Thank you, Jonah, for highlighting what is fast becoming a disability crisis in various regions of the country. I’m not surprised that your column is already generating a furious response. Though I don’t think any fair reader would or should take your column (or the fascinating NPR story you reference) as some sort of class-based assault on the disabled.
I’ve written about this issue before, live in the middle of a rural Tennessee county with a serious disability problem, and have researched the issue in part through extensive conversations with the front-line health-care providers who are seeing these disability patients every day. Back when my wife and I worked with a youth ministry that concentrated on reaching high-risk, poor kids, we were initially shocked to see how many of the parents were living off disability, and we also knew kids whose own disability checks provided the backbone of the family’s disposable income. I’ve spent many, many hours with kids and families whose financial existence revolved around the receipt of their disability check.
A few observations:
First, fraud is real and not uncommon. I’m with Jonah in finding it difficult to believe that anyone would have a problem trying to weed out fraud.
Second, even if we weeded out fraud entirely, we’d still have a disability problem. The relationship between family background, welfare, economic opportunity, education, character, and disability is almost ridiculously complex, with reforms in one area creating perverse incentives in others. While wonk-bloggers do love their charts (like Jonah’s critic at the Atlantic), charts have difficulty capturing the complexities of the millions of individual stories that add up to $260 billion per year in disability payments.
And that brings me to my third point: Analysis of the disability program simply can’t be separated from analysis of the larger problems created by our culture of dependency, where we actually help create the very crises we’re trying to solve. In my original post, I highlighted a real-life example of a blue collar, high-school graduate I called “Rob”:
In early 2009, Rob was laid off from his latest job and immediately began receiving unemployment benefits. He’d received unemployment before and had always found another job, but this time the job market was more difficult. He looked for work, but he looked less and less diligently with each passing week. Benefits were extended — then extended again. While unemployed, he lived a far more sedate lifestyle and quickly began gaining weight — eating foods purchased with government assistance — and as he gained weight, his health deteriorated. His joints ached, his blood pressure rose, and he became extremely anxious.
Knowing friends on disability — and realizing that the benefits were roughly equal to the pay he received at his last job — he applied, claiming that his muscular-skeletal problems combined with his anxiety prevented him from working. Within months, he was approved, and he stopped any effort to look for work, knowing that if he found a job his benefits would cease. His sedate lifestyle continued, his health deteriorated even further, and — soon enough — he was truly “disabled” by any objective medical measure.
In other words, we safety-netted Rob into chronic illness and long-term dependency.
Now, let me contrast Rob with another real-life example, an Iraq vet I know who I’ll just call “Brian.” Brian was seriously wounded by a rocket blast (where he suffered shrapnel wounds and a traumatic brain injury). He’ll likely carry shrapnel in his head the rest of his life, he suffers from debilitating headaches and other symptoms of his wounds, and not one person alive would fault him if he never worked another day. Yet just as soon as Brian got home and got out of the Army, he started looking for work. He went back to school and worked through the pain of his injury to get another degree, and eventually ended up with an excellent job — but he still struggles every day with the effects of the rocket blast.
I freely acknowledge that Brian is an extraordinary man. I can’t imagine being so resilient and determined if I faced the same injuries. A nation, however, is built on the backs of the Brians, not the Robs. Yet we seem to be hell-bent on perpetuating a government, a pop culture, and an education system that is perfectly constructed to create more Robs. For millions of Americans, “disability” isn’t just a medical diagnosis, it’s also a state of mind — a state of mind we subsidize, sustain, and encourage.