Avik Roy, of the Manhattan Institute, recently published a piece for Forbes about the growing number of people receiving disability payments from the government. The federal government now spends $200 billion a year (about 5% of the 2012 federal budget, which spent $3.5 trillion) on roughly 14 million disabled people.
Roy argues that disability has effectively become a backdoor form of welfare or unemployment assistance, and that the problem is getting worse. Disability applications have risen during the last decade, approaching 20 applications per 1,000 adults — or 2% of the adult population. The number on disability is growing faster than the natural growth rate you'd expect from an aging U.S. population.
So, if disability is becoming a refuge for people having trouble finding work, what's the solution? Roy says the problem started with the 1984 Social Security Disability Benefits Reform Act, which:
"... instructed the government to place greater weight on applicants' own assessments of their disability, especially when it came to pain and discomfort; to replace the government's medical assessments with those of the applicants' own doctors; and to loosen the screening criteria for mental illness, among other things."
The result, Roy argues, is that it's become easier for people to assess themselves as disabled — in particular, by having a mental illness (e.g., depression), or back pain or other "musculoskeletal" problem — with less chance of a rigorous, professional medical evaluation overruling them.
Others besides Roy have suggested that disability is masking the true rate of unemployment and creating an incentive for potentially productive workers to drop out of the workforce. Disability is a tempting option for the unemployed who aren't having any success getting a job, but such fraud worsens the fiscal problems already had by Social Security Disability Insurance (SSDI). And it threatens Medicare, too, because it accepts people on disability (in addition to seniors).
Broadly speaking, I agree with Roy. It is suspicious that the population on disability should increase so quickly, even as medicine and workplace safety regulations do more and more to keep us healthy.
At its root, though, this isn't a problem with government; it's a problem with altruism. Helping the needy is a good thing, but it's prone to abuse. Seeing that people in need sometimes get stuff for free, there are some folks who will pretend to be needier than they really are. Hence the stories about people pretending to be 9/11 victims, or Hurricane Katrina relief funds paying for football tickets, or the high percentage of Long Island Railroad workers who retire on disability. Perhaps something like this explains the disabled "iron man", the high pay for some non-profit executives, and the "adult baby," as well.
But the response to this isn't to give up on altruism. Rather, it's to make sure our efforts to help the needy are well considered and well policed, so that people can't take the selfish side of altruism.
And the most straightforward way of doing this here would be more rigorous medical examinations (Roy himself suggests this). This is an added up-front expense, but it could pay for itself if it weeds out baseless claims of disability. And it might also give us a better diagnosis of those who genuinely are disabled so that they get the right treatment, potentially getting them off disability and back to being healthy.
In that vein, we should also make sure that judging someone to be disabled doesn't become a decision that lingers undisturbed. There should be regular assessment of people on the disability rolls, to make sure they don't stay there as a matter of bureaucratic inertia.
More generally, we need to take a harder stance on what counts as a disability. It seems like every few months a new study comes out claiming that an even-greater percentage of the population is subject to some sort of ailment requiring more delicate treatment and more medication. It would be foolish to dismiss these studies out of hand. A lot of illnesses, physical or mental, are real and debilitating. But what percentage of the population is really disabled?
False claims of disability take money away from the truly helpless. We should take a harder stance on that, too: people who intentionally defraud government assistance programs should be disqualified from those programs altogether.
Being human, all of us are vulnerable to perhaps the ultimate illness: wanting to have others foot the bill for us, and being willing to dishonestly call in sick to make it happen. But that illness is hurting our budget and our economy, and we need to put a stop to it.