No. of Recommendations: 76
A large amount of the debate in Washington centers on both the current budget deficit (~ $1 Trillion/year) and the cumulative debt (~ $16 trillion.) Nobody really wants to talk about the unfunded liabilities of Social Security and Medicare, so we will just ignore those. The sequester is a debate about making relatively small changes in spending versus increased taxes. Related to all of this is the debt ceiling debate which has become a point of contention. Also related is the unemployment rate, which a lot of Federal programs are intended to help soften the pain. None of this is news to METARites.

What you might not have heard about is the increased number of people receiving Social Security Disability. These are people that are under the Social Security Retirement age. The number of people receiving disability has been steadily rising since 1989. It has risen under all presidents of both parties. [1] There are currently 14.1 million people receiving disability. What is important to understand is that these folks are NOT counted in the unemployment figures. They are also not counted in any of the “welfare” statistics.

Recently I have been hearing firsthand about one person’s path to receiving disability. Long story short, the commonly perceived definition of disability is NOT consistent with the definition used to successfully receive benefits. I only knew the intimate details about this one case, until today.

National Public Radio reporter Chana Joffe-Walt spent 6 months learning how the system works in the real world. You can read her report here. [3] If you would like to listen to her report, you can download a podcast of it here. [4]

The report is fairly long and I STRONGLY suggest you read it/listen to it if you are interested. Here are a few brief excerpts that that were news to me. (Don’t worry, I will get to the METAR implications of this later.)

1. Hale County, Alabama has 1 out of 4 working age adults on disability. Most of them were certified by a single medical doctor, Perry Timberlake.

"We talk about the pain and what it’s like," he says. "I always ask them, 'What grade did you finish?'"

What grade did you finish, of course, is not really a medical question. But Dr. Timberlake believes he needs this information in disability cases because people who have only a high school education aren't going to be able to get a sit-down job.

Dr. Timberlake is making a judgment call that if you have a particular back problem and a college degree, you're not disabled. Without the degree, you are.


The implication is that many of the low paying jobs where you could sit down all day are GONE AND NOT COMING BACK. i.e., these folks will be permanently disabled.

2. But disability has also become a de facto welfare program for people without a lot of education or job skills. But it wasn't supposed to serve this purpose; it's not a retraining program designed to get people back onto their feet. Once people go onto disability, they almost never go back to work. Fewer than 1 percent of those who were on the federal program for disabled workers at the beginning of 2011 have returned to the workforce since then, one economist told me.

People who leave the workforce and go on disability qualify for Medicare, the government health care program that also covers the elderly. They also get disability payments from the government of about $13,000 a year. This isn't great. But if your alternative is a minimum wage job that will pay you at most $15,000 a year, and probably does not include health insurance, disability may be a better option.

3. A person on welfare costs a state money. That same resident on disability doesn't cost the state a cent, because the federal government covers the entire bill for people on disability. So states can save money by shifting people from welfare to disability. And the Public Consulting Group is glad to help.

PCG is a private company that states pay to comb their welfare rolls and move as many people as possible onto disability. "What we're offering is to work to identify those folks who have the highest likelihood of meeting disability criteria," Pat Coakley, who runs PCG's Social Security Advocacy Management team, told me.

There's a reason PCG goes to all this trouble. The company gets paid by the state every time it moves someone off of welfare and onto disability. In recent contract negotiations with Missouri, PCG asked for $2,300 per person. For Missouri, that's a deal -- every time someone goes on disability, it means Missouri no longer has to send them cash payments every month. For the nation as a whole, it means one more person added to the disability rolls.

4. When he started in 1979, Binder represented fewer than 50 clients. Last year, his firm represented 30,000 people. Thirty thousand people who were denied disability appealed with the help of Charles Binder's firm. In one year. Last year, Binder and Binder made $68.7 million in fees for disability cases.

The way Binder tells it, he's is a guy helping desperate people get the support they deserve. He is a cowboy-hatted Lone Ranger going to court to fight the good fight for the everyman.

Who is making the case for the other side? Who is defending the government's decision to deny disability?

Nobody.

"You might imagine a courtroom where on one side there's the claimant and on the other side there's a government attorney who is saying, 'We need to protect the public interest and your client is not sufficiently deserving,'" the economist David Autor says. "Actually, it doesn't work like that. There is no government lawyer on the other side of the room."



Of course all of this relates to the unemployment rate, the state of the Social Security Trust fund, the annual budget deficit, the cumulative debt and the unfunded liability of Social Security.

A while back on METAR, I asked the question: Why do we NOT have people in soup lines like they had in the 1930’s? After reading this article, I have a lot better understanding why. Many of the folks that would have been unemployed are now receiving disability payments. Make no mistake, this is NOT a path to driving the latest Mercedes. Payments are about $13k per year, but you also get Medicare thrown in for free. If these folks were NOT receiving these benefits, it is not clear how they would survive economically.

Yoda is NOT advocating any particular changes or solutions. Yoda is not saying this problem was caused by any particular political party. You could reasonably argue that many of these folks SHOULD be counted as unemployed, even if you continue to pay them disability.

Yoda’s point is that you can NOT solve a problem unless you correctly identify it. Add solving “disability” to the long list of other issues waiting for Washington solutions.

Very significant to the US economy IMO and I strongly recommend you read the article and form your own opinion. Your conclusions might be very different from the excerpts I chose.

Thanks,

Yodaorange



[1] History of Social Security Disability recipients
http://news.investors.com/business/042012-608418-ssdi-disabi...

[2] Latest report from the Social Security Administration including disability
http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/

[3] NPR story on disability
http://apps.npr.org/unfit-for-work/

[4] NPR podcast on disability
http://www.npr.org/blogs/money/2013/03/22/175076784/episode-...
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YO's struck another bullseye with macro implications.

Two elaborations:

1.

Re: Who is making the case for the other side? Who is defending the government's decision to deny disability?

Nobody.


Well, not quite nobody. But the reality is worse than nobody because the semblance of equitable justice is preserved despite flagrant abuse. My source is a BF of 15 years ago who was a Social Security Agency professional attorney -- his job, precisely, was defending SSA decisions denying disability.

SSA law is a sub-branch of Administrative Law with its own separate set of courts, judges, procedures, and lawyers, and its evolution (via precedents) in decades since WWII has left the system as originally intended utterly hamstrung, overwhelmed, and vulnerable to those welling to hire attorneys to game the system.


2.

Hale County, Alabama has 1 out of 4 working age adults on disability.

Those with enquiring minds notice that "Net of taxes and payments, funds are transferred by the federal government from more productive states such as Delaware, Minnesota, New York, Texas, and California to less productive states such as West Virginia, Virginia, Mississippi, Alabama, New Mexico, and Montana,

[see http://www.economist.com/blogs/dailychart/2011/08/americas-f...

but HOW?"

Seems the three biggest answers are

military expenditures (varying from the military industrial consulting and research empire of Northern Virginia to various western USA military bases originally established to fight "Indian Wars"),
social security and disability payments, and
congressional pork barrel expenditures leveraged up by the constitution apportioning senatorial power equally to the least as well as most populous states.

Last studies in depth I could find were done around 2005:

http://taxfoundation.org/tax-topics/federal-taxes-paid-vs-sp...

YO's bullseye is in identifying a category that is shifting most rapidly, and so is undermining the status quo. Something will have to give.

david fb
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yodaorange: Yoda’s point is that you can NOT solve a problem unless you correctly identify it. Add solving “disability” to the long list of other issues waiting for Washington solutions.

Excellent, fascinating article. Thanks for the summary and for the link.

skorthos
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No. of Recommendations: 62
Excellent take one again Yoda,

The scope is more staggering than folks seem to be aware. But main stream America is starting to get the picture.

As part of our prenatal history taking we ask questions that are supposed to identify social needs in the household of the pregnant lady who is starting her pregnancy care. I will give one example, and it is not isolated.

This young woman was 20. She already has two kids. She is now pregnant with her third. She lives at home with an adult borother (21), her mother (42) her uncle (45) and her grandmother (60).

This made 7 individuals in the house. Two of them young children, and the other 5 are adults. None of the adults worked at all. NONE OF THEM! Her brother at least was not on the dole. He was merely unemployed after dropping out of high school and not the best of job applicants I suppose. The mother was "disabled" with her "nerves". Her uncle was "disabled" with his "back problems". Her Grandma was "disabled" with her morbid obesity, insulin dependant diabetes and Hypertension.

While we can all say we want to help those who simply through misfortune (accidents, REAL medical issues, etc...) cannot take care of themselves, we have so far gone past that tipping point it is ridiculous.

Hey it's not just anecdotes! It is pervasive throughout the culture that has steadily grown in our country.

Just as an aside, I happend to ask this young mother to be where was "baby's daddy"? She said he violated his probation so he would be in prison for at least the next 6 months. ........ Yikes! ......

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Old Chinese Proverb

"The Fourth Generation loses the Fortune"

A brilliant young energetic man pondered and dreamed. He came upon an idea that was needed and desired by those in his community and country. He built a vast fortune over his adult lifetime because of his hard work and intuitive nature. He was the First Generation. He had one son.

His son grew up knowing how hard it was and how many hours his father spent growing and maintaining his business. But not being as inventive and intuitive as his father he followed in his footsteps, but could only maintain what his father had built. He had a great appreciation for what his father had done and applied himself diligently to he family business. He was the Second Generation. He had one son.

His son grew up with all the nice things his Grandfather's business could provide. He saw his dad go to work each day and come home to a happy home and live a life of relative ease. He never knew his dad to stay late at work and he always had others doing things for him at work and at home. From his perspective, his dad had a life of great enjoyment and little real work. He did not really appreciate all the work his father had done when he was a little boy, and as he got older had no real understanding of how the business and family fortune came about. He knew he would one day step into his father's shoes and live a life of ease as well. He never worked a days work in the business except when his father grew older and his grandfather had been laid to rest many years before. As he stepped in to take the reins of the business things had already begun to falter and the business stumble. Knowing little of what made things work, he relied on those around him to call the shots and things continued to slide year after year. He was the third Generation. He had one son.

His son grew up completely ingnorant of his great grandfather. All he knew was that his father was little respected by those at his business. He heard the whispers of how things were going and how the business was failing. He had never seen his father work and could only see how he was using the business to his own ends. Yes, using it even as it seemed to be losing ground to other businesses in town to fund his every whim for as long as possible. Eventually, due to his excesses his father died an early and untimely death, leaving the business, such as it was to his son. The fourth Generation. In desperation to have any portion of a fortune, he sold off the business piece by piece until nothing of what his great grandfather had built remained. He had one son.

This young boy heard stories of generations gone by and great wealth with many beautiful things in his family's past. The ladies who surrounded him in the opium den stroked his father's hair and told him maybe one day he would return his family to such grandeur. The young boy ate his gruel and really had no idea what lie in ruins from the splendor of generations gone by.

....................................................................

We are at the fourth Generation of Welfare consequences. Those entering the "system" now have no appreciation whatsoever of what this generosity of 50 years ago was meant to be for, or accomplish within our American Culture. It has been bastardized into a form that would have been unrecongnizable in 1968.


Wooly................... who knows that there are way more folks in the wagon than those who are pulling the wagon. We are past the tipping point, and I see no clear avenue of return. Sad, but true.
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Last year, Binder and Binder made $68.7 million in fees for disability cases. The way Binder tells it, he's is a guy helping desperate people get the support they deserve. He is a cowboy-hatted Lone Ranger going to court to fight the good fight for the everyman.

The cowboy's ad budget must be astronomical. Binder and Binder advertises, of course, in CA. See other commercials in the right column.

http://www.youtube.com/watch?v=3p6Jp71C6XE
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While we can all say we want to help those who simply through misfortune (accidents, REAL medical issues, etc...) cannot take care of themselves, we have so far gone past that tipping point it is ridiculous.

One thing that would help would be a single standard for "disability".

For a while my father was in a peculiar condition where his physical and medical failings were bad enough that the state's industrial-insurance program would not cover him, effectively making him unemployable - yet Social Security was still maintaining that he was not disabled.
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I find it quite odd that we can easily find, research, and wax eloquently on how the poor abuse the system and live on the backs of the taxes of the rest. The reason I find it odd, is that we don't seem to apply the same energy, outrage, and eloquence to the rich who are also feeding off the labors of the many, and doing so through government programs.

Yet the money thrown at corporate welfare and tax loopholes dwarfs the amounts spent on the most egregiously abused programs for the poor.

Offshore accounts to pay less taxes; multi-trillion offshore profits; short-term gains taxed at long term cap gains rates; oil, corn and sugar subsidies; banking bailouts, etc., etc. Yet our outrage is spent on the sad case of an obese grandmother, an unemployed parent, and a multiply pregnant young woman whose father-of-her-child is in jail. Is this story sad because of the human tragedy or because of the money spent to support those people?

I would suggest that if corporations are people, then their sucking at the teat now needs to be chronicled with as much eloquence.

But then, what else would one expect from a redneck in Florida?

Poz
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The key point missed is the fact SSDI is insurance.

The key point missed is an important one: How long are they on disability? Generally, it is less than ten years--then they hit FRA (Full Retirement Age) and they go on Social Security (i.e. they are *off* SSDI).

Part of the determination to establish eligibility for SSDI is the ability to get a job that reasonably exists in the US economy. And therein lies the rub. Many of the jobs those people did no longer exist in the US economy, so the ability to get a similar/comparable job no longer exists. Medically, they are not able to work their old job--so they are (by definition) disabled and this out of the workforce.

Retraining would not be cost-effective due to their relatively short remaining time in the workforce (maybe 5-9 years). As a national policy, it is less expensive to put people into disability for a relatively short period than any available reasonable alternative.
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YO,

You made the biggest point of them all and I am surprised no one wants to discuss it or has seen it.

People on minimum wage make $15k per year and have no benefits.

But bankers make tens of millions per year and have mansions.

Most people in the middle class are starting to wonder what would happen if in relative terms minimum wage was raised to a livable wage.

There are certain benefits to raising minimum wage.

- when done across the board demand for the goods of local small businesses rises substantially.

- people get a much fairer pay for their labor.

- businesses that can not afford minimum wage go under leaving the market to much more successful companies....that is huge....

- throw in some form of health care and you actually start to have economic justice in our country. I know not everyone is for that.

- possibly more people working and not taking any flavor of welfare be it disability or state sponsored welfare.

- unemployment from all of the above shrinks.

- believe it or not if minimum wage rises so does the lower part of the income ladder. I know politically smaller earners with their own businesses have been bamboozled to believe they simply can not afford for minimum wage to go up, but in fact their wages out of their companies would be booosted. Income is on a ladder. It is not isolated to one guy with a hammer somewhere pounding nails.

So who does this cost? Well if more people have more money more businesses do better. But there is competition out there, so it costs the businesses that are less able to compete. The same eejits who generally vote for the wealthy to have tax breaks and hope for a tax break trickle down effect. There is no such thing as a trickle down tax break effect. That my friends is a redistribution of wealth away from the middle class and the working poor and up to the the major corporations. As is welfare and disability payments along with seniors getting social security. All of those govt payments are not much for the individual, but they en mass are great for corporate America, our masters.

Dave
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YO,

BTW anyone 'earning' minimum wage is automatically dependent in some form or another on their families.

This is the biggest reason the general public are wondering about raising minimum wage substantially. Why should someone's son or daughter work hard for 40 hours and not be able to support themselves? Be in need of family support? Most people work for very little. Most people are working in businesses that have limited economics for the individual worker ie retail, restaurants and some semiskilled forms of work. In other words the worker only does so much at a given time unlike an assembly line. See the last post one why being overly limiting on what they can earn as we have been since 1970 causes problems for the vast majority of American corporations small and large. A comparison to Germany is in order because the German society takes care of the individual worker to a greater extent and we can note that the German economy does better per capita than the American economy.

Minimum wage as it stands is a huge strain on American family life. In fact we could add a study here on why the overall population is growth neutral <except for immigration> because earnings in general are so low for most folks they responsibly can not have kids. They cant afford them.

We have seen no such economic studies. But we see a constant stream of crying about how irresponsible people are in America.

I'd say most of the working poor who might like to have kids dont because they know they can not responsibly afford to have kids. Or that they limit their family sizes based on economics.

It is always easier to throw stones than seek the truth.


Dave
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http://www.thisamericanlife.org/blog/2013/03/trends-with-ben...

This American Life did a report on disability

Didn't hear it yet.

V
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Board,

They the powers that be really should have just opened up Medicare to everyone. The current affordable health care act is clearly designed as a buy out of the health insurers business and legal rights. It is in my book wrong to give the health insurers anything, but a good kick in the butt.

The 'affordable act' also buys out the pharma companies rights etc as well.

The next bill some four or five years from now will completely reign in all the costs of insuring the entire population of the US. God speed.

Structurally we can probably all agree that medical expenses are the one thing in our economy that need the most restructuring.

There is no waving a magic wand and making everything perfect, far from it.

Dave
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As a middle class guy working lots of hours, I'm in the wrong spot in this economy. I see a huge, wasteful government with lots of easy jobs. Now, the answer to the problem of the 1% and corporations "stealing" from society is to encourage able-bodied and unskilled workers to "get on some" disability, medicade, food stamps, etc.

Since I will not be joining the 1% any time soon, I think I'll look for a government gig. That's if this back pain doesn't get any worse...
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caboth,

I think you'd do well on $13k per year.

why not?

Dave
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I heard the same story on NPR yesterday while driving around for errands.

A story like this yields many insights about unintended consequences and basic management. One key statistic from the story I may be mis-remembering slightly was that something like two thirds of disability claims are REJECTED in the "first round" but now nearly 90 percent of appeals are APPROVED. That has two related, perverse effects:

1) it encourages more people to appeal the first layer of decision making
2) it involves more expensive resources for the government and the claimant in the appeals process

If you assume that X percent of claimants really SHOULD get benefits, the management of the process should be structured in a way that ensures you come as close to X percent approval on the right claimants in the first round as possible, minimizing the total number of people involved in the transfer. That produces confidence in the system which reduces the temptation of players to game the system by over-running that first tier of defense.

In military terms, it's the equivalent of making a show of a defense around the castle which only encourages the huns to "suit up" and completely overwhelm the castle guards once they compromise the 2-foot deep moat.

What's the real problem here?

Poorly trained 1st tier government staff that "over-rejected" too many legitimate claims because they lacked the expertise to separate the legit from the bogus?

Under-staffed 2nd tier government staff that lacked the resources to raise adequate defenses of legitmate rejections and just caving when brought to court?

Crooked, opportunistic lawyers who discovered a way to extract a profitable cut from what should have remained a relatively simple transfer payment from legitimate government program to legitimate beneficiary when properly managed?

A growing problem with pension and disability coverage provided by employers of workers with "hard skills" that use strategic bankruptcy to walk away from pension and disability obligations to miners, steelworkers and other high-toil, high-risk jobs?

Or is it a reflection of a growing divide in the workplace exacerbating a problem with a gulf between "hard skills" and "soft skills"? If you're a roofer, you can either climb the roof with a nail gun and lay the shingles down on a 100 degree afternoon or you cannot. If you lay carpet or tile, you can either spend 8 hours a day on your knees laying flooring or you cannot. If you're a surgeon, you can either stand for six hours straight through an operation with steady hands and an ability to concetrate or you cannot.

If you're employed in "soft skills" like marketing, IT or management, you have MANY more opportunities to use "soft skills" without being proven to be able or unable to do your job and thus you are more employable. (And let's be clear here, the fact you're able to sit in a meeting tracking "action items" on a "project" or a "program of projects" for the "executive steering committee" doesn't mean SQUAT about your true value to society. It just means your skills fall into a gray area of accountability and productivity.)

Speaking from experience, there are hundreds of thousands of people employed in "IT" or "engineering" as it is currently labeled who have few skills whatsoever for actual networking, software or hardware engineering. They are only employed because management insists on sub-dividing and outsourcing so much work that PILES of documents and meetings are required to "scope" the contracts and "manage the deliverables." This creates an entirely new pile of "soft work" that can be pushed around for weeks/months by people only able to use PowerPoint and Excel who have zero expertise in the core problems.


WTH
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Yodaorange, thank you for sharing this important information.

I would like to share charts that show the growth of transfer payments, which are all payments for which no value is currently received. This includes private and public pensions, Social Security (including disability), food stamps, Medicare, Medicaid, unemployment insurance, etc.

The data below is for January 2013, in billions of USD.



Personal Current Transfer Receipts (PCTR) 2,424.30 20%

http://research.stlouisfed.org/fred2/series/PCTR

Compensation of Employees, Received: Wage and Salary Disbursements (A576RC1) 6,973.10 58%
http://research.stlouisfed.org/fred2/series/A576RC1


DPI that is not wage/salary or transfer payments 2,525.80 21%


http://research.stlouisfed.org/fred2/series/A576RC1

Disposable Personal Income (DSPI) 11,923.20 100%
http://research.stlouisfed.org/fred2/series/DSPI



This shows that transfer receipts equal about 1/3 of wage/salary income. The transfer receipts come from many sources, but the total is a large part of total disposable income. (I am adding apples and oranges here, but it's hard to tease out all the numbers to get a pure income from transfer receipts.)

In a thought experiment, let's go back to a time when transfer receipts did not exist. This would remove 20% of the U.S. economy in one fell swoop.

I am not making a political comment for or against transfer receipts. Just saying that, little by little, this segment of the economy has grown to an enormous size. Personal transfer receipts exploded after the 2007 recession and 2008 financial crisis, when millions of people suddenly lost their jobs and left the work force, as shown by the plunge in the Civilian Participation Rate.

http://research.stlouisfed.org/fred2/series/CIVPART

Clearly, transfer receipts will grow as the work force ages. The growth in transfer receipts is faster than the growth in wage/salary income.
Wendy
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The growth in transfer receipts is faster than the growth in wage/salary income.

So, clearly, we need to increase employment and wages. This would reduce unemployment benefits paid out, as well as increase the amount available for the remaining transfer payments.
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Raising the minimum wage sharply would very likely be a terrific way to enforce immigration laws.


Many of the jobs illegals have worked would be destroyed, and if they were preserved they would be attractive for legal workers. Legal workers would start insisting that illegals be fired, and call in immigration and wage enforcement worked to see that laws are enforced.

We might well see millions of illegal immigrants become unemployable and return to Mexico, Latin QAmerica or where ever.


Seattle Pioneer
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Raising the minimum wage sharply would very likely be a terrific way to enforce immigration laws.

...

We might well see millions of illegal immigrants become unemployable and return to Mexico, Latin QAmerica or where ever.


Seattle Pioneer



Too late, already happening.


Any <Be careful what you ask for, you may get it> mouse

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/29/t...

We’re running out of farm workers. Immigration reform won’t help.

Posted by Brad Plumer on January 29, 2013 at 9:54 am
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What's the real problem here?

There isn't one.

Poorly trained 1st tier government staff that "over-rejected" too many legitimate claims because they lacked the expertise to separate the legit from the bogus?

No. The initial test is designed to reject most of the first-time claims except those that are very specifically categorized.

Under-staffed 2nd tier government staff that lacked the resources to raise adequate defenses of legitmate rejections and just caving when brought to court?

It is an administrative hearing--not a court. So, there is no "defense". It is up to the person (or their attorney) to prove they *meet* the requirements of being disabled AND not being able to reasonably work in the economy (i.e. gainful employment).

A growing problem with pension and disability coverage provided by employers of workers with "hard skills" that use strategic bankruptcy to walk away from pension and disability obligations to miners, steelworkers and other high-toil, high-risk jobs?

No. Not having another source of income is NOT a valid reason to get disability. If a person can still do the work, they are not disabled. A medical doctor has to certify disability--and why it is a disability. That information can then be independently checked in an examination done by a doctor paid by SSDI (i.e. not the first doctor). That makes it an independent evaluation of the patient from two doctors.

Or is it a reflection of a growing divide in the workplace exacerbating a problem with a gulf between "hard skills" and "soft skills"?

Yes and no. A "physical" job wears out the worker's body--so most people in those types of jobs will be "disabled", possibly before age 60. They would qualify for SSDI. Many will be able to make it to 62-65 (66-67) and then retire (62 for early retirement at a reduced benefit).

When an industry moves offshore, those who are 50-55+ might also qualify for SSDI if they have relatively minor disabilities. That is compounded by the fact there is no work in the US economy for them (i.e. no gainful employment for them in the area based on their training and experience). Guess what has been a major problem for the last 10+ years? Offshoring of business from the US--leaving mostly older employees with little-to-nothing to show for 20-30+ years of work.

If you're a surgeon, you can either stand for six hours straight through an operation with steady hands and an ability to concetrate or you cannot.

With the da Vinci robots, they don't have to stand any more--they sit and run a remote control computer-operated surgical machine.
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They the powers that be really should have just opened up Medicare to everyone.

That would seem to be the easiest way to cover those without insurance. But:

-- At the current $1K outgoing costs per beneficiary per month? Who could afford it? It would seem the only "fair" way to assign costs would be risk-based. Otherwise, total U.S. health care costs in 2011 were about $8K per person, so that would be the starting point for "no fault" health insurance.

-- How many physicians will be able to stay in business if more patients only bring in Medicare-level payments? What good would it do if someone can get Medicare if fewer and fewer doctors accept Medicare patients?

Do we let Medicare set prices for all services, and then let medical professionals decide if they will provide those services or not?

At what point do we decide someone isn't worth the cost of providing medical care?
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With the da Vinci robots, they don't have to stand any more--they sit and run a remote control computer-operated surgical machine.

And one day there may actually be a reason to use them.

A reason other than marketing, that is.
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And one day there may actually be a reason to use them.

There are good reasons to use them.

Less stress on the patient. Fewer mistakes by the surgeon. Fewer people involved in the surgery. Fewer surgical complications. And so on.
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BTW anyone 'earning' minimum wage is automatically dependent in some form or another on their families.

Does that need to be true?

I recently looked at a retirement community that had several studio floor plans of less than 400 square feet. Facility-provided meals, although apartments did have small kitchens (smallest studio only kitchenette). Heating, A/C, basic cable, and all utilities except phone included. Scheduled transportation.

Why limit such facilities to those in retirement (or college)?

What cost per month could be achieved for room and board?

And we have "senior group homes" available as well. Why limit that concept to those in retirement, or in need of assisted living? In most of those homes, they have about 6 resident rooms, with a couple providing the meals and other services.

I suppose similar to the old "boarding houses"...

Hmmm. That brings to mind a line from the movie "In the Good Old Summertime":

"I was living in a boarding house back then, along with other young hopefuls...".
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Less stress on the patient. Fewer mistakes by the surgeon. Fewer people involved in the surgery. Fewer surgical complications. And so on.

That’s certainly the marketing hype.

So far the only thing that’s been documented is an astronomical increase in costs.

A 2009 study of 2,600 men who underwent minimally invasive or robotic radical prostatectomy is a case in point. The laparoscopic group had a shorter length of stay as well as fewer blood transfusions, respiratory complications, and surgical complications. Men who had the robot-assisted surgery were more likely to have genitourinary complications, to become incontinent, and to experience erectile dysfunction (JAMA 2009;302:1557-64).


http://www.acssurgerynews.com/index.php?id=14883&tx_ttne...
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I find it quite odd that we can easily find, research, and wax eloquently on how the poor abuse the system and live on the backs of the taxes of the rest. The reason I find it odd, is that we don't seem to apply the same energy, outrage, and eloquence to the rich who are also feeding off the labors of the many, and doing so through government programs.


pretty sure that outrage is expressed on this board daily.
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The hype here is on the part of Dr Soper and Talamini. The referenced JAMA article did not distinguish between laparoscopic and robotic assisted surgeries, they were both included mixed together as MIRP. I wonder if Dr S & T even read the JAMA article. I suspect that Drs S & T don't know how to do MIRP.

Surgeons often do not consider pain disability and time off work in the "outcome" of surgery. All of these are less with MIRP


This summary of the JAMA article does not make those mistakes.
http://news.cancerconnect.com/minimally-invasive-prostate-su...

a variant of laparoscopic surgery known as robotic-assisted laparoscopic surgery, Since they were all included under the name MIRP the JAMA article does not specifically compare the robotic variant with open surgery. Also note that the JAMA study ended in 2007 when robotic surgery was just getting going, the surgeons were less experienced, no doubt results are better now.
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I suppose similar to the old "boarding houses"...

Hmmm. That brings to mind a line from the movie "In the Good Old Summertime":


What it brought to my mind: http://www.youtube.com/watch?v=WrhAC0dFis0
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http://cnsnews.com/news/article/social-security-ran-478b-def......

The Social Security Administration also released new data revealing that the number of workers collecting disability benefits hit a record 8,827,795 in December--up from 8,805,353 in November.

In 2011, according to the Bureau of Labor Statistics, there was an average of 112.556 million full-time workers in the United States, of whom 17.806 million worked full-time for local, state or federal government. That left an average of only 94.750 million full-time private sector workers in the country.

That means that for every 1.67 Americans who worked full-time in the private sector in 2011, there is now 1 person collecting benefits from the Social Security administration.
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The problem with this post is that it is based on some pretty shoddy reporting. Chana Joffe-Walt's piece that ran on Friday's Planet Money was an excerpt of the This American Life show that came out over the weekend. Media Matters examined several of the shows claims and found them untrue.

http://mediamatters.org/mobile/research/2013/03/22/this-amer...
This American Life Features Error-Riddled Story On Disability And Children
NPR's All Things Considered Also Promoted Story


PF
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I didn't post the Friday Prince clips on Friday but one of his discussion points was about the desperate shortage of truck drivers in the US with average age of existing drivers over 55 years of age. I'm reasonably sure driving trucks does not require a masters degree... and they do pay very well but for some reason nobody seems to want to do the job.

I suppose the same could be said for oil workers in Alberta though having lived and done military exercises in winter in Alberta in my youth I can't say as I blame all of them there. }};-()

Just a thought, perhaps I'll go back and see if I can find the clips. Prince has been bullish on the US economy for a couple of years now and seems to have been right most of the time.


Any <fully retired> mouse


OT - Rotten Kid spent a week in Florida recently and called it "the largest retirement and nursing home in the world". The little ones loved it. They are off to a resort in the Bahamas on Saturday.
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Tim, I'd like to hear your idea of "they do pay very well."
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They are only employed because management insists on sub-dividing and outsourcing so much work that PILES of documents and meetings are required to "scope" the contracts and "manage the deliverables." This creates an entirely new pile of "soft work" that can be pushed around for weeks/months by people only able to use PowerPoint and Excel who have zero expertise in the core problems.


This is exactly the problem that I have seen in the publishing industry. The worker bees are being fired to keep the drones employed, because if the worker bees are doing their jobs, then the drones aren't really needed.

The problem is that the drones are the ones who decide what is outsources and who should be employed.

I don't expect this problem will get any better until the worker bees own their own business and kick out the drones.
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Yet the money thrown at corporate welfare and tax loopholes dwarfs the amounts spent on the most egregiously abused programs for the poor.

Diatribes aside, arguing that we should continue to fund poorly-run programs because their are other programs that are even dumber is not much of an argument, unless you're arguing that both sides need a severe haircut, which you don't appear to be. Perhaps if we went to a flatter tax (i.e., both corporate and income) system with fewer loopholes AND a system that didn't reward laziness and punish ambition (note the comment about it being better to be on disability than to get a job), we would all be better off. But that would require holding everyone more accountable than they are now, which is why I'm not betting on it.
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I'd like to hear your idea of "they do pay very well."

MH

Good point, Prince said it, a quick check (for Canada) shows between $17-$33 per hour which is a pretty wide range and doesn't exactly shoot the lights out. I assume they would be similar?

Looking further down the table Halifax shows as one of the lowest.


Tim
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Also worth keeping in mind: expenses required to live on the road. These include showers (for the low price of between $8-$10), cell phone, food from on the road vendors (most trucks can only support very small microwaves and refrigerators).

Health, life and disability insurance premiums take a healthy chunk as well.

The expenses add up quickly.
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Health, life and disability insurance premiums take a healthy chunk as well.

The expenses add up quickly.



MH

Canucks rarely think of such things when job hunting.

Interesting and somewhat related a question came up in an email discussion as to what Canada did for abortion laws. I had no idea but checked and discovered we don't have any. Apparently we had some but they were struck down long ago and efforts to replace them failed so now we just leave it up to the docs and their "patient". A politician tried to mention it during the last election but his own party pounced on him and it "disappeared".


Any <sometimes silence really is golden> mouse
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I find it quite odd that we can easily find, research, and wax eloquently on how the poor abuse the system and live on the backs of the taxes of the rest. The reason I find it odd, is that we don't seem to apply the same energy, outrage, and eloquence to the rich who are also feeding off the labors of the many, and doing so through government programs. Yet the money thrown at corporate welfare and tax loopholes dwarfs the amounts spent on the most egregiously abused programs for the poor.

While I agree that corporate welfare and tax loopholes should be intensely and critically examined, please provide a credible citation for your claim that the corporate area of exploitation "dwarfs" individual welfare such as disability.

Here's the case for individual entitlement exploitation. Where's yours?

Entitlement Bandits
http://www.nationalreview.com/articles/271006/entitlement-ba...

These anecdotes barely scratch the surface. Judging by official estimates, Medicare and Medicaid lose at least $87 billion per year to fraudulent and otherwise improper payments, and about 10.5 percent of Medicare spending and 8.4 percent of Medicaid spending was improper in 2009. Fraud experts say the official numbers are too low. “Loss rates due to fraud and abuse could be 10 percent, or 20 percent, or even 30 percent in some segments,” explained Malcolm Sparrow, a mathematician, Harvard professor, and former police inspector, in congressional testimony. “The overpayment-rate studies the government has relied on . . . have been sadly lacking in rigor, and have therefore produced comfortingly low and quite misleading estimates.” In 2005, the New York Times reported that “James Mehmet, who retired in 2001 as chief state investigator of Medicaid fraud and abuse in New York City, said he and his colleagues believed that at least 10 percent of state Medicaid dollars were spent on fraudulent claims, while 20 or 30 percent more were siphoned off by what they termed abuse, meaning unnecessary spending that might not be criminal.” And even these experts ignore other, perfectly legal ways of exploiting Medicare and Medicaid, such as when a senior hides and otherwise adjusts his finances so as to appear eligible for Medicaid, or when a state abuses the fact that the federal government matches state Medicaid outlays.
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... but one of his discussion points was about the desperate shortage of truck drivers in the US with average age of existing drivers over 55 years of age. I'm reasonably sure driving trucks does not require a masters degree... and they do pay very well but for some reason nobody seems to want to do the job.

Back in the day when I was on long (several days) road trips on the first day the idea of becoming a truck driver would occur to me.

No worries; driving someone else's truck, buying diesel with someone else's credit card, seeing the country etc. etc.

By about the third day reality would hit me: Driving is boring!
Gott'a keep your eyes on the road, can't do anything else oh and keep your eyes on the road.
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Can't say.

It is still too new to see it generally used so it can be compared.

More analysis, especially of a variety of different types of surgeries, are needed to determine if it is really effective. From a conceptual point of view, it does make more sense that it would be safer and more effective overall.
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one of his discussion points was about the desperate shortage of truck drivers in the US with average age of existing drivers over 55 years of age. I'm reasonably sure driving trucks does not require a masters degree... and they do pay very well but for some reason nobody seems to want to do the job.

If it really was a "good gig", then few truckers would quit the business (because it was so profitable--right?). The facts say differently.

Most truckers are independent contractors--not salaried. I just got a quote for a 1000-mile one-way delivery (full 40' container = $2500-$2600), takes 2 days. Biggest cost = fuel, of course. Then there is the cost of buying the unit--$100+k. Truck stops are NOT "low cost" anything.
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Yoda

What do they mean when they say people get Medicare?

During your work life you pay into Medicare-A (hospitalization). This is NOT optional. If this is what they are getting early, then it may be a relatively small problem (depending on the average age of disability).

If they are also getting Medicare-B (which is optional) and you pay for in qualified retirement, then they are getting a LOT because the Federal government covers 80% of the expenses. In brief this covers physician expenses. It also has a deductible (I think $300.).

Do they also get Medicare-D which is prescription medications? Those that have this pay something for it and it is complicated, but, if the disabled also get this, it would lead to large deficits in the program. I don't have Medicare-D, which is also optional, so I don't know a lot about it except for the famous "donut hole" which is due to be phased out in Obamacare.

There is also Medicare-C or Medicare Advantage that I feel is a fraud in which the government bribes certain health companies to participate in Medicare-B at a 15% premium. Participants do get something extra for taking this option. I presume that the disabled don't get this, but what do I know? I believe this option is due to be phased out in Obamacare.

Chances are when they say the disabled get Medicare, they don't specify which Medicare they are talking about or which group of Medicare alphabets are included.

When the qualifying age for Social Security was phased to 67, nothing was done about early participation at age 62 with somewhat reduced monthly payments. Personally, I think that anyone who doesn't take the early Social Security is foolish as you earn 5 yrs of payments that you can bank or invest if you don't need them. Who knows, you might not even make it to 67. Disclosure: I do not qualify for Social Security.

brucedoe
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Wooly

Ahem. It sounds like you have made a case against inheritance as it promotes sloth or welfare for the wealthy just as welfare does for the indigent. If this is your point, I buy it; however, deep in the human psyche is a desire to leave something, even a lot, to the future generations of your family, whether it is good for them or not.

A good case in point was Hamm's beer (from the land of sky blue waters...) whose fourth generation sold the company to Heileman's and then Olympia (which I believe no longer exists).* But then companies are throw away institutions and are not meant to last forever though companies like IBM and Corning are making a good stab at it. But they are not in the same business they started with. U.S Steel is a survivor that is still in the original business of making steel, I believe. They were the largest corporation in 1900, and, though they are no longer the largest company, they are still significant.

* But apparently you can still find Hamm's if you look hard enough as Miller produces some. (http://en.wikipedia.org/wiki/Hamm's_Brewery)

brucedoe
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It is not by accident. The connected, wealthy, educated, rich try to make their government subsidies complex. The more complex, the less it's above the radar. The more complex, the more professionals (lobbiests, attorneys, CPA's, etc.) you need to take advantage of it. The more complex, the smarter you are for being in the know and taking advantage.

Personally, I take advantage of every subsidy I find but vote against them. I would imagine that's what most people would do. Hence we have to be very careful what we subsidize as a society and err to the side of not providing any subsidy.
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I mainly make money from my mind. But I'm getting stupidier every day. Killing my brain cells with stress, pot, and alcohol is certainly part of the problem but alot of it's just age too.

Do I qualify for free medical care and disability payments?

:O
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