Etalkinghead

Although most public attention to the Social Security Administration now focuses on President Bush’s plan to scare American workers into privatizing the retirement system, I was glad to see the Boston Globe examine the agency’s disability program instead. The availability of benefits for sick and injured workers, with accompanying benefits for their minor children, is generally ignored by those who want to move their payroll deductions from the government into the stock market. It’s easy for those who are young and healthy to overlook the possibility that they might, tomorrow, become too disabled to work.

My interest in the disability program stems from several sources. I worked for Social Security for more than two years in the mid-1970s as a claims representative. Among other things, the job called for interviewing applicants for benefits and collecting the paperwork needed to determine their eligibility. For seven months in the mid-1980s I worked for a state agency that makes disability determinations for SSA. Soon after, as part of my post-doctoral work in psychology and law, I interviewed SSA workers and wrote a long paper on the politics and subjectivity of evaluating disability claims, especially those based on mental impairment. (That paper on my website routinely receives more hits than any other.)

And then, in the mid-1990s, I became disabled myself. My state-university job was not covered by Social Security, so I didn’t have to apply to the agency I used to work for, but dealing with a university retirement system brought home in a personal way dynamics of subjective disability evaluation I had earlier seen only as a worker and an academic.

The Globe article, by Martin Kranish, points out that SSA’s disability program is a complex web of state and federal decision making:

But the biggest problem with the disability system, according to critics, is that it seems designed to be inequitable. While the disability program is run by the federal government, much of the decision-making authority is handed over to state-employed workers. That may explain why only 36 percent of initial claims are approved in Connecticut, close to the national average, compared to 60 percent of those who apply in New Hampshire. Medical reviews are performed by state bureaucrats, often based on evaluations done by private consultants whose expertise varies widely.

A federal report said applicants are much more likely to get benefits in New England, which is overseen by the Boston office of the Social Security Administration, than in other parts of the country. ”The odds of being allowed benefits for claimants whose hearings took place in the Boston region were approximately two times higher than for claimants whose hearings took place in other regions,” according to a 2004 report by the Government Accountability Office, a disparity that apparently has not received public notice until now.

Kranish’s last line is wrong, though. The disparity among state denial rates is a basic finding of disability research, as I discovered when I reviewed the literature two decades ago. This provides one way to think about disability politics — about how state policy makers set in motion varying ways of interpreting what are, in theory, identical rules across the country. As one of those “state bureaucrats” Kranish refers to in that very same Boston office, I was well aware of Massachusetts priorities. Of course, identifying regional variability tells us nothing about which region is getting it “right.”

What interests me more than the state disparities Kranish emphasizes is the process he noted in passing: disability decisions are made by bureaucrats based on outside medical evaluations. In fact, in disability programs like Social Security’s declaring someone “disabled” is a legal decision rather than a medical one.

At least officially, doctors don’t make the final decision because their expertise is medical, not legal. They can describe someone’s physical and mental impairments, but they have no special expertise to decide whether someone with those impairments “can work” or whether they should instead be considered “disabled enough” to receive benefits. That final determination is always a political decision: where do you draw the mark, given what, in most non-obvious cases, are hazy, subjective sources of information despite SSA’s claim to use only objective evidence. As an example, any totally blind worker who quits a job is automatically declared disabled, a decision that has less to do with ability to work than with political lobbying and public sympathy.

In a society that cared about meeting basic needs, there would be no clear distinction among benefit-granting systems. Disability, retirement, unemployment, welfare — these are all different ways to get money to people who need it. Our system, though, is based on political decisions hidden by the pretense of scientific objectivity and bureaucratic rationality. So long as that is the case, disparity will continue. Some people who could be working will continue to receive benefits without clear justification. More troubling, though, many who cannot work in any meaningful sense will continue to fall through the system’s many large cracks, long before those privatized next eggs are large enough to matter.