http://apps.npr.org/unfit-for-work/?wpisrc=nl_wonk






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about a 10 minute read, interesting and somewhat scary stuff.

Heard this on the radio yesterday.

Think of all the money insurance companies have to spend trying to determine if people are faking an injury/disability. That could be so much better spent if people weren't assholes. It really gets passed on to us.

Plus my wife, who actually is sick, cannot collect any disability because the CDC does not recognize Chronic Lyme Disease. So I have to work two jobs, cancel cable and my land line, sell most of my possessions, and pray she gets better before one of our cars shits the bed. It's like a system designed to help people who are good at scamming.

Yeah, so it looks like the anti-welfare propaganda is heading to the States. And why not, it's working so well here.

it's always been here.

bootstraps


But really the NPR report was more about the manipulation of the disability support system as a replacement for welfare, which ends up hurting both. Worth a read. I found this part particularly troubling:




I am not sure how society solves this one.

What's interesting to me is hearing this story broadcast on the radio (the link on the op is pretty much a transcript of the broadcast word for word) the tone wasn't anti welfare or deminizing of these people at all. Seems to be the opposite of what people are taking away from it in a different medium.

this seems like the problem to me.

My brother has severe Spina Bifida, which means (among other things) a shunt that runs through his head and a number of stunted mental processes. I'd like to use his situation to illustrate two points regarding efforts to "clean up" or police the Medicare/Medicaid systems:

1. Tight Policing of Such Programs Needs to Be Delicately Structured

It's unquestionable that people scam this system. But Ross tried for years to get a job, and could never find anything that paid as well as what he got from the government if he wasn't working. He even earned an Associates Degree online (we all chipped in to pay for that one), and had a decent work history (he got a job at a movie theater in high school, and continued working there until he turned 22). But nothing. Furthermore, when he DID manage to get work it would often cause huge problems down the line. For example, he managed to land a job working phones for Chicago's Civic Opera House during their up-season, and then was let go when the season ended. He wasn't able to find work after that, but was now officially on the government's "See, you can totally work, so fuck off" list. He's lucky enough to have family who can afford to send him money, or I have no idea what he would have done in the more than eight months it took to get his status returned. Seriously, at one point he was on the phone with some bureaucrat, who actually said "According to our records you are no longer disabled." "That's fantastic," he responded, "wait until I tell my legs."

So while it's important to engage greater control on the output of these programs, that control needs to take the form of something more complicated than "Pretty sure this dude can work, yo." A lot of the time, a topic becomes politicized, we all become very insightful bystanders, and decisions get made based on what looks good rather than what is going to be most effective....because effective is often more complicated, and a lot harder to explain.

2. What Seems Like Common Sense Rarely Is

Last year, Ross developed an open sore on his toe, and was told that unless it became infected (inevitable, as the toe is incapable of healing itself) amputation would be regarded as cosmetic and thus not eligible for government assistance. Basically, they could give him antibiotics and a wrap to help protect it, but unless he was willing to take on the bill himself he had to wait for an infection to manifest before doing anything more.

Of course, it did manifest eventually, and they took the toe. But that kind of waiting game is super duper Russian Roulette...several of the kids we met over the years through the Spina Bifida Association have died because of exactly that. One of them, a fun guy named Dusty, by the time the surgery to amputate his foot was set to occur they discovered it had spread up as far as his hips. A few days later he was dead. He'd had the open sore for several months, but, you know, sorry....can't operate yet. It's not actually a danger.

So, to recap, with Ross the government ended up paying for the amputation anyway and, because of the policies and procedures it currently relies on to protect itself from getting ripped off, it also ended up paying for multiple extra visits and tests, copious amounts of antibiotics, and is now preparing to face the entire situation all over again (not to mention being in a constant state of putting a person's life at risk) over what could have been a single, fairly simple, surgery.

Now, there again, Ross is just a single individual going through the system, and his experience is a little outside the norm because the range of Spina Bifida's outputs can be so enormous...you can be in really, really bad shape, or you can just be John Mellencamp (I....I mean...there.....is a difference there....right??). It's not a condition that lends itself to clearly defined parameters or fill-in-a-circle paperwork. But it's exactly the 'outside the norm' scenarios that make me cringe when pathos-based "Meet Carl. Imagine how much better Carl's life would be if B. See? B. End of story, and now that you know about Carl you can discuss the entire complicated issue by discussing what you know about Carl" journalism props up on any given issue.

thanks for that, McP, i'm sorry for the frustration the system is causing your family. do you know if anything in the Affordable Care Act will provide any relief? I thought it was supposed to reward more of the preventative measures (like treating toe sores)?

NPR isn't known for anti-welfare propaganda. At least part of this story is a partial explanation of why the unemployment rate isn't higher and why the labor participation rate is so low. The states have been doing their darndest to dump people from unemployment to (federal) disability coverage. The difference for the individuals involved is that its riskier returning to the workforce after being on disability than on unemployment.

The majority of preventative measures it incorporates for adults comes in the form of screening for things like cancer or heart problems, is my understanding.

Listened to another part of this story today.

So apparently states hire consulting firms to comb through their welfare lists and look for cases where the person can be moved from welfare to disability pay. The reason for this, when welfare reform was introduced in the Clinton years it shifted the cost of welfare to the states in an effort to give them incentives to provide work opportunities to get these people off welfare and back to work. Well, the states don't pay disability the federal government does, so they're trying to move as much as they can to disability to lower their costs.

Now, this may sound like an abuse of the system but the more they got into it the more it didn't seem to be. The consulting firms aren't doing anything illegal. They're not looking for loopholes, they're finding legit cases of people on unemployment who can be receiving disability benefits instead. They're paid about 2 grand or so per person they transfer from one person to another, so what they end up doing is cold calling these people, surveying them about their health, and help them navigate the process to get disability benefits. They go so far as tracking down health records, and even scheduling doctors appointments when no health paperwork exists. Sure, they're doing this for a profit but if they're helping people who belong on this program to get on this program then what's the big deal?

I think what this illustrates is the point McParadigm made. The solution here isn't obvious, and what seems like common sense isn't. One of the big cath-22s here is that very often, the mental disabilities that prevent people from working also prevent them from navigating the bureaucratic process to get the benefits they need.

I don't see an obvious solution here, but I don't see an obvious identifiable problem either. I think what we're seeing in this report is a symptom of larger issues we face. So much of the anecdotal stories they presented showed that so much of the problems with the amount of people on welfare or on disability is results of things like globalization, recession, shifting industries in certain regions, etc.

the part about the lawyers and how the appeals court operates had me most frustrated.

i see. for the record, the "i can't wait to tell my legs" comment was just the right amount of humor to carry that story. thanks again for sharing.

Well, sometimes it's hard to tell if perverse incentives are the problem or the symptoms.

My brother is pretty awesome. I've told this one before, but once upon a time we were making our way around downtown Chicago, and this lunatic comes up to him and very loudly declares "If only you would BELIEVE, then you would be able to WALK!" This is 100% the kind of moment where I need about 10-15 seconds for a total system reboot. But Ross just calmly looks up at the guy, blinks in mock surprise, and then waves his hands in exasperation over his legs while he says, "Really?! Because this morning I thought I could fly, and NOW look at me!"

I think that's the first time I've seen "amputation" and "cosmetic" in the same sentence.

Will amputations for those with body dismorphic disorder be covered by ACA?

it is a quandary, to be sure.