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Thursday, April 04, 2013

Trends with Benefits

I listened to “This American Life” episode Trends with Benefits, and canvassed some of the subsequent media criticism of the program.  I will share my thoughts below, but wanted to set the table a bit first.   

The episode is described as follows: “The number of Americans receiving federal disability payments has nearly doubled over the last 15 years.  There are towns and counties around the nation where almost 1/4 of adults are on disability.  Planet Money's Chana Joffe-Walt spent 6 months exploring the disability program, and emerges with a story of the U.S. economy quite different than the one we've been hearing.”

 

The interaction of disability and employment is really complicated, really important, and as the reaction to the program demonstrates, really charged.  Although different researchers use different numbers, as a general principle it is pretty uncontroversial that the employment levels of people with disabilities are not good (the most recent numbers from the Department of Labor Office of Disability Employment Policy show the labor force participation for people with disabilities as 20.7% (compared to 68.8% for people without disabilities), and the unemployment rate for people with disabilities at 12.3% (compared to 7.9% for people with disabilities)).  These numbers have not improved much, if at all, since the passage of the Americans with Disabilities Act.  

There are no doubt many reasons for this: even post-ADA, discrimination against people with disabilities by employers; the failure of job training programs generally, and for people with disabilities specifically; the failure of public and private health insurance systems to address the needs of people with disabilities; larger problems with transportation and home supports that might, if addressed, put people with disabilities in more of a position to be successful.  And, as Trends with Benefits addresses, included in this list a social safety net program that has linked the inability to work with the assistance payments and health insurance.

Addressing these issues is really hard.  And as a policymaker whose judgment I trust recently told me, some humility is needed – it is not as if smart people haven’t been thinking about this for a long time. The underemployment of people with disabilities is not unique to our country – as I blogged about before, we recently hosted a conference discussing policy challenges and solutions both in the US and Japan.  So with all of that said, how does the Trends with Benefits advance the debate, if at all?

Initial disclosure – I really, really like This American Life.  I try to listen to as many episodes as I can.  Here, despite the criticism it has received, I thought the program demonstrated some important points (in its own signature way).  Most significantly, the economy has changed, and there are parts of the country where people with physical limitations will not be able to do any job they could realistically get.  Because the Social Security definition of disability is linked to the inability to do substantial gainful activity, these people do meet the definition.  In this sense, the social security program is functioning as it should – providing supports to people who because of their disabilities, cannot work. 

I was most frustrated that in making this point, Trends with Benefits missed an opportunity.  The disability rights movement has struggled to get people to accept a vision of disability as at least in part a socially constructed category, involving the interaction between the individual and society’s response to that individual’s impairment.  Disability is not necessarily inevitable, and can be the result of policy choices that we make, or do not make.   In criticizing the medical-based definition of disability, Trends with Benefits was perfectly poised to help make the point in a constructive way, but instead seemed almost hostile to it – bemoaning that there was no clean, medical diagnosis of “disability” that would serve as a gatekeeper for these programs.  There is no such definition, and any attempt to get one misses too much.  When we view it in that way, the focus becomes adopting policies that acknowledge stigma against disability (like the ADA), and try to limit socially-constructed barriers to full participation in society.  The Social Security definition of disability, like any, is a policy judgment (and one that places too much power in the hands of medical professionals), not a magic formula.  It probably is not fair for what is supposed to be an entertaining radio program to make that point, but I was disappointed. 

Trends with Benefits also made some mistakes.  To point out just a few, at one point, the reporter riffs that the only way someone can lose their social security payments is by aging into other programs or dying.  Again, this misses the point (and an opportunity) to point out the more significant way people can have their payments and health insurance cut – going back to work (although the program does make this point later).  To my mind, this is the key policy dilemma – finding social supports that acknowledge that some people with disabilities may be in and out of the workforce as theirconditions require.   While acknowledging that social security disability insurance (SSDI) is not the path to riches(except for the lawyers, who the program expects somehow to work without getting paid), I thought the program too breezily made SSDI look like a picnic, without adequately discussing that one can only get SSDI if you have worked and paid into the system, and that it really is not a pleasant road for anyone involved.  A more balanced discussion is here

Posted by Michael Waterstone on April 4, 2013 at 10:13 AM | Permalink

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Good post. One minor quibble is that you can get into the SSDI program as the disabled adult child of a retired worker. For many disabled since birth the path is child SSI -> standalone SSI -> SSDI (and two years later Medicare).

Posted by: brad | Apr 4, 2013 2:45:17 PM

It's a small matter, but I think the program did a better job on the measures you set out than you give it credit for. I didn't interpret the program as "bemoaning" the lack of gatekeepers, for example. I thought it reported in a pretty objective and even-handed way. I also thought it was ultimately fair - not hostile - in its treatement of the doctor and lawyers who seek expanded disbility benefits; indeed, most of the profiled individuals really came off as pretty likable. And I thought all of this made the program's ultimate point much more powerful: there are institutions being used to address a set of social problems that ought to be addressed but could, perhaps, be addressed better through some alternate institutional framework, if only we would take the time to be more reflective and deliberate.

I also thought, incidentally, the program /did/ make the point that disability was socially constructed, although it didn't use that explicit vocabulary. The program fairly made the case, at least, that being poor, uneducated, unskilled, socially immobile in a depressed place with any kind of physical ailment meant unemployment, even if the ailment wouldn't be viewed as serious outside of that context. The program showed that social context surrounding the physical condition made all the difference.

Posted by: Michael Young | Apr 5, 2013 1:54:43 PM

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