An Anecdote About Social Security Disability Insurance
There's been some talk about dependency created by Social Security Disability Insurance (surprisingly from Nick Kristof!). Via Ben Domenech at The Transom, Veronique De Rugy recently put out a study showing how more people are taking advantage of the program, and for longer. The Boston Globe notes that once on the program, people have little incentive to get off of it.
So I thought I might share an anecdote about a friend's experience with children and SSDI.
A psychiatrist I know used to work at an urban health clinic in New York, where this doctor dealt mainly with adolescents and their parents. Some (perhaps most) were Medicaid recipients, but the important thing is that these people were just barely getting by and needed government help. Imagine the breakdown of the health care system being presented to you daily, and seeing how it related to the breakdown of the family.
A typical anecdote from any given day would go like this: A parent would arrive for the appointment, late, of course, leaving only 10 minutes to talk to the child. The child would have a small television or video game, usually expensive, to distract them and wouldn't be paying attention. The child would be asked to put it away, and the child would talk back. The parent would do nothing. Finally, the parent would be asked to take away the thing. The parent would get defensive and say they already knew what the problem was -- the kid has ADHD, evidenced by the child's inability to listen to the parent, and proven to the doctor by the child's inability to pay attention.
Incredulous, the doctor already knew the parent was raising this child alone, and so the child was frequently acting out, and the parent believed the easiest way to get the kid to behave was to put him on Ritalin. For the parent, it had the additional benefit of allowing her to get a check in the mail every month.
Worse still, there was little for the doctor to do about this. If the doctor objected to writing the prescription, the RPTN (prescription-writing nurse) of the clinic would do what the doctor wouldn't, even though he/she had less training on the negative effects of ritalin. (It does cause seizures in some cases, and messes with your brain chemistry in ways I couldn't articulate.) It was a matter of professional opinion, and the parent would get their way, one way or another.
The RPTN would often spend more time with the patients anyway, because that's how the workflow went -- the RPTN would interview for longer than the doctor, and the doctor would have to supervise and make sure the diagnoses were correct, because the doctor was expected to do all the paperwork. If there was conflict between the RPTN and the doctor, the RPTN could always stir up the social workers in the office, who got the most face-time with the patient (yet had the least training -- their time was cheaper), who would all make life hell for the doctor. HMOs had this wonderful effect of empowering the cheaper mental health professionals, after all.
When this doctor left that job, it was the height of the paperwork craze -- most of the day would be spent writing up reports instead of working with patients who had real problems. That way, if someone committed suicide or had to go to jail, neither the clinic or the doctor (who was the one really under the gun) could be sued for neglect. Except neglect was precisely the thing encouraged by taking the doctor out of giving care.
It's not that these parents are bad -- they're looking for the best ways to deal with their own inability to provide for their kids.That 700 bucks is a godsend to them, and having that kid be more focused is also a blessing. It's obvious this is no substitute for a father, and no substitute for the health care their family needs. But it's all they can get in a system that's indifferent to their actual needs. So they have to game it to maximize what they can use.
I imagine that this will be happening on a much larger scale once we all finally realize the dream of universal, government-mandated, IPAB-approved health care.
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Comments:
Jun '11
Re: An Anecdote About Social Security Disability Insurance
Thanks for the story and the link to the article, a surprising one for the New York Times. I had no idea a child's learning disability translates into cash for the parents. When even the NYT sees there are perverse incentives there you can believe it is true.
The NYT article describes a financially struggling young woman who has two children and a fiancee, and is pregnant with twins. The writer concedes that more government intervention might not effect much improvement in her situation, but for the childrens' sake we should try it. What's the definition of insanity?
Sep '12
Re: An Anecdote About Social Security Disability Insurance
First, I'm not sure I quite follow the connection between receiving a prescription for Ritalin and receiving a check for $700. I suppose it's because if diagnosed as ADHD that qualifies the child as disabled and therefore entitled to money to help buy his Ritalin? Seems completely circular. What would a non-cynical rationale for this even be?
Second, I also noticed how smoothly the NYT writer transitioned from the perverse incentives of government programs to the need for more government programs--just without the perverse incentives that someone forgot to account for in the past. As if it were that easy.
Third, it strikes me that it is better to criticize these programs not primarily because they are expensive but because they don't work and make life worse for the people they're supposed to help. Emphasizing our objection to the cost alone implies that we're simply stingy--the government could help the poor but we just don't want to because we'd rather have our tax cuts. That's the impression that makers-vs-takers rhetoric leaves, I'm afraid. Tough love wins; cheap and cruel doesn't.
Apr '12
Re: An Anecdote About Social Security Disability Insurance
It's a disability, so you can get a social security check. (One of the less publicized reasons SS is going down, I'd guess.) I know a couple of folks who get those, but it's for things like the kid was born with a major problem and so dad left, or they had a can't-ever-move-out disabled kid, were fine, and then dad died. (Talk about horrible luck.)
Sep '12
Re: An Anecdote About Social Security Disability Insurance
It would be interesting to see if there's any reporting on what, exactly, qualifies as a disability. How did ADHA get to qualify?
Apr '12
Re: An Anecdote About Social Security Disability Insurance
Bing to the rescue!
(and if those don't make you feel sick.....)
Edited on December 13, 2012 at 6:22pmSep '12
Re: An Anecdote About Social Security Disability Insurance
So the Ritalin is mostly needed as evidence to secure payments; it's not that the payments are needed to buy the Ritalin. And you can easily see how doing well at school is a mark against the disability claim.
Yes, the money wasted here is bad. But it's so much worse to contemplate the damage being done to these kids to provide an income for their parents, and that's not to mention the resources that could be going to kids so disabled they can't walk or talk.
And you know that if anyone would ever suggest, you know, maybe being more careful about distributing benefits--not even cutting back!--they'd be accused of wanting to turn children with cerebral palsy out into the snow.
May '11
Re: An Anecdote About Social Security Disability Insurance
The evil of obamacare is not being forced to buy insurance, though that is bad enough. The real evil is the result that we see in this doctor's story. Hayek called it the road to serfdom. Rand just asked "Who is is John Galt?"
Oct '12
Re: An Anecdote About Social Security Disability Insurance
I have evaluated hundreds of kids, many of them poor and inner city for disabilities. As a psychologist I was responsible for conducting the IQ and neuropsych testing battery. Like the physician mentioned in the story, I have dealt with many kids and parents who were trying to obtain a diagnosis that would result in extra monthly payments and/or services at school. When I worked in Memphis, one of the large inner city churches offered classes to the community on what to say for you child to qualify.
It's a perverse system that determines disability by failure and achievement as a lack of disability. The federal law that overs this in kids is IDEA (Individuals with Disabilities Education Act idea.ed.gov) and ADHD falls into the category of Other Health Impairment which also includes illnesses such as diabetes and asthma. It's important to remember that ADHD for disability gets you cash, the school system has a different set of eligibility to determine services in school. In the Memphis clinic I mentioned above, we often found that the parents who brought children to us wanted the disability supplement, but did not follow through on educational services.
Sep '12
Re: An Anecdote About Social Security Disability Insurance
PsychLynne, any idea how ADHD, diabetes, and asthma got included in the disability category? Before this thread, I knew there was social security disability for families of disabled kids, but I would have assumed it was for conditions such as cerebral palsy, autism, Down's Syndrome--cases of a physical or mental handicap that precludes functioning as an independent adult.
Any idea if there are different levels of compensation? So is the family of an ADHD child receiving the same payments as someone who needs 24 hour care?
I alternate between sadness and anger about this whole thing. So much exploitation.
Apr '12
Re: An Anecdote About Social Security Disability Insurance
PsychLynne:
In the Memphis clinic I mentioned above, we often found that the parents who brought children to us wanted the disability supplement, but did not follow through on educational services. ยท 5 hours ago
How on earth did they avoid it?!
I got classified as needing special ed, basically because I'm pig headed, and the school jumped on it as a great source of funds the moment my folks didn't fight it.
Although, come to think of it, I don't remember any of the fetal alcohol syndrome kids from the rez being sent to the classes, so maybe you have to say "yes" at some point-- so passive fighting works, or simply never showing up.
****
Totally unrelated, I need more coffee: my imagination keeps trying to come up with a superhero power set for PsychLynne.
Jul '11
Re: An Anecdote About Social Security Disability Insurance
I was on SSDI for a about a year and a half after a brain injury. I was considered completely disabled. SSDI wasn't a lot of coin, but it was roughly $1,200 per month, which is more than enough to live on, especially if you're receiving any other assistance in housing, food, medical care, etc.
To keep it short, I recovered. But to get off SSDI involved a mild Herculean effort. I had to prove to the USG that I not only was "abled", but that I had the capacity to fend for myself, food/clothing/shelter, etc. I was told, not in so many words, that it's just better for me to stay on SSDI.
The demand drives the budget requirements, so the SS administration is tacitly encouraged to keep the rolls growing if they want their budgets to grow, so (from my limited experience) there is jack in the way of oversight for SSDI qualification and monitoring. The result is an explosion of growth in SSDI payments, and the occasionally confused citizen wondering how in the hell someone without much more than a stubbed toe is considered to be disabled these days.
May '11
Re: An Anecdote About Social Security Disability Insurance
My wife is deaf and gets SSDI. Since we didn't need the money, we asked to be removed from the program. We are not in any way wealthy, we just don't need charity. Then when she tried to use my military medical insurance, she was denied coverage because we involuntarily withdrew from SSDI. So I had to pay for Tricare and Medicare. So she went back on SSDI because I can't afford two insurance policies. Then they learned we have a daughter and forced us to take even more money for her. They were emphatic that the law requires it and we have no choice. SSDI is a perverse system. I know many people who legitimately rely on it, but it has far too many perverse incentives to exploit it and penalties if you don't.
Edited on December 16, 2012 at 1:48pmMay '11
Re: An Anecdote About Social Security Disability Insurance
For some reason I can't edit on my iPad. The word 'involuntarily" should be "voluntarily."
Jul '11
Re: An Anecdote About Social Security Disability Insurance
I know many people who legitimately rely on it, but it has far too many perverse incentives to exploit it and penalties if you don't.
This is SSDI in a nutshell. It's built to be exploited. It's been modified/enhanced to foster exploitation. It actually discourages you from continuing to exploit the payments.
There's a reason why SSDI enrollment has spiked in the last 4 years. This is a transfer payment, pure and simple, and guarantees votes for Democrats. There is nothing more obvious under the sun.