HEALTH CARE/Joan Retsinas

Disabling the Disabled

A Stealth Budget-Cutting Memo

Official memo from the Social Security Administration: "We are proposing to revise the definitions of the age categories we use as one of the criteria in determining disability under titles II and XVI of the Social Security Act. The proposed changes reflect our adjudicative experience, advances in medical treatment and healthcare, changes in the workforce since we originally published our rules for considering age in 1978, and current and future increases in the full retirement age under Social Security law. ..."

Unofficial, apocryphal but plausible memo from the budget-cutters:

Great news! We can slash $6 billion from the budget over the next ten years, without touching Iraq, Homeland Security, or tax cuts. We'll pick a "soft" target: the newly-disabled.

With this strategy, the disabled won't know they've been fleeced until long after the fleecing.

We'll make it a stealth mission -- taking the money with a sleight of hand that will win us tickets to the White House Christmas party.

We'll embed the change in the complex grid of Social Security disability regulations. Social Security pays monthly stipends to injured people who cannot work at their jobs for at least a year. But the key to Social Security's determination of "disabled" is an almost Byzantine grid. In that grid we budget-cutters can wreak our legerdemain.

The grid consists of medical evaluations: How impaired is the person? Can s/he do the previous work? Can s/he work at another job? Literacy and proficiency in English matter; both kinds of workers are excluded from white collar jobs.

Age also matters; younger disabled workers are presumably more likely to find re-training in other fields. Right now the categories are ages 45 to 49 and ages 50 and up. Imagine the same medical and functional impairment: The Social Security Administration might expect a 45-year-old man to get another job (and not get a Social Security stipend) than a 50 year-old man.

A bit confusing? Good. That confusion will mask the change.

We will simply raise the ages of the grid-categories by 2 years. Instead of ages 45 to 49, the grid-category will be 47 to 51; the next category will begin at age 52, not 50.

A petty change? Good. Its seeming pettiness will obscure the import.

Once this goes into effect, thousands of disabled people will discover that they do not quality for payments under the new age-rules -- and, as a corollary, that they are not entitled to Medicare or Medicaid. [Typically, people disabled enough for Social Security get Medicaid for two years, until they are eligible for Medicare.] We can roll the change in gradually, starting with one region of the country -- a gentle escalation, so that most people won't know the change is coming until it has happened. We'll grandfather existing recipients into the new system, so that they won't object. Only the people who apply for benefits will be affected -- and they won't know that under the older system they would have qualified. Brilliant? Yes.

We will justify the change with "updated demographic research." Today people in general are healthier, and more jobs are white-collar, than in 1978, the year that Social Security established the grid. So presumably the population of people with disabilities is also healthier, with more job possibilities. It sounds logical to amend the grid.

As for objections, we haven't heard much. We buried the change in the Federal Register (November 2005). The usual suspects objected. The National Organization of Social Security Claimants Representatives, the Center for Budget and Policy Priorities, and the National Center for Primary Care noted the discordant facts: people with disabilities have fewer job opportunities today than they did in 1978. (In 1988, 22% of people with disabilities reported that they were employed; in 2004, the percentage dropped to 17%, according to the Center for Budget and Policy Priorities). Since minority workers are disproportionately disabled, this age-change will have a disproportionate impact on them. For disabled people with low incomes and low education, two years of uninsured, impoverished limbo will be cruel.

Catherine Komp in The New Standard (April 27) discussed the consequences. But this is not prime-time news -- it will not push the newest blockbuster movie or the latest war casualties off the media-waves.

It's an easy $6 billion. Mission accomplished.

Joan Retsinas, Ph.D., is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, June 15, 2006

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