Conor here: It’s interesting to read this in tandem with all the gnashing of teeth from capital about worker shortages. The Brookings Institution recently estimated that “the labor force is about 900,000 people smaller than one would have expected, primarily because of deaths related to COVID-19 and reduced immigration.” Brookings concluded with the following:
Ultimately, the amount of goods and services the U.S. produces will likely have to adjust to align with a smaller labor force. However, such challenges with regard to the size of the labor force would be mitigated if policies and other structural changes increased participation rates.
By Zachary Morris, Assistant Professor at the Stony Brook University School of Social Welfare, where he researches disability and health policy both in the US and abroad. Originally published at The Conversation.
More than half of U.S. adults over the age of 50 with work-limiting disabilities – likely over 1.3 million people – do not receive the Social Security disability benefits they may need, according to new peer-reviewed research I conducted. In addition, those who do receive benefits are unlikely getting enough to make ends meet.
The Social Security Administration operates two programs intended to provide benefits to people with disabilities: Disability Insurance and Supplemental Security Income, the latter of which hinges on financial need. Their shared goal is to ensure that people with work-limiting disabilities are able to maintain a decent standard of living.
I think it’s fair to say that if a disability benefit is truly available to those who need it, then a large portion of people with work-limiting disabilities should actually receive the aid.
To learn if that is true for the disability programs, I analyzed data over time from a long-running survey of adults older than age 50 called the Health and Retirement Study. The survey included information on disabilities and finances for tens of thousands of people from across the country and was linked to disability benefit records from the Social Security Administration. As the disability programs primarily serve those in their working years, I only looked at people who hadn’t yet hit the full retirement age.
The data showed that the share of people with substantial work-limiting disabilities who received Disability Insurance, Supplemental Security Income benefits or both rose from 32% in 1998 to 47% in 2016, which was the last year the data was available. This is just a little above the average among 27 high-income countries I compared the data with.
Using the most recent Census data, I estimate that more than half of those with work-limiting disabilities between the ages of 50-64 — about 1.35 million people — likely need these benefits but aren’t getting them.
I also examined the generosity of disability benefits in the U.S. by using regression analysis, a statistical tool that allowed me to compare the relationship between multiple variables. This helped me identify whether disability benefit recipients experience greater difficulty achieving financial security compared with adults who are not on benefits but have similar social and demographic backgrounds.
I found that those receiving benefits, and particularly Supplemental Security Income, struggled more and experienced less financial security than their peers.
Why it matters
Nearly a quarter of U.S. adults who head a household will report a severe disability that limits their ability to work at some point in their lives.
Many will look for financial support from Social Security’s disability programs, which together provide benefits to more than 12 million people in 2023.
The Disability Insurance program, established in 1956, provides benefits to those who meet a specific definition of disability and have paid Social Security payroll taxes. The average payment as of February 2023 was $1,686 per month.
The Supplemental Security Income program, established in 1972, pays cash benefits to adults and children who also meet the definition of disability and who have financial need. The maximum payment as of 2023 was $914, though some states supplement this with their own programs.
My research suggests that well over 1 million people with disabilities who face substantial barriers to employment are not getting the assistance they need. But what’s more, even those who receive benefits are likely not getting enough. Past research shows that more than 20% of Disability Insurance recipients and 52% of Supplemental Security Income recipients live in poverty despite receiving these benefits.
What still isn’t known
This research looked at data from 2016 and earlier, but a lot has changed since then.
Chronic understaffing at benefit offices — long-running but worse since the COVID-19 pandemic began — are making benefits harder to get at a time of growing need. An estimated 500,000 people are experiencing disabilities as a result of long COVID. And those experiencing it report having even more trouble receiving benefits.
So the problem is probably worse today.
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For additional context, stats from pre-pandemic, when times were good:
Final outcome of disabled-worker applications, 2010–2019
The final award rate for disabled-worker applicants has varied over time, averaging 31 percent for claims filed from 2010 through 2019. The percentage of applicants awarded benefits at the initial claims level averaged 21 percent over the same period and ranged from a high of 23 percent to a low of 20 percent. The percentages of applicants awarded at the reconsideration and hearing levels have averaged 2 percent and 8 percent, respectively. Denied disability claims have averaged 67 percent.
https://www.ssa.gov/policy/docs/statcomps/di_asr/2020/sect04.html
Let the horror-stories commence (I know the commentariat here is good for many of these).
Our son has schizophrenia and was approved on the first application. But… he was compliant with medications, had 2 privately paid providers that were experienced in applications and 2 parents that are supportive and educated. Remove any on of the 3 legs on the stool and claim would have been denied. If a person is not fully compliant with medication they are denied. I am familiar with many stories of repeated denials on the original claim and subsequent appeals. How can a mentally ill person navigate this maze? They don’t! This is part of the reason why so many mentally ill persons are homeless.
He had slightly more than than the 20 quarters of earning credits necessary to qualify. One of the most significant benefits is qualifying for Medicare after 2 years; that is a big deal. With SSI people are on Medicaid which is not the best insurance or heath care.
I’m deferring collecting my SS because his benefit is eventually tied to mine because his disability occurred at a younger age. Currently most of his ~$800 monthly benefit goes to paying Medicare premiums and medical expenses.
Cut DOD to <2% of GDP. Remove the cap on FICA taxes. Tax capital gains as ordinary income. Bring back Eisenhower income tax rates.
I will add my two cents on this issue from hard learned experience.
I hate to always start this way, but I must. WHEN I WAS MUCH YOUNGER, the system was so much more compassionate. Obama cannot be blamed in total for this, the worst parts began to happen with the Clinton/Gingrich combo, and then so much worse with Shrub and DeLay.
But Clinton balanced the budget! screams MSNBC and NYT without a hint of irony or introspection.
When I was young, a primary care doctor would fill out a few forms for SSI when the need arose. You were then often contacted by 1-3 SSI case workers or physicians on the phone to discuss the situation. The individual would then appear in the office. And then there was more back and forth between myself and the case workers at SSI. Disability was granted about 90% of the time without a hitch. It must be noted that I had no desire in any way to game the system and only went to bat for those who were really in need. Psych, injury, and chronic medical issues included. When I was on the fence, there was lots of discussion with specialists, psychiatrists and even clergy.
This was taken so so seriously.
And then in our culture, we have been smacked by one thing after the other with direct impact on this. The opioid epidemic. All kinds of bad lawyers and doctors literally using the system as a cash register ( I have been shocked watching the episodes of American Greed that have to do with this). A culture in our middle and under classes where dads disappeared and all kinds of system gaming became the norm. The deprivations of people losing their homes in 2006-2008 and all the psych issues with that. And I would say the general overall massive decline in American’s health like nothing I have seen before.
Today, it is almost a given that the local primary doctor is not asked to be involved in any way. If you insert yourself, you are instantly swatted down. Unless there is an OBVIOUS issue, ie paralysis, lost extremity, head trauma, etc, the patients are guaranteed to be declined often multiple times. There is no mercy shown. This is particularly acute in psychiatric issues where as you say the patients end up on the street with no help at all. Almost all of this ends up in some kind of legal affair with judges, etc. The “medical” input is from doctors being paid by the system. Ergo, follow the money, their motivation has nothing to do with the patient.
What a disgrace. The decisions are made NOT by doctors or nurses who have training to identify disabilities. Rather, overwhelmed judges and vulture attorneys hold the fate of these people in their hands. The attorneys love declines and delays for a very simple reason. Once approved, the patient gets a lump sum payment in full all the way back to their initial claim. So the longer this gets dragged out, the more the lawyers get since their pay is a percentage of this lump sum.
And like so often in our world today, the tragedies and human suffering I see are just overwhelming. Literally little kids starving, etc.
I have quite frankly given up.
I can confirm IM Doc’s characterization of the Kafkaesque bureaucracy that is the process for Social Security Disability Insurance (SSDI) because I have been fighting with the federal government for disability for 3.5 years now. Neoliberalism has infected the legal infrastructure so that the affiliated lawyers, administrators, and judges have a malincentive to exploit the disabled applicant, who in addition to purported disability is almost certainly weak and poor. Wealthy people seldom have to go through this humiliating process of disability because they likely already have ways to ensure money flows in from property or financial assets.[1]
As an example of lack of mercy and compassion, take a look at Garrison v. Colvin, a case where Ms. Garrison was repeatedly denied SSDI. She suffers “from a variety of physical ailments—including chronic neck and back pain, degenerative joint disease, sciatica, obesity, asthma, and herniated discs” and “a variety of diagnosed mental impairments, including bipolar disorder, anxiety, bouts of insomnia, auditory and visual hallucinations, and paranoia.” In this case, the Administrative Law Judge (ALJ)—who is curiously anonymous—determined that Ms. Garrison was not disabled according to the very strict rules as delineated by the Social Security Agency (SSA) mostly because Ms. Garrison’s deteriorating physical and mental health momentarily improved.
Considering Ms. Garrison’s impairments, there is almost zero possibility that she can navigate through these byzantine legal procedures. The SSA’s website states there are four (not so easy) steps for appealing. Each of these four steps gets increasingly onerous. By the time one gets to the last step of filing a federal district court action (which is where I am right now), highly specialized disability attorneys must be hired. Such disability lawyers are difficult to find because many will not have experience with disability lawsuits at the district court or circuit court level. Even if this hypothetical lawyer does have the relevant expertise, he will decline to represent the client unless the case has a high probability of winning. After all, disability lawyers usually work on contingency. They don’t get paid unless you win your disability case. In contrast, the SSA employs the ALJ and lawyers whose full time job is to ensure that the weak and poor disabled person does not get paid a dime.
The Administrative Law Judge (ALJ) is hired by the SSA, which should immediately raise red flags for malincentives. ALJs, as far as I can tell, only adjudicate over SSDI and SSI cases, and not other criminal or civil matters. This means the ALJ is probably not impartial. The ALJ in Garrison v. Colvin appeared to have a personal vendetta against Ms. Garrison. If a SSDI applicant has the misfortune of being assigned a sadistic ALJ, that applicant has to stick with that ALJ. On the rare chance that a higher court rules in favor of the applicant, the higher court will remand the case right back to that same ALJ, who has already ruled unfavorably for the disability applicant. The people in power in our society should easily recognize that human nature will encourage more antagonistic behavior from the ALJ upon a remand.
I don’t know if the ALJ assigned for me has a personal vendetta with me, but he did curiously dismiss my oral testimony and years of medical evidence from my doctors. I have some extremely rare neurological disorder which results in a systemic augmentation of sensory stimuli and neurological overreactions[2] to seemingly everything. My ALJ ruled against me because he believes that my impairments are not severe, which is contrary to what my doctors stated in my medical records. An ALJ can, apparently, capriciously side with medical experts who work for the SSA even if that contradicts the expertise of the claimant’s treating and examining doctors—who presumably would be knowledgeable about how disabled his or her patient is. (Actually, the ALJ is not supposed to do that. He “must provide clear and convincing reasons for rejecting the uncontradicted opinion of an examining physician.” See Lester v. Chater.)
[1]: Let’s not forget there is a practical need for our society to have mercy and compassion for the weak and impoverished. We don’t want a disabled person to have extremely urgent and desperate desires for money. He might feel pressure to commit crimes against the rest of us because his disability precludes him from earning an income by working.
[2]: One reason why I am fearful of Covid-19 is I surmise that I will have a neurological overreaction to SARS-COV2. Immune system overreactions to Covid-19 can cause death. Neurological overreactions can cause long Covid. What about my overreactive nervous system? Let’s not find out.
I worked decades as a RN, MS, level. All types of positions, floor nursing to managing mid level 50 million dollar budgets. When I broke my back, I applied for disability. I lost lower extremity function, and elimination functions. Applied, waited for the SS doctor consultations to be completed. The process I completed on my own as I had a “paper work” background. The only contact I had with the SSDI office was when I looked online to track my claim and a few phone calls. I noted about month 4 during the waiting period that I was put into a “audit” category. A phone call and this led me to a person in the next state; that stated I was pending review. Said to call back in two weeks. Repeat, called in two weeks. Still in audit, pending status. The SSDI clerk stated she would push it to her supervisor by end of day. I looked online later that evening…approved. Took five months. No issues moving forward. Put into “unlikely to see improvement category “. The fact that I had a medical background did help. This is now my advocacy work, free of course.
I had a discussion about this with my kids last night, because of school projects they were working on. The whole history of SS and how it’s funded is usually garbled in the media and any kind of discussions that happen at school. I wonder if any actuarial studies have been done to look at the net impact of COVID on the long term health of SS being able to pay out yet? All the articles and comments from current pols that I’ve seen refer back to ideas and studies pre-pandemic. I think we’re in a much different place now.
I’m still not sure if one of the reasons the US government ultimately decided to let COVID tear through the country wasn’t to “reduce the surplus population” and solve the pension/elderly crisis through means of “advanced attrition”…
I’m pretty sure the agency of the US gov’t was to keep the economy humming because that is the most reliable way to get reelected. Death panels were never a real thing even if there were a few people who thought it was a good idea. In any case long covid will only swell the disability claims beyond the capacity to service.
Social Security was instituted to provide retirement insurance. Disability insurance was tacked on much later. Now who doesn’t know someone who must only be paid in cash because if they show income they will be thrown off disability. The system is abused and abusive. It is a typical political solution called “just throw money at it”
The author advocates for the disabled in terms of monetary assistance not social support. The ones who don’t need it are milking the system and the ones who do need it are not being provided with any programs to give them the opportunity to return value to the society. They are like economic prisoners.
You’ll get no argument from me that the system for disability support in the US at the fed and state level is abused and abusive. But the rest? Haven’t there been numerous articles posted on NC discussing how the socialist measures the US government enacted during COVID did great and helped do a lot for relatively little? The child tax credit modification being the best example. So I’m not sure I can agree with the position that they had to kill those programs to save the economy. Or that the feds had no agency in deciding to “let ‘er rip” and adopt policies that permitted easy transmission of COVID throughout the country. As Yves is so fond of pointing out, the tweets from various agencies which claim covid is not airborne are still up as if they’re valid.
So with that understanding, is it so hard to imagine some person calculation the cost of continuing to maintain support for programs and comparing it to possible savings if, say, a couple million elderly died sooner rather that later?
Chris wrote: “’… still not sure if one of the reasons the US government ultimately decided to let COVID tear through the country wasn’t to “reduce the surplus population” and solve the pension/elderly crisis through means of “advanced attrition”…
Trump only opened the USA wide to covid after he heard the infection was mostly in big cities (in Blue States). So the GOP was fine with it mostly killing Democratic voters. It was something of a bonus if it also killed off a lot of what the Libertarians call “useless eaters”.
It later spread to the rural areas where the GOP voters mostly live. Karma?
You don’t have to be a lawyer to collect disability in the USA. But you will have to hire one.
The Oligarchs/Plutocrats running this country need to go away.
No.
Trump was told shutting our borders and doing various other things that he wanted to do, was racist and not helpful. He was fought on this in congress and the senate. But let’s take your argument at face value and assume you’re correct, people in the Trump administration decided to let it rip once they heard it was affecting mainly large blue state urban areas…Joe Biden takes office in January 2021.
Biden brings with him “the serious people” and “the adults in charge” who “believe in science” (if you doubt them, just look at the signs they have on their well manicured front lawns!) and his administration aggressively opens up the country so that many more people have died on Biden’s watch than Trump’s. By the time we have an election in 2024, it looks like 1 million more people will have died under Biden than during Trump’s period of handling the country with the pandemic. Trump will come in at roughly 300k dead. Biden will come in around 1.3 million dead.
And remember, the same people who fought Trump on closing things down are also those who stayed in the federal bureaucracy to open things back up under Biden. Just like how Kamala and others claimed they would not trust the Trump vaccines when they were running for office, but once elected, doubled down and nearly made it a criminal act to go unvaccinated.
Lastly, I will always kick back hard at anyone who thinks the infection of rural areas was karmic retribution because that is an evil thing to believe. SARS2 did not come here because some farmers in Iowa who wore MAGA hats got sick and spread it around the local county fare in late 2019. We got SARS2 on our shores because rich people living in blue society had passports and traveled or attended high end professional conferences with people from all over the world. And then, when life became too hard for them in their gilded city cages, they fled to the rural parts of the world and brought the virus with them. Or they insisted on keeping their help full time and unprotected, and that spread it in the poor and more suburban communities. Trump is an awful person and he will have much to answer for sooner or later. But if you’re a professional, and a Democrat, and you want someone to blame for SARS2 in the US, look in the mirror. You’ll see the face of someone from NY, or MA, or CA who caused the pandemic to spread.
–“We got SARS2 on our shores because rich people living in blue society had passports and traveled or attended high end professional conferences with people from all over the world. And then, when life became too hard for them in their gilded city cages, they fled to the rural parts of the world and brought the virus with them. Or they insisted on keeping their help full time and unprotected, and that spread it in the poor and more suburban communities.”
aye!
thats about as succinctly as one can get.
i sure AS HELL DIDNT BRING THE DAMNED THING IN ON AN AIRPLANE.
that was the folks who can afford to ride on planes and visit other continents
Tragedy Of The Commons.
If you have to hire a lawyer to get your benifits, then there is something wrong with that program.
My late brother had brain cancer, and got turned down twice for disability and had to hire a lawyer to qualify.
I mean how hard could it be for them to contact his doctor who would verify that yes, he had brain cancer, but a combination of chemo & radiation did the trick, pay up!
My recollection is that Big Bill McGuire was the CEO of UnitedHealthcare when their processing department became the Claims Rejection Bureau.
It is very hard to find references to him online these days, almost as if he never existed, almost as if he never received over one billion dollars in compensation for his role in making a health insurance company obscenely profitable.
380,000 people work for UnitedHealthcare which makes its owners very rich by taking premiums and then refusing to give them back in the form of healthcare reimbursement whenever possible.
The entire Social Security Administration only employees 60,000 people.
This is a sick country.
If the wikipedia entry is to be believe, Mr. Williams reminds of the Sacklers of opioid fame. Such colorful people who never seem to pay a real price for their duplicity and murder. They just pay off the right people and courts, and go on living nice lives.
My brother was on disability. Then at some point they said they paid him too much money and they wanted it back. His lawyer said to just give them what ever paper work they wanted (even if you have to do it multiple times) and after two years they finally said everything is fine. I don’t know if they are incompetent, evil, or both.
Lambert often points out that “benefits-testing” is a jobs program for the PMC. This is perhaps a perfect illustration of that.
Perhaps the program is working exactly as intended and as designed — it’s just that the intent of the design is not what it is superficially portrayed to be.
The benefit increases including property and income limits never match inflation. Add that it can take years to get nowadays and I have to assume that this is a deliberate effort at culling the herd. If it can take over two years with me, close to three really, and needing a lawyer despite decades of documentation from five doctors. I mean, really…
Also, while there is always a lack of funding the applications process, there are a lot of offices and levels to go through that have to receive some funding. County, state, and federal levels. Plus multiple offices for each. IIRC, my process went to five cities and three four counties in California as well as to Little Rock, Arkansas for emergency processing due to the backlog at the time. Also, several of the offices dealt with my case at least two times. Then add the initial application, plus the several subsequent appeals, which was followed to the federal level judicial appeal with a disabilities lawyer.
It went on for so long that I wasn’t given backpay for the entire process as there is a limit to the time covered. Another way to limit payments, I guess, because going over the limit was not due to me.
There is also the denial of SSDI benefits if any paid work was done during the application process. One hour of babysitting or mowing the lawn does count, which probably makes liars of most applicants as well as the counselors, lawyers, and clerks. Most people do not consider being able to babysit during a multiyear wait adequate reason for denial of benefits. It’s a game. A game with real consequences, if it does so happen that someone did some babysitting, and an officious busybody decides to put it in the record, off you go.
Plus multiple requirements for Medicare, Medi-Cal, SSI, and SSDI with different gotchas to reduce or eliminate your benefits. It is a bit of a thicket, which kills people everyday. I should say, murders people everyday.
My God. I am so sorry to hear that was your experience. It sounds awful.
Really, compared to others, it wasn’t that bad(?). Having family and doctors supporting and pushing does wonders as was their financial support.
Instead, think of all those people who do not have such. These are the ones on the streets often having greater or more obvious disabilities. The system is set up to appear to winnow out only the undeserving, ostensibly, but it is just stopping as many people as possible without breaking that appearance. Exhaust the applicants or find something, anything, to disqualify them. Make them give up. Sometimes, they just die waiting for approval. It is a sick system designed to help those people who have the ability to endure it, not the people with the greatest need, who often can’t endure it.
Here’s my horror story with SSI. SSi is a welfare program of SS. The max amount you can qualify for is about 800 a month. You are limited in resources of $2000 as a single person and $3000 is you are married.
I am disabled and have been on dialysis for 6 years. My mother died in 2020 and I inherited her IRA of about 25k. SSI said you are not allowed to have this (Not even an IRA) and kicked me off the program. I was then ordered to repay 2k in benefits. SS said you have to spend this money in a year to get back on SSI. A year goes by, I spent the money. I try to get back on SSI and the woman on the phone says they need receipts for the spend down! What I tell her no one ever told me that previously! Crickets. Then they start asking me about my vehicle. Before MOM died she gave me her car and I scrapped my old car and got $350 for it which I reported at the time. But of course they had no record of that. Turns out SS started dunning me for another $330. I have never felt so worthless as a human being in my life. So now I am forced to work because SSI will not reinstate me. My son a schizophrenic applied for SSI in 2020, received one month then lost it because of his inheritance. He reapplied and was denied. They said he could work a job. He’s medicated but it does not take care of all his symptoms. My best friend with RA got covid at her job, and it affected her so much she was out of work for almost a year. When she returned they fired her, she was denied disablity and the examiner lied and said she only became disabled when she lost her job. She had her first surgery in 2018 and her 2nd one last year. She had to hire a lawyer. The US is a very cruel country.
And it is $h!t like this that makes me say that I am one truly of the lucky ones. No ifs, ands, or buts.
And can I add that just how cruel the system is depends on which state and county you are in. I live in the San Francisco Bay Area, which compared to even other parts of the state like Los Angeles is less brutal. As unpleasant as my experience was, it is nothing compared to Los Angeles or the far worse Southern states.
People with Long Covid are going to be treated the same as people with Lyme Disease were as in being accused of lying or faking it. They are amorphous diseases with often no clear causes or obvious symptoms that it easy to deny the real suffering. Just how many more people will be on the streets?
Read: https://www.ssa.gov/oact/STATS/table6c7.html for the SSI statistics by year since 1965. This webpage lists number of applicants, percent accepted and number per 1,000 workers. My gut opinion is that early-on there was a backlog of physically disabled. More recently… draw your own conclusions. I see no pattern except a high rate during certain administrations and a low rate when the system was in financial trouble. And now there may be so much gaming of the system that people like some of those mentioned in the responses above are caught in a system designed to weed out the people- and lawyers- gaming the system.
About the data on which this article is based. The article says: “To learn if that is true for the disability programs, I analyzed data over time from a long-running survey of adults older than age 50 called the Health and Retirement Study.”
So I follow the “Health and Retirement Study” link looking for the source of the data. According to the only “Study” link that mentions an actual sampling technique: https://hrs.isr.umich.edu/news/data-announcements/2021-hrs-perspectives-pandemic, the study seems to be based on a mail-out survey,
When I explore the huge tree of information for more about the actual data I find at https://hrs.isr.umich.edu/sites/default/files/biblio/h1996inf.pdf the following:
“HRS uses an important method to collect data that are usually subject to high rates of non-response (Heeringa, Hill, and Howell, 1995; Hill, 1999; Juster and Smith, 1998). A key feature of the method is to allow a respondent who is unwilling or unable to answer an “amount” question to provide “bracket” information about the “amount.” To utilize the “bracket” information collected, one needs to unfold brackets, or impute the amount variables with brackets.”
Which is a nice way of saying “A huge number of people ignore mail-in surveys, so we try to make it a bit easier by giving the potential respondents bracket choices (meaning a range of values) instead of asking for an actual number.” No mention of what the actual response rate is or how they draw inferences about non-responders.
GIGO. Garbage In Garbage Out. The data this story is based on is essentially meaningless. A wasted five minutes reading the article and a wasted 15 minutes to read the details on the underlying data and to writing this. If I’ve missed something, please tell me what I’ve missed.