alike. The two defining events of this generation were the Great Depression and World War II. These times of great stress and deprivation forged a philosophy based on hard work and sacrifice. This generation paved the way for the freedom and prosperity subsequent generations enjoy. In the process, however, the message became distorted. The concept of delayed gratification and self reliance were deemphasized and replaced by a system intended to keep people from failing. Never mind the aphorism of faltering repeatedly, learning from one's mistakes, and ultimately rising a stronger person. The government's ability and resolve to differentiate between those who truly need help and the slackers has been lost.

Functioning among us are a cadre of politicians, medical professionals, lawyers, social workers, and advocacy groups who compound the problem. They are no longer stewards of a system meant to assist those legitimately in need of help but enablers who squander limited financial resources and make endless excuses. To reverse this decline will require a new type of leader who will not pander to the masses and will demand accountability from those receiving benefits from the government. In times of prosperity it is too easy to ignore frivolous behavior, but as times become more difficult there will be a day of reckoning when the country can no longer bear granting generous gratuities to the not-so-disabled.