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.