Will be interesting to follow these numbers when self-driving semi-trucks start taking over.
Edit: I meant similar to UBI in the sense that the group that views themselves as unemployable has found a way to get the government to supply a "basic income". I'm aware it doesn't fit the idea in other ways. It is clearly, though, being used by people that are not suffering a real disability.
That would possibly be fixed with the introduced bill to "..allow recipients to keep some of the subsidy even after they’re employed rather than being cut off."
I think it's the exact opposite of UBI. The key defining feature of UBI is that everyone gets it. You don't lose it if you are able to work.
Whereas the key feature of SSDI is not really being "disabled" as TFA explains, but rather that you must not have any substantial gainful activity -- no more than $1,170 per month.
SSDI has become less of a form of insurance against a set of particular diseases, and more a kind of insurance for where someone decides it's no longer viable to work, as long as there's an associated physical scapegoat. Either because work is not available, or not reliable enough, or because your body is not reliable enough for the jobs that are available, it's a steady check that you can get, only if you don't work.
The issue is confounded by the fact that after about 3 years of qualifying for SSDI you also become eligible for Medicare, which can provide more value in reduced healthcare costs than any locally available job could ever hope to.
>[disability is] where someone decides it's no longer viable to work
How did you conclude that viability to work is a "decision"?
You also imply that it's better to have medicare than any insurance through a job. Medicare actually really sucks compared to many alternatives. Lots of providers won't even let you in the door with it.
"Viable to work" is almost always a decision. A potential employee must decide if it's viable for them to get their ass to work and if they would end up, at the end of the day, economically advantaged for having done so.
As in, "I am sick and hurting but I will get my ass to work anyway because I need to to survive." versus "I am sick and hurting and fuck this, lets see what the alternatives are."
Of course there are cases when it is cut and dry. I think the thesis of TFA is that the rapid expansion of SSDI program is because the way the program works now it's not cut and dry at all.
Now the operative part of better w.r.t Medicare is free. Medicare is the biggest insurance network in the world. "Lots of providers won't let you in the door" is equally true with private insurance too.
But if you are earning just your SSDI check, you also qualify for Medicaid in states with Medicaid Expansion. I'm not exactly sure how it works, but I think you do actually get both, and Medicare is the primary payer and Medicaid pays second. Which basically means you can walk into any hospital in your state, for any reason, and pay nothing.
I usually add more references to avoid the impression I'm making shit up. I do have significant experience dealing with SSDI; the application process, the approval process, the payment calculations, and the SGI requirements. It's also something I've researched extensively along with the ACA as a kind of public policy hobby.
The "I'm not sure exactly how it works" statement was specifically related to having both Medicare and Medicaid at once. But my claim that Medicare is primary and Medicaid is secondary was based on [1].
EDIT: In reply to 'icantdrive' which needs 'showdead' to see;
Getting SSDI is not guaranteed, you have to get through the approval process. But it's clearly not insurmountable if 20% of a county can be on it. Certainly everyone does not have a qualifying condition. But many people have qualifying conditions but who are not currently on SSDI. Many people have SSDI with a qualifying condition (not fraud) but who might otherwise be able to earn more than $1,170 / month. This is the population we are studying, and trying to understand why they ultimately decide to forgoe working and get on SSDI.
Medicare premiums for someone on SSDI will be almost nothing. But importantly the co-pays are still 20%. You qualify for Medicare 29 months from the time you were deemed disabled and you also stopped working (later of the two). You are absolutely correct that Medi-Cal is what most people are relying on. For the first 29 months it covers everything at no cost, and after Medicare kicks in it covers the Medicare co-pays.
Of course not everyone will take Medi-Cal. But major hospitals and their doctors on staff do take it, so you can walk into Stanford, Lucile-Packard, UCSF, etc. and get fantastic care at zero cost.
I care about the system mostly due to the warped secondary effects it creates. SSDI is an incredible program and an essential benefit for millions of Americans. It has the right heart, but like most things governmental, goes about it all wrong.
When a crucial benefit comes with a condition that you can't work more than $1,170 / month, that is broken. People who are disabled and legitimately qualify for SSDI should not have an economic gun to their head keeping them from working at all. They should be free to work as much as they are willing and able to.
The program claims to provide benefits to people unable to work. But increasingly (for about 50% of enrollees) what it really does is provide benefits to people willing to not work. Because of the broad range of ailments that are covered, the most important factor becomes the applicants willingness to just give up on working. Actually, more to the point, the spectrum of programs (SSDI, Medicare, Medicaid, TANF, etc.) actually drive people to give up working, because the economic value of giving up on work is astronomical.
1) SSDI is determined by a medical doctor. The patient has the decision to apply, but after that it's a judgement call by "professionals". I used quotes because the system is severely flawed. Getting a dissability lawyer involved early is prudent planning. It shouldn't be this way, but the system is severely flawed.
2) Just rambling?
3) agree
4) not totally free. Agree "lots of providers won't let you in the door."
5) I belive you get Medicare after two years on SSDI? The people I knew who were on dissability were all relied on state medical benefits. In California, they relied on Medi-Cal. Most doctors won't accept medi-cal. Sure, they got free hospital visits. Depending on where you live, a hospital might be your only recourse. Yes it's free, but it minimal quality of help. Many drugs are not on an approved Formuliary. They purposely make getting benefits very difficult. Going to a hospital should be the last resort? The system forces some people into going to the emergency room. Still not fixed, even after Obamacare?
I don't know. Let me ask you something? Why would you pay a hospital bill you have absolutely no control over? I see some noble people trying to pay off their padded hospital bills, and I don't get it. I would understand it if their wasn't collective bargaining, and some standard way of computing hospital costs. Right now they can charge you whatever. My father was given a gift basket by the hospital staff. Months later he looked at the bill. That gift basket was $300.00. He refused to pay even his 10% of the adjusted bill. (Had great Union insurance.)
If someone qualifies for free medical care; why do you care? Our medical system is not a free market entity. We like to think it is, but it's a closed system.
My congrats to any collective barging entity(like Medicare, and many private party insurance companies) that keeps prices down for its members. Actually, they just refuse to pay the bill on many cases because they can.
Obamacare gave us a few rights. They look like they will be history though?
Yeah, no joke, truck drivers are currently the most common job in over half of the states.[0]
Eventually we're going to get a lot of professional video gamers.[1]
My biggest hope is that we get something like FoldIt to take off, and the collective unemployed on UBI playing video games all day end up curing cancer in their spare time.[2]
That story is a little flawed as well. They first compare 2.8 million truck drivers (a specific job) to large categories like "food services".
Then, they do get specific, and show specific jobs, like cashier (3.3 million) at the top of the list...which only serves to confirm that "truck driver" is one of the largest.
Whenever self-driving trucks do get here, it will affect more than the ~3 million truck drivers. Other trucking occupations like dispatch, then related businesses, like truck stops and motels are obvious big hits. I assume there's lots of smaller ones as well...things like CB radios, custom mud flaps, trucker talk radio, porn on DVD and so on.
> That story is a little flawed as well. They first compare 2.8 million truck drivers (a specific job) to large categories like "food services".
I'm not sure it was really a flaw. That was the entire point of the article. The complaint was about how the NPR (and the BLS by extension) lumped anything that had a tiny resemblance to a truck driver into one category, but broke up other industries into smaller groups, such as the 80 different categories teachers can be found in.
When they applied those broad strokes to other industries, truck driver didn't look so big anymore. Truck driver represents about 1-2% of the workforce. About the same size as the farmer population. Strangely, nobody is worried about self-driving tractors – which are further along than their road-travelling brethren – taking away farmer jobs, despite a similar impact in numbers.
> Whenever self-driving trucks do get here
If is the bigger question. As many of us around here are engineers, we know it's easy to get a 90% solution and it's easy to demo a 90% solution to get people excited about what you are working on. But the last 10% required to actually put these things on the market can take forever.
Lots of outstanding problems that we still have absolutely no idea how to solve. Past performance is not an indication of future results.
Personally, I think it's closer than self-driving cars. I suspect they can take over the interstate routes fairly quickly just by using some roadside land as "ports" to transfer control to human drivers. That would get the vast majority of the miles automated without tackling the harder, non-interstate, parts.
But even then, long haul truckers only make up about half of the truck driving sector, so not only will the other half still be necessary as always, there will be additional need for short-haul drivers to handle the loads coming in off interstate routes that they were previously handled by the long-haul driver end-to-end. Additionally, the industry has been quite vocal about wanting to have more trucks on long-haul trips, but cannot afford the talent. If those costs come down, there will be even more trucks on the road, needing even more short-haul truckers.
So, while the may be some decline in the job numbers for that industry, it doesn't seem that impactful.
I dismissed your comment before reading the article, but you are kind of right. The biggest thing holding back people on disability from finding work (according to the article) is fear of losing health insurance and that cushion. It sounds like allowing people to keep disability benefits, at least for a couple months, after finding employment would help significantly.
This sounds like you could get two paychecks for a while and potentially better for abusing, but remember the bottom line:
>Economists believe declining job prospects and an aging workforce, not fraud, explain the growth of disability claims.
>>Economists believe declining job prospects and an aging workforce, not fraud, explain the growth of disability claims.
That's an odd quote though. How would "declining job prospects" explain growth in disability without also implying fraud?
Edit: Both explanations below make sense, but 15 to 20+ percent of "all residents age 18 to 64" within a single county on disability benefits? I don't see how that could not imply fraud, perhaps with the exception of a mining heavy county.
You can be disabled and power trough a workday. Also in disability evaluation is local work. If you can't do the work found locally also helps.
The current opioid epidemic started from Appalachian miners that powered trough back pain to work IIRC. The jobs ended, the pain and addiction remained. Throw hopelessness in the mix and it is not hard to see how a medical condition could turn into social one.
Did you read the article? It specifically covers this question.
People who are in some sort of pain can still do work if they can find a job that doesn't aggrivate their pain. One example from the article was a woman who had a bad back, but could work a desk job like at a call center. Whent the prospects of that sort of job disappear from their geographical area, the person becomes eligible for disability.
I did. That's one anectodal example. They also say "Recipients are often hesitant to look for full-time employment because they don’t want to risk losing the financial cushion and access to health care that disability insurance provides".
The reason is that the process for getting SSDI is a nightmare. It takes months or years and often requires a judgement by a law judge.
In the meantime, you're screwed. You can't work, have no money and end up in debt. If you don't have kids, you're a low priority for subsidized housing and if you lack relatives who can help, you're in a bad place.
This makes sense. The crop of "disability lawyers" is somewhat depressing. I wonder how much of your benefits they take in exchange for their services. I assume it's a big number, as they all advertise doing it on contingency..."you don't pay unless we get you approved".
Edit: Looked it up. It does get paid out of your benefits, and it can be a substantial amount.
"The fee specified in the agreement does not exceed the lesser of 25 percent of the past-due benefits or...$6000"
The upper limit of $1130 on a person's income makes it difficult to tell for sure. It could be that 30% of people everywhere can legitimately qualify as "disabled" using their criteria, but most people won't apply because they already make too much money.
If the jobs start moving away or disappearing, then the alternative is to sign up for disability.
You keep your benefits for 9 months after starting substantial gainful activity (earning more than $1,170 / month). And yes that means for 9 months you do get to double dip.
There are also trial work periods which you can "fail" out of and not lose your benefits.
It's hard to walk away from a guaranteed monthly payment for life (when SSDI stops regular social security kicks in). But just looking at the monthly check misses the forest for the trees.
Keep in mind that the act of working a job is actually very expensive. Having those 50+ hours back and not having to be out of the house performing labor for some 3rd party is generally worth much more than the actual monthly payments.
To put it another way, if you can stay home and live anywhere you want (no commute) your cost of living can easily drop below $15k / year. Whereas working full time your cost of living may be double, triple, or more.
Once you get on SSDI, even a job paying $60k/yr or more might not be economically superior.
Oh, then throw in that you're paying almost no taxes, you qualify for all kinds of other subsidies and rebates... then there's the bit about free healthcare. Add it up and even a $70k-$80k job might be economically inferior.
First, it matters a lot how you define "an $80k / year job". If you are talking about the gross payroll, taxes and benefits (PT&B) cost to the employer, it's a lot different than $80k "net take-home". I mean the former. Call that $50k take-home.
Second, it matters if you are an adult disabled with a family being paid children benefits. Children and spousal benefits can boost total SSDI income up to 80%.
Third, it matters how sick you are. Employee health plans will often have large deductibles and even higher annual out-of-pocket maximums. Medicaid has neither. The poor man insurance could save you over $20k per year.
Fourth, it matters how handy you are and therefore how much you can make of that extra 50 hours per week you get by being on SSDI. If you can repair your house, repair your car, cook all your own meals, and never have to hire a contractor for anything, that can save a LOT of money. Maybe on SSDI you don't need a car at all. Maybe on SSDI you never have to call the car mechanic, the plumber, the handyman, or the housecleaner, etc. Most particularly, maybe on SSDI you don't have to pay for childcare. The direct, indirect, and opportunity costs of working could easily exceed $20k.
In review, let's say your $50k take home job results in $10k increase in healthcare costs, and also a $10k increase in other total household expenses; increased auto expense, food cost, restaurant bills, mechanics, handymen, and most of all, childcare. So you are working your ass off for $30k of income, where-as staying at home with SSDI would have paid you and your children $30k per year.
I agree. We've had low-grade BI for a certain % of the population for a long time as a cost of staving off social disorders and disasters. (Or as the author below puts it, so LA doesn't burn to the ground).
It masquerades under the pretense of "questions asked, must have disability", but the two programs really are no questions asked, as long as you fit a certain demographic (and the two serve very different demos - SSI is for inner city people who have never worked and may never, ever. Most people who have had a driveway at one point in their lives have never even heard of it and cannot get it. SSDI is for rural and rest-belt.)
SSDI and also SSI (Supplemental Security Income, no relation to Social Security, and does not come from social security taxes) are medicalizing UBI in order to put it into a form that Americans will accept.
The Last Psychiatrist wrote two articles about each of these in 2010 and 2013 saying that they were essentially a UBI that Americans would accept. He deleted the articles in 2015 when his anonymity was dispelled. I think they make poignant summaries and that its an important topics, so here they are.
The Terrible, Awful Truth About Supplemental Security Income (2010):
> The rise of psychiatry parallels the rise of poverty in industrialized societies. The reason you see psychiatry in the U.S. but not in the Sudan isn't because there's no money for it in the Sudan, but because there is not enough money in the US to make some people feel comparatively like they're not in the Sudan. Hence Zoloft. It is the government's last resort to a social problem it may or may not have created, whatever, but has absolutely no other way of dealing with. Predictably, world psychiatry will also be the temporary solution to world poverty until the aliens return to see what became of their 6000 year experiment. So invest in Pfizer, it will only go up. It has to.
> I know, the idea of people getting paid for nothing gives me the heebie jeebies as well, I'd want to shrug, too. But the point here is not whether poor people deserve living wages, the point, again, is that since this is precisely what they are getting, already and irrevocably, can we do it more efficiently, cheaply? Why do we have to go through all this bureaucracy that massively inflates the costs-- for example, Medicaid (the poor have to first become "patients" and get meds to get disabled, after all)? Why not more efficiently deliver the "assistance"? Cut out the middlemen-- send them directly to an ATM? I see how that might lead to an "entitlement culture", but isn't "disability culture" actually worse AND more expensive?
> But no one would stand for it. You, we, I, everyone, will gladly pay more in taxes or plunge deeper into galactic sized debt to not see the reality that some will get money just because, so that we can lie to ourselves that the "disability system" isn't supposed to be used this way, they are gaming it. The problem is not economics, the problem is psychology. You're paying extra for the deniability. Is it worth it?
No... it's a byproduct of welfare reform that can provide men with meaningful benefits.
It depends in your definition of disability.
With the ease of background checking and creeping expansion of all sorts of compliance bullshit, a felony conviction is essentially a disability. You cannot get a job other than lowend labor jobs which have been replaced by technology. Nailguns, paint sprayers and workers comp killed those gigs.
For women with low skill but family obligations, its a way to get income when temporary assistance runs out.
For state and local government, they are happy because it's all federal money.
would love to see a cross reference with obesity rates and other negative health behaviors. CP is an odd one because it can afflict you greatly or little, but it still is life altering. Comparing similar to non permanent issues is a bit unfair to those who had no choice in how their life was.
anecdotal, the obesity numbers interest me because two relatives in a Midwestern state both are on SSID from obesity related issues.
It's remarkable to me that people can collect SSID from diseases that are preventable without even needing medical treatment. That seems... wrong. As someone who's gone through substantial weight loss before, I know it's challenging, but at the very least the government should require people getting SSI for obesity-related issues to go to food addiction counseling or something.
Obesity itself isn't an allowable condition (it was, but then was later removed). I assume they are getting approved through potentially related problems like diabetes, back pain, etc. Probably too slippery a slope to automatically decline based on BMI. I suppose your idea of education makes sense though.
This is true but I think a lot of obesity issues in this country, especially among the poor, are in large part due to the strange way food is subsidized. It is just cheaper to eat badly and while exercise and what not obviously matters the quality of affordable food is just very very low with large amounts of sugar and sodium making obesity and diet based diseases a lot more common.
Eh. Most research shows that only 10% of people succeed in losing weight in the long term once they are morbidly obese. The only thing that seems to work is bariatric surgery.
"It's remarkable to me that people can collect SSID from diseases that are preventable without even needing medical treatment. That seems... wrong."
You might be interested to learn that in the United States, recipients of food benefits (food stamps) can use those benefits to buy things like soft drinks and candy bars.
Yeah one of the big aha things for me was how the states are hiring companies to help people get onto disabilities as they are a federal responsibility.
That and how many who knows the system acknowledges that many really have no hope besides getting onto disabilities.
Something stuck me when I first listened to this: there was a little anecdote about how one of the radio producer's co-workers had an injured back, but continued to work at his office job with relatively little impact on his performance. The same kind of injury would be career-ending for someone who's primary job skills are in a field that involved manual labor (e.g., welder, plumber, or one of the many oil-extraction jobs). The growth of disability claims is often characterized as a case of people gaming the system to extract handouts from the government. But maybe what is happening is we're seeing aging boomers and gen-xers who work as manual laborers, and who's bodies are finally breaking down to the point that they can no-longer function at their jobs. That seems like genuine disability to me, and so isn't it appropriate for them to use these government services?
Do you have personal experience with this? For example I know someone on disability who used to sell cars, that hunts every day. Is hunting easier on your body then selling cars? I don't think so, but it is likely more fun.
Just looking at the map, I conclude that a lot of people are going to be really surprised that the president they voted for, who stated among other things during the campaign his undying dedication to preserving Social Security, has appointed a Secretary of Health and Human Services who wants to cut its benefits 20%.
Average age seems to hover over 50. Young people who now have the worst job oppertunites for any generation and mountain of college debt are now enslaved into paying for obamacare and SS for older people. Seems fair. My girfriend who makes a less than 3k/month pays $700 for obamacare and ~$500 for student debt. People have called me "white supremacist" for criticizing Obamacare, apparently you don't have to a white person to be supremacist these days.
This is a total generalisation what follows but it's what I feel....
I don't even mind paying for social care as when you are old you are vulnerable and unable to work. I'm just sick of being told I have never had it better or I am lazy etc, a general lack of appreciation from the older generation who have not prepared well for this stage of their lives.
A little appreciation is needed as the next twenty years when the baby boomers go through old age are going to be tough on the system.
I was born at the tail end of the baby boom. Maybe it's a regional thing, or a bias due to hanging out with people from mostly one political side of the aisle. But I don't know anybody who thinks that young people have it easy compared to our generation.
I have plenty of friends who have experienced the "new normal" of their kids graduating from college and then coming back home because they can't find jobs right away. These people are also fully aware of the issues facing the working class right now.
And I've personally noticed that the young people coming into the workforce are bright, enthusiastic, and hard working -- quite the opposite of the "entitlement generation" meme.
> now enslaved into paying for obamacare and SS for older people. Seems fair. My girfriend who makes a less than 3k/month pays $700 for obamacare and ~$500 for student debt
A private insurance company is charging $700/month for her plan, not the federal (or state) government. The money goes to the company, not the government, but yes, young, relatively healthy people paying for insurance are basically subsidizing the health care for older, less healthy people with insurance from the same company. That's how all insurance works.
I would think $3k/month would be low enough income to qualify for federal subsidies. I have employer-provided healthcare so I don't know too many of the details.
The ACA has slowed how quickly health costs increase but they do still increase every year and are "spiky" (some costs for some people can go up by a lot). Sounds like you're in favor of the more lefty, socialist solution of single-payer health care, like all the other developed nations. Me too.
It's interesting to note changes in the type of disability claims. It looks like there has been a dramatic decrease in disability claims arising from circulatory and nervous system illnesses, likely due to improving health conditions in the workplace. But those gains seem to have been eaten up completely by a dramatic rise in musculoskeletal and mental illnesses. There doesn't seem to be any rational explanation for these as I'm sure the modern work place is much less physically strenuous and much less mentally taxing that what existed in the 60s. Could these be explained by the dramatic rise in psychologists and chiropractors that have started diagnosing people that would not have sought or would not have been eligible for disability benefits in times past?
There is no diagnosis of disability. One person diagnosed with high blood pressure could be on disability while her identical twin in precisely the same condition living in a different area could be denied it.
It is still the case that to qualify for SSDI in the US you need a diagnosis from a doctor of a condition that prevents working. I'm wondering if SSA would accept assessments made by chiropractors or psychologists, neither of which are medical doctors.
As far as I know--no. Medical Doctors can diagnogose a disability, but it's always challenged by a SSI/SSDI Doctor.
It's not a well oiled machine. I have known two people on dissability, and was shocked at what they went through.
One had a pretty bad case of cerebral palsy, and she was told by a dissability doctor she could lose weight, and "do something?" This girl was fired from all her menial jobs. She did try though. She eventually got dissability, after her mother died.
Another was a nice guy, but no one in their right mind would hire him. He was just too excentric. The psychiatrist who reevaluated him said, "You got me on a good day, but don't come back to this hospital for anything related to mental illness/dissability." The doctor inferred he would be black balled by the other doctors. (What gives being in a good mood matter?)
>Could these be explained by the dramatic rise in psychologists and chiropractors that have started diagnosing people that would not have sought or would not have been eligible for disability benefits in times past?
Yes, combined with the welfare-to-work program implemented under Clinton. In that program, welfare recipients who were unable to find jobs were pushed onto disability, since disability is paid out by the federal government. Thus, Clinton could say he 'ended welfare as we know it' and state politicians could boast that they reduced unemployment (which is paid for by the states), since unemployment statistics don't account for workers not in the workforce.
Here's an article from a few years back about this:
As mentioned in other comments, this is America's first foray into UBI. While not stated outright, the push for putting 'unemployable' individuals onto disability is a clear admission that automation and offshoring has created post-work economy for the least educated and the least mobile.
It seems pretty clear people are using disability benefits as an income safety net, perhaps while they wait to reach the regular social security eligibility age.
Also interesting the regions with the highest percentage of claims are in deep red territory, where the political climate and political agenda is strictly anti-safety net. I wonder how that will work itself out.
The only way the economy works itself out is jobs. If there are no jobs then the government has to do something about it. Government gets all of its money from business. So in the end you have an efficient market, where robots create everything and most of the profit that is generated from sales of items is confiscated by the government and given to people so they can buy things the robots produce.
In my view, the biggest problem with this program is it isn't based on whether you can work, it is based on whether you can work at any job available in your hometown.
If any job that the person could do is available anywhere in the country, then instead of perpetual disability payments, perhaps the government should help relocate people to places where there is viable employment. Otherwise, places where there simply aren't any jobs become perpetual resource drains on society and also aren't truly helping those people live fulfilled lives.
While you have a right to economic opportunity (and disability payments if you truly cannot perform any form of work), you don't have a right to opportunity or payments in a specific, random place in the country. The same people who want these handouts are the descendants of people who migrated from other continents in search of a better life. We should expect them to do the same and be willing to move to the more prosperous cities of our country.
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[ 2.5 ms ] story [ 85.8 ms ] threadWill be interesting to follow these numbers when self-driving semi-trucks start taking over.
Edit: I meant similar to UBI in the sense that the group that views themselves as unemployable has found a way to get the government to supply a "basic income". I'm aware it doesn't fit the idea in other ways. It is clearly, though, being used by people that are not suffering a real disability.
Whereas the key feature of SSDI is not really being "disabled" as TFA explains, but rather that you must not have any substantial gainful activity -- no more than $1,170 per month.
SSDI has become less of a form of insurance against a set of particular diseases, and more a kind of insurance for where someone decides it's no longer viable to work, as long as there's an associated physical scapegoat. Either because work is not available, or not reliable enough, or because your body is not reliable enough for the jobs that are available, it's a steady check that you can get, only if you don't work.
The issue is confounded by the fact that after about 3 years of qualifying for SSDI you also become eligible for Medicare, which can provide more value in reduced healthcare costs than any locally available job could ever hope to.
How did you conclude that viability to work is a "decision"?
You also imply that it's better to have medicare than any insurance through a job. Medicare actually really sucks compared to many alternatives. Lots of providers won't even let you in the door with it.
As in, "I am sick and hurting but I will get my ass to work anyway because I need to to survive." versus "I am sick and hurting and fuck this, lets see what the alternatives are."
Of course there are cases when it is cut and dry. I think the thesis of TFA is that the rapid expansion of SSDI program is because the way the program works now it's not cut and dry at all.
Now the operative part of better w.r.t Medicare is free. Medicare is the biggest insurance network in the world. "Lots of providers won't let you in the door" is equally true with private insurance too.
But if you are earning just your SSDI check, you also qualify for Medicaid in states with Medicaid Expansion. I'm not exactly sure how it works, but I think you do actually get both, and Medicare is the primary payer and Medicaid pays second. Which basically means you can walk into any hospital in your state, for any reason, and pay nothing.
Basically you're making all sorts of unsubstantiated claims about something you openly admit not knowing how it works. At least you admit it.
That's OK, I'm like that with some things too. For example I have never tried escargot but I am pretty sure it is disgusting.
The "I'm not sure exactly how it works" statement was specifically related to having both Medicare and Medicaid at once. But my claim that Medicare is primary and Medicaid is secondary was based on [1].
EDIT: In reply to 'icantdrive' which needs 'showdead' to see;
Getting SSDI is not guaranteed, you have to get through the approval process. But it's clearly not insurmountable if 20% of a county can be on it. Certainly everyone does not have a qualifying condition. But many people have qualifying conditions but who are not currently on SSDI. Many people have SSDI with a qualifying condition (not fraud) but who might otherwise be able to earn more than $1,170 / month. This is the population we are studying, and trying to understand why they ultimately decide to forgoe working and get on SSDI.
Medicare premiums for someone on SSDI will be almost nothing. But importantly the co-pays are still 20%. You qualify for Medicare 29 months from the time you were deemed disabled and you also stopped working (later of the two). You are absolutely correct that Medi-Cal is what most people are relying on. For the first 29 months it covers everything at no cost, and after Medicare kicks in it covers the Medicare co-pays.
Of course not everyone will take Medi-Cal. But major hospitals and their doctors on staff do take it, so you can walk into Stanford, Lucile-Packard, UCSF, etc. and get fantastic care at zero cost.
I care about the system mostly due to the warped secondary effects it creates. SSDI is an incredible program and an essential benefit for millions of Americans. It has the right heart, but like most things governmental, goes about it all wrong.
When a crucial benefit comes with a condition that you can't work more than $1,170 / month, that is broken. People who are disabled and legitimately qualify for SSDI should not have an economic gun to their head keeping them from working at all. They should be free to work as much as they are willing and able to.
The program claims to provide benefits to people unable to work. But increasingly (for about 50% of enrollees) what it really does is provide benefits to people willing to not work. Because of the broad range of ailments that are covered, the most important factor becomes the applicants willingness to just give up on working. Actually, more to the point, the spectrum of programs (SSDI, Medicare, Medicaid, TANF, etc.) actually drive people to give up working, because the economic value of giving up on work is astronomical.
[1] - https://www.medicareinteractive.org/get-answers/programs-for...
Like I said I totally hate escargot, never even tried it, but can you imagine eating snails? So disgusting.
1) SSDI is determined by a medical doctor. The patient has the decision to apply, but after that it's a judgement call by "professionals". I used quotes because the system is severely flawed. Getting a dissability lawyer involved early is prudent planning. It shouldn't be this way, but the system is severely flawed.
2) Just rambling?
3) agree
4) not totally free. Agree "lots of providers won't let you in the door."
5) I belive you get Medicare after two years on SSDI? The people I knew who were on dissability were all relied on state medical benefits. In California, they relied on Medi-Cal. Most doctors won't accept medi-cal. Sure, they got free hospital visits. Depending on where you live, a hospital might be your only recourse. Yes it's free, but it minimal quality of help. Many drugs are not on an approved Formuliary. They purposely make getting benefits very difficult. Going to a hospital should be the last resort? The system forces some people into going to the emergency room. Still not fixed, even after Obamacare?
I don't know. Let me ask you something? Why would you pay a hospital bill you have absolutely no control over? I see some noble people trying to pay off their padded hospital bills, and I don't get it. I would understand it if their wasn't collective bargaining, and some standard way of computing hospital costs. Right now they can charge you whatever. My father was given a gift basket by the hospital staff. Months later he looked at the bill. That gift basket was $300.00. He refused to pay even his 10% of the adjusted bill. (Had great Union insurance.)
If someone qualifies for free medical care; why do you care? Our medical system is not a free market entity. We like to think it is, but it's a closed system.
My congrats to any collective barging entity(like Medicare, and many private party insurance companies) that keeps prices down for its members. Actually, they just refuse to pay the bill on many cases because they can.
Obamacare gave us a few rights. They look like they will be history though?
Eventually we're going to get a lot of professional video gamers.[1]
My biggest hope is that we get something like FoldIt to take off, and the collective unemployed on UBI playing video games all day end up curing cancer in their spare time.[2]
[0] http://www.npr.org/sections/money/2015/02/05/382664837/map-t...
[1] http://webcache.googleusercontent.com/search?q=cache:dVz9Ks8...
[2] https://www.sciencedaily.com/releases/2011/09/110918144955.h...
But not really[0]
[0] http://www.marketwatch.com/story/no-truck-driver-isnt-the-mo...
Then, they do get specific, and show specific jobs, like cashier (3.3 million) at the top of the list...which only serves to confirm that "truck driver" is one of the largest.
Whenever self-driving trucks do get here, it will affect more than the ~3 million truck drivers. Other trucking occupations like dispatch, then related businesses, like truck stops and motels are obvious big hits. I assume there's lots of smaller ones as well...things like CB radios, custom mud flaps, trucker talk radio, porn on DVD and so on.
I'm not sure it was really a flaw. That was the entire point of the article. The complaint was about how the NPR (and the BLS by extension) lumped anything that had a tiny resemblance to a truck driver into one category, but broke up other industries into smaller groups, such as the 80 different categories teachers can be found in.
When they applied those broad strokes to other industries, truck driver didn't look so big anymore. Truck driver represents about 1-2% of the workforce. About the same size as the farmer population. Strangely, nobody is worried about self-driving tractors – which are further along than their road-travelling brethren – taking away farmer jobs, despite a similar impact in numbers.
> Whenever self-driving trucks do get here
If is the bigger question. As many of us around here are engineers, we know it's easy to get a 90% solution and it's easy to demo a 90% solution to get people excited about what you are working on. But the last 10% required to actually put these things on the market can take forever.
Lots of outstanding problems that we still have absolutely no idea how to solve. Past performance is not an indication of future results.
Personally, I think it's closer than self-driving cars. I suspect they can take over the interstate routes fairly quickly just by using some roadside land as "ports" to transfer control to human drivers. That would get the vast majority of the miles automated without tackling the harder, non-interstate, parts.
So, while the may be some decline in the job numbers for that industry, it doesn't seem that impactful.
This sounds like you could get two paychecks for a while and potentially better for abusing, but remember the bottom line:
>Economists believe declining job prospects and an aging workforce, not fraud, explain the growth of disability claims.
That's an odd quote though. How would "declining job prospects" explain growth in disability without also implying fraud?
Edit: Both explanations below make sense, but 15 to 20+ percent of "all residents age 18 to 64" within a single county on disability benefits? I don't see how that could not imply fraud, perhaps with the exception of a mining heavy county.
The current opioid epidemic started from Appalachian miners that powered trough back pain to work IIRC. The jobs ended, the pain and addiction remained. Throw hopelessness in the mix and it is not hard to see how a medical condition could turn into social one.
People who are in some sort of pain can still do work if they can find a job that doesn't aggrivate their pain. One example from the article was a woman who had a bad back, but could work a desk job like at a call center. Whent the prospects of that sort of job disappear from their geographical area, the person becomes eligible for disability.
I did. That's one anectodal example. They also say "Recipients are often hesitant to look for full-time employment because they don’t want to risk losing the financial cushion and access to health care that disability insurance provides".
In the meantime, you're screwed. You can't work, have no money and end up in debt. If you don't have kids, you're a low priority for subsidized housing and if you lack relatives who can help, you're in a bad place.
Edit: Looked it up. It does get paid out of your benefits, and it can be a substantial amount.
"The fee specified in the agreement does not exceed the lesser of 25 percent of the past-due benefits or...$6000"
https://www.ssa.gov/representation/fee_agreements.htm
If the jobs start moving away or disappearing, then the alternative is to sign up for disability.
There are also trial work periods which you can "fail" out of and not lose your benefits.
It's hard to walk away from a guaranteed monthly payment for life (when SSDI stops regular social security kicks in). But just looking at the monthly check misses the forest for the trees.
Keep in mind that the act of working a job is actually very expensive. Having those 50+ hours back and not having to be out of the house performing labor for some 3rd party is generally worth much more than the actual monthly payments.
To put it another way, if you can stay home and live anywhere you want (no commute) your cost of living can easily drop below $15k / year. Whereas working full time your cost of living may be double, triple, or more.
Once you get on SSDI, even a job paying $60k/yr or more might not be economically superior.
Oh, then throw in that you're paying almost no taxes, you qualify for all kinds of other subsidies and rebates... then there's the bit about free healthcare. Add it up and even a $70k-$80k job might be economically inferior.
Second, it matters if you are an adult disabled with a family being paid children benefits. Children and spousal benefits can boost total SSDI income up to 80%.
Third, it matters how sick you are. Employee health plans will often have large deductibles and even higher annual out-of-pocket maximums. Medicaid has neither. The poor man insurance could save you over $20k per year.
Fourth, it matters how handy you are and therefore how much you can make of that extra 50 hours per week you get by being on SSDI. If you can repair your house, repair your car, cook all your own meals, and never have to hire a contractor for anything, that can save a LOT of money. Maybe on SSDI you don't need a car at all. Maybe on SSDI you never have to call the car mechanic, the plumber, the handyman, or the housecleaner, etc. Most particularly, maybe on SSDI you don't have to pay for childcare. The direct, indirect, and opportunity costs of working could easily exceed $20k.
In review, let's say your $50k take home job results in $10k increase in healthcare costs, and also a $10k increase in other total household expenses; increased auto expense, food cost, restaurant bills, mechanics, handymen, and most of all, childcare. So you are working your ass off for $30k of income, where-as staying at home with SSDI would have paid you and your children $30k per year.
It masquerades under the pretense of "questions asked, must have disability", but the two programs really are no questions asked, as long as you fit a certain demographic (and the two serve very different demos - SSI is for inner city people who have never worked and may never, ever. Most people who have had a driveway at one point in their lives have never even heard of it and cannot get it. SSDI is for rural and rest-belt.)
SSDI and also SSI (Supplemental Security Income, no relation to Social Security, and does not come from social security taxes) are medicalizing UBI in order to put it into a form that Americans will accept.
The Last Psychiatrist wrote two articles about each of these in 2010 and 2013 saying that they were essentially a UBI that Americans would accept. He deleted the articles in 2015 when his anonymity was dispelled. I think they make poignant summaries and that its an important topics, so here they are.
The Terrible, Awful Truth About Supplemental Security Income (2010):
https://web.archive.org/web/20130527155520/http://thelastpsy...
> The rise of psychiatry parallels the rise of poverty in industrialized societies. The reason you see psychiatry in the U.S. but not in the Sudan isn't because there's no money for it in the Sudan, but because there is not enough money in the US to make some people feel comparatively like they're not in the Sudan. Hence Zoloft. It is the government's last resort to a social problem it may or may not have created, whatever, but has absolutely no other way of dealing with. Predictably, world psychiatry will also be the temporary solution to world poverty until the aliens return to see what became of their 6000 year experiment. So invest in Pfizer, it will only go up. It has to.
The terrible, awful truth about SSDI (2013):
https://web.archive.org/web/20130420171159/http://thelastpsy...
> I know, the idea of people getting paid for nothing gives me the heebie jeebies as well, I'd want to shrug, too. But the point here is not whether poor people deserve living wages, the point, again, is that since this is precisely what they are getting, already and irrevocably, can we do it more efficiently, cheaply? Why do we have to go through all this bureaucracy that massively inflates the costs-- for example, Medicaid (the poor have to first become "patients" and get meds to get disabled, after all)? Why not more efficiently deliver the "assistance"? Cut out the middlemen-- send them directly to an ATM? I see how that might lead to an "entitlement culture", but isn't "disability culture" actually worse AND more expensive?
> But no one would stand for it. You, we, I, everyone, will gladly pay more in taxes or plunge deeper into galactic sized debt to not see the reality that some will get money just because, so that we can lie to ourselves that the "disability system" isn't supposed to be used this way, they are gaming it. The problem is not economics, the problem is psychology. You're paying extra for the deniability. Is it worth it?
It depends in your definition of disability.
With the ease of background checking and creeping expansion of all sorts of compliance bullshit, a felony conviction is essentially a disability. You cannot get a job other than lowend labor jobs which have been replaced by technology. Nailguns, paint sprayers and workers comp killed those gigs.
For women with low skill but family obligations, its a way to get income when temporary assistance runs out.
For state and local government, they are happy because it's all federal money.
anecdotal, the obesity numbers interest me because two relatives in a Midwestern state both are on SSID from obesity related issues.
It's remarkable to me that people can collect SSID from diseases that are preventable without even needing medical treatment. That seems... wrong. As someone who's gone through substantial weight loss before, I know it's challenging, but at the very least the government should require people getting SSI for obesity-related issues to go to food addiction counseling or something.
You might be interested to learn that in the United States, recipients of food benefits (food stamps) can use those benefits to buy things like soft drinks and candy bars.
That and how many who knows the system acknowledges that many really have no hope besides getting onto disabilities.
I don't even mind paying for social care as when you are old you are vulnerable and unable to work. I'm just sick of being told I have never had it better or I am lazy etc, a general lack of appreciation from the older generation who have not prepared well for this stage of their lives.
A little appreciation is needed as the next twenty years when the baby boomers go through old age are going to be tough on the system.
I have plenty of friends who have experienced the "new normal" of their kids graduating from college and then coming back home because they can't find jobs right away. These people are also fully aware of the issues facing the working class right now.
And I've personally noticed that the young people coming into the workforce are bright, enthusiastic, and hard working -- quite the opposite of the "entitlement generation" meme.
The compassion definitely is out there.
(Bronze plans for late 30s here are $350 before subsidies)
A private insurance company is charging $700/month for her plan, not the federal (or state) government. The money goes to the company, not the government, but yes, young, relatively healthy people paying for insurance are basically subsidizing the health care for older, less healthy people with insurance from the same company. That's how all insurance works.
I would think $3k/month would be low enough income to qualify for federal subsidies. I have employer-provided healthcare so I don't know too many of the details.
The ACA has slowed how quickly health costs increase but they do still increase every year and are "spiky" (some costs for some people can go up by a lot). Sounds like you're in favor of the more lefty, socialist solution of single-payer health care, like all the other developed nations. Me too.
It is still the case that to qualify for SSDI in the US you need a diagnosis from a doctor of a condition that prevents working. I'm wondering if SSA would accept assessments made by chiropractors or psychologists, neither of which are medical doctors.
It's not a well oiled machine. I have known two people on dissability, and was shocked at what they went through.
One had a pretty bad case of cerebral palsy, and she was told by a dissability doctor she could lose weight, and "do something?" This girl was fired from all her menial jobs. She did try though. She eventually got dissability, after her mother died.
Another was a nice guy, but no one in their right mind would hire him. He was just too excentric. The psychiatrist who reevaluated him said, "You got me on a good day, but don't come back to this hospital for anything related to mental illness/dissability." The doctor inferred he would be black balled by the other doctors. (What gives being in a good mood matter?)
I've worked on farms, and in offices. The offices are much more mentally taxing, and for me much more likely to lead to mental issues, and depression.
Yes, combined with the welfare-to-work program implemented under Clinton. In that program, welfare recipients who were unable to find jobs were pushed onto disability, since disability is paid out by the federal government. Thus, Clinton could say he 'ended welfare as we know it' and state politicians could boast that they reduced unemployment (which is paid for by the states), since unemployment statistics don't account for workers not in the workforce.
Here's an article from a few years back about this:
http://apps.npr.org/unfit-for-work/
As mentioned in other comments, this is America's first foray into UBI. While not stated outright, the push for putting 'unemployable' individuals onto disability is a clear admission that automation and offshoring has created post-work economy for the least educated and the least mobile.
Also interesting the regions with the highest percentage of claims are in deep red territory, where the political climate and political agenda is strictly anti-safety net. I wonder how that will work itself out.
If any job that the person could do is available anywhere in the country, then instead of perpetual disability payments, perhaps the government should help relocate people to places where there is viable employment. Otherwise, places where there simply aren't any jobs become perpetual resource drains on society and also aren't truly helping those people live fulfilled lives.
While you have a right to economic opportunity (and disability payments if you truly cannot perform any form of work), you don't have a right to opportunity or payments in a specific, random place in the country. The same people who want these handouts are the descendants of people who migrated from other continents in search of a better life. We should expect them to do the same and be willing to move to the more prosperous cities of our country.