Monday, May 11, 2009

"The Disability Mess" -- And How to Clean It Up

The New York Times blog presents several perspectives on what's wrong with federal programs intended to support people with disabilities -- and how the Obama Administration should improve them. The administration's proposed 2010 budget assumes that huge savings can be generated by spending more to eliminate fraud, abuse, and waste in Medicare, Medicaid, and the Social Security disability insurance program.

Federal spending on disability insurance rose 65 percent from 2001 to 2007, but the but the number of medical reviews to determine eligibility for continuing disability payments dropped from 840,000 to 190,000 in the same period. The Times asks: "Why have federal disability costs skyrocketed? Is it because of fraud, an increase in the number of the truly disabled, or are there larger problems with the program?" There are no easy answers, as these excerpts show:

Jennifer Erkulwater, political scientist: "As the recession wears on and more people apply and fewer people are re-examined, disability rolls can be expected to grow. However, the villain here is not fraud. Instead, program growth is the result of intentional changes to policy and administrative capacity."

Richard Burkhauser, public policy professor: "President Obama could be the same agent of change toward disability policies as President Clinton was on welfare reform. The key is recognizing that most working age people with disabilities could and would work, if work paid."

Gary Burtless, Brookings Institution: "The federal government can certainly reduce the disability rolls and the cost of the disability program by conducting more frequent and tough-minded reviews of recipients’ disability status. There will be collateral damage, however....It makes sense to conduct the reviews, but it would be sensible to focus reviews on workers with medical conditions that are most likely to improve."

Tim Moore, former state disability examiner: "Fraud...occurs in a very, very small percentage of cases....Though the disability benefits are paid by the federal government, they are processed in a system that involves both federal and state agencies. The salaries of disability examiners are paid by the federal government, but they are state employees. In this recession, some states are furloughing these workers, too."

Morley White, administrative law judge: "I generally believe in the sincerity of what [disability claimaints] say. They are poor and the benefits they receive are now only $674 a month for an eligible individual. What are these people supposed to do in this economy with the limitations they say they have? There is too much emphasis on reputed individual fraud and not enough on how the system itself can be reformed."

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