The disability fraud epidemic in the US

Gotcha.
There isn't one.
But in the news today was the story  of a "ring" set up to fraudulently claim payments for 9/11 responder injuries. In the past 6 months was another story of someone making bogus disability claims based on their "trauma" after being profiled in the news for their brutality against unarmed peaceful protesters.
If your personal prejudice is that disability fraud is the norm rather than the exception, these stories are going to reinforce those beliefs.

But the facts are very different.

Chart 11. Final outcome of disabled-worker applications, 1999–2009

The final award rate for disabled-worker applicants has varied over time, averaging nearly 45 percent for claims filed from 2000 through 2009. The percentage of applicants awarded benefits at the initial claims level averaged 28 percent over the same period and ranged from a high of 37 percent to a low of 26 percent. The percentage of applicants awarded at the reconsideration and hearing levels are averaging 3 percent and 13 percent, respectively. Denied disability claims have averaged nearly 53 percent. 

SOURCE: Tables 59–64.

NOTES: Awards are calculated as medical allowances minus subsequent technical denials. Technical denials include both nonmedical decision technical denials and medical decisions that were subsequently denied for technical reasons.

The proportion of claims awarded at each level of the process is likely to change as a result of the Prototype Process being tested in 10 states. Under this test, the reconsideration step of the appeals process was eliminated for applications filed October 1, 1999, or later. Elimination of the reconsideration level in these states is likely to result in a decrease in the overall proportion of claims awarded at this step.

 Source link

 So the initial claim for Social Security disability benefits APPROVED  "averaged 28 percent over the same period and ranged from a high of 37 percent to a low of 26 percent".
So after you apply and are initially denied, you request reconsideration. Hope you are in the 3% who get approved at that level.
Well, not surprisingly you are going to have to move on to the hearing level before you actually get to talk face-to-face with anyone about your case. This will involve hiring a lawyer if you have any hope of being in the lucky 13% who get approved here. And it will only cost you 25 - 50% of your final award amount. Lucky you.
Per the Social Security Administration, they deny over half the disability claims that are presented.
That does not just include "back pain" claims. That includes every paraplegic, every schizophrenic, every gravely disabled person in this country. All the babies that now survive who require medical interventions their whole lives? They are in there too. Every brain injured person on a ventilator, every person dying of a terminal illness. Everyone who has applied for the benefit.

So my prayer for you this new year is this, I pray that you and yours do not ever have need of this benefit. I pray that reason and compassion will someday win out over political expediency and those that have the most needs are no longer treated as "entitled".
And frankly, I pray that I am in that 13%.

And Justice for All

Justice.
Big concept, and integral to so many conversations we are having in the world right now.
And no small issue with so many of these conversations is that the Justice that is being argued is based on very different definitions.
Almost universally, allegories of Justice feature a scale and a sword. The blindfold that we are familiar with in the US seems to be a more recent elaboration. And what the sword and the scale represent is very different depending upon the viewer.
For many, Justice is about punishment of the wicked and reward of the good. For others it is about fairness and equity. The wikipedia page offers many definitions and a lot of insight into the varying ideals and history of the concept.
So why is this important? Because it informs our outlook on the roles of government, society, and delegation of resources. Because when we are having a discussion about issues related to Justice with someone who has a different definition, any sort of consensus becomes well-nigh impossible.

So besides cogitating on the role of Justice in a free society, where am I going?
In the US, where I live, we are embroiled in an ongoing battle over what our government should provide to it's citizens - what role the government has in Justice for all.

One group believes (many quite fervently) that Justice is determined by the individual and the outcomes of their actions/accomplishments/deficiencies. They believe that hard work and following the rules will result in well-deserved prosperity and well being. It follows, then, that if one is successful or prosperous it is deserved and therefore just. And if one is unsuccessful or poor it is almost certainly due to personal failures and therefore also just. Most people who adhere to this do actually acknowledge that injustices happen and people are elevated or devastated by circumstances beyond their control - but each case that is personally encountered is typically seen as an exception rather than being a rebuttal of the overall world view.


My own personal ideals of Justice in this model are summed up by a character in Bablyon 5:
 "Babylon 5: A Late Delivery from Avalon (#3.13)" (1996)
Marcus Cole: I used to think it was awful that life was so unfair. Then I thought, 'wouldn't it be much worse if life *were* fair, and all the terrible things that happen to us come because we actually deserve them?' So now I take great comfort in the general hostility and unfairness of the universe.

Another group sees Justice from the perspective of social justice. The ideal that Justice is linked to Equity and that inequity demonstrates injustice. Perceptions of the role of government in enforcing equity and the degree of enforcement also vary greatly. The idea that existing social, bureaucratic and cultural parameters all contribute to inequity and reinforce and support the agendas and goals of the successful/powerful/prosperous to the detriment of the worker/middle-class/poor/etc. is a common feature of this worldview. In this view, those who violate the social contract and abuse the systems put in place to help the truly needy are the exception rather than a rebuttal to the overall structure.
Elizabeth Warren sums this up very well:
"There is nobody in this country who got rich on his own. Nobody. ... You moved your goods to market on the roads the rest of us paid for; you hired workers the rest of us paid to educate; you were safe in your factory because of police forces and fire forces that the rest of us paid for. You didn't have to worry that marauding bands would come and seize everything at your factory, and hire someone to protect against this, because of the work the rest of us did. Now look, you built a factory and it turned into something terrific, or a great idea. God bless. Keep a big hunk of it. But part of the underlying social contract is, you take a hunk of that and pay forward for the next kid who comes along."

In discussions of Justice, studies showing inequity aversion in animals are sometimes cited as evidence of an innate "need for Justice" and that equity is therefore demonstrated as a basic need. While I sympathize with the sentiment, I think that inequity aversion is being conflated with altruism by those who do not look carefully at the conditions of these tests. Anyone who has been around a toddler or multiple pets has seen ample evidence of innate inequity aversion. But it is much more infrequent to see evidence that toddler A, or Fluffy, or Simba will object to being the beneficiary of largesse at the expense of the competition. In fact, most pack or troop social structures involve top monkey getting more than bottom monkeys - but the bottom monkeys do not agree with this and spend a lot of time trying to either elevate their status or simply steal the top monkey's goodies. Insert pet/toddler/etc in previous as appropriate.

So why spend so much time thinking about this? Because how we think about Justice and what it means has a real and lasting effect on the lives of so many people.

As a nurse, I have spent a lot of time explaining what our current concepts of Justice, the Social Contract and the "safety net" mean in real terms to people who suddenly find themselves needing to utilize these systems. There are so many common misconceptions about what help is available, about what the system fails to provide (a LOT) and about what the individual or their family must shoulder (a LOT). A sense of Justice that has created the belief that because someone played by the rules, paid their taxes, filled out all the paperwork, is REALLY sick, had a TRUE catastrophic issue - then of course they will have the help they need...is not questioned until that time actually comes.
And then the discovery is made that FMLA means you can take up to a year off your job to care for a family member - without pay. And that no government program will send someone to take care of that family member at home.
Or that the COBRA coverage that was going to provide healthcare to you and your family when your job gets sent overseas will cost you a huge amount of money each month. (Our quote was $600 for just the laid-off employee and $1200 for both of us - per month).

These are two examples of programs that are presented as justice-based programs for those truly in need, which are not really affordable for those same people.
The current tug-of-war is between a President who feels that Justice should include the provision of healthcare for all citizens and a small political caucus who feel that Justice is a reward for hard work and that universal healthcare violates this by rewarding even those who do not contribute.
The economic arguments of lack of sufficient funds to provide this care vs need to overhaul the existing delegation of revenue to fund the care is definitely fodder for another time!

Personally, I am not even slightly unbiased. I have been a professional in the healthcare field, often tasked with explaining to families of dying patients how much of the burden of care was on them.
I am also now a member of that "entitled" group of souls blessed with a disability that gets us off the hook of making a living in our chosen field. I get to sit around all day, filling out paperwork and hiring lawyers in an attempt to get disability pay that is a small fraction of what I used to earn. I have now been doing that for 3 years. I am breaking all my pills in half this month since my husband who supported me just had his job sent to India, and we cannot possibly afford COBRA coverage for prescriptions.
If we don't wind up qualifying for Medicaid coverage, we now have the assurance that we can both get healthcare after Jan 1st thanks to the Affordable Care act. The idea that some wealthy ideologues may take this away from us as a game play for status or power both nauseates and infuriates me.
And guess what...I am NOT an exception. I am just one of the many Americans who have been impoverished or bankrupted by illness and healthcare costs. And the kicker here is that this is not about skin color, sexual orientation, language - about 99% of Americans are going to have to deal with these issues on behalf of themselves or a family member.

So I am working towards Compassion, rather than Justice.

Quality of Life and of Mercy

  

I think most of us spend a certain portion of our lives thinking about or imagining what life will be like when we are old. The definition of what is "old" certainly changes, particularly as some of those previous benchmarks get closer! Some of us spend more time than others in this activity, and we all have different experiences to draw from that inform how we imagine that will look. But most of us do picture ourselves reaching some sort of state of decrepitude at some point in our lives.

    My own experiences in end-of-life and palliative care, geriatrics, and caring for many dementia patients has certainly colored my perceptions of what that can look like, and certainly caused a lot of contemplation of what my preferences are should I have any input. Certainly now struggling with my current disabilities has brought this into even sharper perspective. As you experience the losses of abilities you previously enjoyed, as you try to compensate or let go and anticipate future needs and losses your criteria for what constitutes quality of life is constantly being analyzed.

Having had some earlier life experience with a friend who suffered severe Traumatic Brain Injury (TBI) my personal horror has been the loss of my cognitive and analytical abilities. Never having been much of an athlete, the loss of physical abilities has never been a great bugaboo. Having seen the gradual loss of cognitive abilities in various forms of dementia/organic brain syndromes it becomes obvious how difficult it is to pinpoint a particular time and say "OK, quality of life has dropped below my tolerable limit right there".

    The wonderful and delightful Terry Pratchett discusses this much more eloquently than I could ever hope to in this Guardian post discussing practical solutions in the UK.

    I have the good fortune to live in a very progressive state that has already enacted a law allowing doctors to assist their patients with terminal illnesses to die within strict criteria. Which leads us back to the whole quality of life question. When I am dictating those instructions to my doctor and family, at what point is my limit reached?

   And I think I finally have found the answer. As important as my intellect is to me, to be able to banter and tell stories, to understand xkcd (ok, most of the time)... the time when I am no longer me is when I can no longer choose to be kind, or to laugh. Those are both deal breakers for me.

    Just to be clear, this is my mental ramblings and not any sort of "message". Of course if anything spectacular happens in the next couple of weeks please feel free to credit me with all sorts of psychic abilities! Otherwise, just the mental musings of the moderately morbid *chortle*

Your ignorance will not save you, your denial will not change reality

 Iron Lung Ward, Rancho Los Amigos Hospital

Santayana had it right - "Those who cannot remember the past are condemned to repeat it."
 Living in a time and place where childhood illnesses are seen as mild annoyances, treated with modern medicines. Where the flu means missing a few days of work, and taking a lot of remedies to feel better. Where the possibility of your child dying is an unthinkable horror, and your worries involve threats that are statistically nearly zero like random gunmen or kidnappings.
Medicine has undergone major changes over less than one lifetime. And has radically changed life expectancy and death rates of children as well as adults. 
We have only been able to vaccinate our children against polio since the 1950s. We have only had antibiotics since the end of WWII. There are vastly more pharmaceuticals available for both minor complaints and major diseases.
Generations that have grown up with this as the status quo take it for granted, of course. It is all we have known. Unless you have listened to stories told by elders or lived in a place that does not have the luxuries we have you can't really imagine what it is like to not have that medical infrastructure.
But deciding to reject the current advances, based on discredited theories and celebrity endorsements, is irresponsible, foolish, and damages not only yourself and your children but our society as a whole. You create a reservoir for diseases that we have worked hard to eradicate because they KILLED CHILDREN. LOTS of children. They killed adults too. But children and the elderly are always hit hardest by these diseases.
It is happening now. We hadn't seen whooping cough (pertussis) in ages. Med students had to learn about it in theory because everybody was vaccinated against it and cases just didn't happen anymore.  Today we are having pertussis epidemics breaking out with depressing regularity.
So - have some numbers. I think they give a feel for the scope of the problem currently:

Anti-Vaccine Body Count

And for a less strident and more informational link:

History of Vaccines
This is a project of the College of Physicians of Philadelphia and has lots of great information in very accessible form. Not just history but also great current information.

Telling me, or your doctor, or the media, that you "don't believe" in vaccinations really means fuck-all. Your belief or lack thereof does not change reality one little iota. That applies to pretty much the rest of science as well.

Glassholes and "Citizen Journalism"

 

An article published in Ars Technica today about a Google Glass user referred to the individual's filming a street altercation as "citizen journalism". This individual not only filmed the sidewalk drama and all the passers-by and audience, he posted it publicly onto YouTube. Without permission of the parties being filmed, and states "99 percent" of those filmed "did not know what I was wearing." The rise in smartphones with cameras and the introduction of this newest technology is increasing the odds of each of us becoming "news" of some sort in the future.

We need to be crystal clear here. There is nothing even remotely journalistic going on in this scenario. Spouting your opinion on a blog (like this one!) is NOT journalism. Tweeting from the airport about something you saw the TSA doing? NOT journalism. Posting photos of your local riot on Facebook? Yep - NO journalism going on there either.

Journalism consists of much more than having an opinion and a platform. Journalism has a code of ethics and is crafted by people with enough professional pride to proofread their copy before they put their name on it. Most current local newspapers have completely done away with journalism, or relegated it to a couple of pages somewhere lost between the giant drop down banner ads, the local flavor blog posts and the 527 soul-crushing comments on the blurb about some local crime or politics story filed by someone who did not fact check nor proofread before hitting "send".

About that code of ethics, the Pew Research Center's Project for Excellence in Journalism has already put together a collection of links for us: Ethics Codes

You will find that there are lots of guidelines for journalists about secret recordings, verification of facts, use of multiple sources, and most importantly - accountability! Reading the ethics codes, you understand why talk radio hosts identify themselves as "entertainers". But this applies equally to all of us who use blogs and other social media to express our opinions. Social media is wonderful for providing a soap-box for everyone who wishes to hold forth on the streetcorner. But don't confuse an opinionated old crank blogging about the demise of quality journalism with an actual journalist.

And that rumbling sound? Is Edward R Murrow ...

Spinning in his Grave

Is Respect & Compassion cost-effective?

It was a physical sensation to see the announcement today that the main provision of the healthcare bill is to be delayed by two more years. Somewhere between nausea and vertigo. Granted, that is often my baseline, but seeing a hard-fought and much-compromised healthcare coverage be denied to people yet again is heartbreaking. And enraging. And frustrating beyond description.

And it got me thinking about the employment climate in this country, how employees are instructed and expected to treat customers versus how they are treated by their employers. And why the huge disconnect there seems to be ignored by all the folks selling the latest-and-greatest-new-marketing- strategy-to-increase-productivity-and-lower-costs. Why is it that you are sitting for hours at the computer doing the mandatory inservice on "Quality Customer Service", being tested on how to treat customers in a manner completely unlike the way you are treated by your employer?
Working in the medical field, I have seen a strong movement away from compassion in healthcare - both compassion towards patients and compassion towards caregivers and fellow employees. At some point we decided that compassion looked too much like paternalism or patronization, so it got thrown out with the bathwater and replaced with Autonomy and Responsibility.

[This has led us to the situation of the physician with the medical degree and years of experience telling a patient their diagnosis and possible treatment options and then asking them to decide what to do! Making them take on the responsibility of deciding on often complex treatment options in the name of "self-determination" or (heaven help us) "buy-in". This is terribly fashionable among providers, and hated by patients - they are paying for healthcare from trained providers and expect a damn sight better than they could get from a google search. Ok, exaggeration for effect, but still. Damn. Do your job.]

In all businesses, treating your employees like irresponsible criminals who are going to flake off or rob you if given half a chance tends to be a self-fulfilling prophecy. Responsible, professional adults won't stay, the folks who do are the ones who either just don't care or who see robbing you as a personal challenge. Either way, you and your customers lose.
If you treat employees like they are lying when they call in sick, like they fake injury on the job, like that death in the family was probably just a vacation, monitor their bathroom breaks, monitor their email, monitor their phone times, are more concerned with clocking in and out on the minute than the quality of work... how can you expect them to treat your customers differently?
If I tell you that I do not value you enough to provide you with medical care, but I will fire you if you call out sick too much? That the state says I don't HAVE to pay you more than minimum wage, so I won't? That our corporation does not provide childcare on-site, but we will fire you if you have to leave because of childcare issues too often?
BUT: "We strive to provide the highest service to all our valued customers and treat them with respect."
What does all this have to do with the Healthcare bill? Or are you just rambling?
Here's the thing. Our culture has become Corporate Culture. It has infused everything. Our expectations, our lifestyles, and even our healthcare. The attitudes, the philosophy, and the dehumanizing effect of being treated as just another unit, another number, another interchangeable part to be slotted in or discarded at the corporate whim.
The thing is that corporations that have tried doing it the other way, treating employees respectfully and compassionately? Wind up with happier customers. And better employee retention to boot! Funny that.

The furtive look of Racism

So having breathed a sigh of relief that the horrific racist rhetoric being thrown around during the past two elections were finally past, we are now in the throes of yet another scandal. This time a minor television celebrity who is renowned for her Southern style was revealed to have a pretty unsavory recent past history of racism and sexism, at least towards those who worked for her. 

The revelations coming from her testimony under oath revealed behaviour that was frankly abhorrent, but honestly mild compared to things being broadcast by "infotainers" during recent elections regarding the President of the United States! 

I have read several well-reasoned blog posts from varying points of view by people of color which discuss the cultural context of the behaviour exhibited.

So why am I not just shrugging and saying "Calm your tits!"?

Here's why:

I am a white woman who has spent a significant portion of my life in areas with very ingrained and institutionalized racism. My father's family were very racist, and I heard the language of racism from a young age. I was also fortunate to have parents who were committed to raising children who did not suffer from that sad affliction, and we were taught young that the language of racism was one of fear. We were told that our grandparents were to be pitied, because they were afraid of everyone who looked at all different from themselves. So I grew up to be a big 'ol liberal!

But living in places with ingrained racism when you are white can be a bizarre experience. You recognize the warning signs - the furtive glance around to ensure that there are no people of color within hearing range - before something is said. A racist statement, a horrible joke, a nasty slur, some filthy gossip. And then the knowing nod, that says "you're white so you understand what I mean".

And this may come from someone you don't know at all, from a coworker, from your boss, from a pastor, from anywhere. And each and every time you have to decide what you are going to do. 

If you say nothing? You just agreed. Like it or not, your silence IS consent. Laugh, and pretend they are joking? Still agreeing. So how do you call them on it? Apologetically? Stridently? 

Of course it depends on who you are talking to - it is very, very hard to call out someone you are asking for money, or a loan, or a reference, or a job.

I have very little good sense, and an overdeveloped sense of justice, so I tended to just explain that it is NOT ok to speak like that to me in any way shape or form, ever. And I deeply resent your assumption that it would be ok.

In stickier social situations, I would just choose that time to pull out photos of my first husband and several of his nieces and nephews (ok, so maybe someone MIGHT think they were mine *evil grin*). This is the "now I make you feel like an asshole" portion of the program, where the offender got to sputter about how they REALLY aren't racist.

Now that I'm older, I think I am going to go back to carrying some photos in my wallet I can pull out and show photos of my grandbabies (I'll need to borrow some from friends), and maybe a photo of my niece and her date in their prom dresses!! 

In the meantime?

Paula - what you said and did is offensive, inappropriate, and unacceptable. And you knew it when you said it and did it, because I know you furtively peered around first to see who was in hearing range. And the fact that people are willing to cut you some slack over it? Is because THEY are awesome people.