They Come To Casablanca ... And Wait ... And Wait ...

by hilzoy

From the NYT, h/t Gary:

"Steadily lengthening delays in the resolution of Social Security disability claims have left hundreds of thousands of people in a kind of purgatory, now waiting as long as three years for a decision.

Two-thirds of those who appeal an initial rejection eventually win their cases.

But in the meantime, more and more people have lost their homes, declared bankruptcy or even died while awaiting an appeals hearing, say lawyers representing claimants and officials of the Social Security Administration, which administers disability benefits for those judged unable to work or who face terminal illness.

The agency’s new plan to hire at least 150 new appeals judges to whittle down the backlog, which has soared to 755,000 from 311,000 in 2000, will require $100 million more than President Bush requested this year and still more in the future. The plan has been delayed by the standoff between Congress and the White House over domestic appropriations.

There are 1,025 judges currently at work, and the wait for an appeals hearing averages more than 500 days, compared with 258 in 2000. Without new hirings, federal officials predict even longer waits and more of the personal tragedies that can result from years of painful uncertainty.

Progress against the backlog, if it happens, cannot undo the three years that Belinda Virgil of Fayetteville has worried about her future since her initial application was turned down. Tethered to an oxygen tank 24 hours a day because of emphysema and life-threatening sleep apnea, Ms. Virgil lost her apartment and has alternated between a sofa in her daughter’s crowded house and a friend’s place as she waits for answer to her appeal."

One of the things that tends to get lost in the wrangling over domestic appropriations is that there are plenty of cases, like this, in which it ought to be uncontroversial that we should raise spending. If appeals to decisions to deny benefits take over 500 days on average, that is simply too long. The obvious way to address this problem is to hire more appeals judges. This will cost money, but it will save people who will, in fact, eventually be found to deserve benefits from losing their homes, their credit ratings, their everything. Hiring more judges ought, therefore, to be a complete no-brainer, and the fact that it is caught in the political crossfire should be a source of shame to us.

While we wait for politicians capable of addressing these problems, we can take at least one simple step to help alleviate the consequences of this nightmare: give money to Gary Farber, who is caught in it. Gary has convenient buttons at the top of his blog that allow you to donate once, or (preferably) subscribe for the amount of your choice. Either will help him survive the appeals process. They will also help to postpone the day when he has to ask again, and if you think about what begging for money must be like, minimizing it is in itself a good reason to give. So if you haven't already done it, now would be a good time.

Thanks.

Comments

[Gary Farber]

Thanks. A few more long-term subscriptions would mean a lot.

Even ten people each doing a $5/month subscription adds up to $50/month, which is large in my fiscal universe.

And every subscriber gets their choice of a free virtual toaster-oven or a no-prize.

[cleek]

yes, it is shameful, as is so much of our government. alas, Congress is busy with more urgent matters right now.

[wonkie]

Are you kidding? It's way more important to spend billionns so Charles can have a victory in Iraq.

Actually I think that donations to a good cause (such as Gary) can be great Christmas gifts. One year, to my delight, I got a share in a water buffalo. The buffalo lives in Cambodia so I get the fun of "owning" one without the poop.

[Kris]

You know, the SSA did try to speed the process up a few years ago by scanning in disability documents and storing them electronically instead of working off of all paper copies. That was a half-billion dollar project funded by Congress. I don't know if it has slowed down the increasing backlog or not, but at least they're trying to streamline the process somewhat.

[trilobite]

Thomas Geoghegan's book, "See You In Court," makes a similar point: when you don't fund the regulatory state, including administrative law judges, investigators, and the Article III judiciary, you don't have rule of law. You have arbitrary enforcement, arbitrarily delayed.

The same problem turns up, notoriously, in the criminal justice system, where "speedy trial" laws either are ignored, or force the courts to let random prisoners go because they can't be brought to trial in timely fashion.

[me2i81]

If 2/3 of appeals ultimately prevail, that would seem to mean that the initial application process denies too many applicants.

[liberal japonicus]

Or it means that we are catching 1/3 of the lying welfare cheats. We gotta look at the total number of people to decide if the policy is working. If we deny enough people, we will have stopped welfare fraud!

/sarcasm

[Bruce Baugh]

Yes, it does indeed, me2i81. It's common wisdom among advocates for the disabled, disability lawyers, and others who deal with the system that the initial rejection is basically an endurance test. It's intended to scare off people who lack the determination and/or outside resources to continue. It would be fair to say that I think this is a hideously evil thing to do to people who are applying for the help that's available when other forms of help are out of reach. The system is cruel as well as wasteful.

[Bernard Yomtov]

Without new hirings, federal officials predict even longer waits and more of the personal tragedies that can result from years of painful uncertainty.

I'll say. Since it seems more cases get filed than get decided it looks like the wait is headed for infinity.

[John Thullen]

I read somewhere a few months ago (maybe an AARP article) that staffing is woefully low at the Social Security Administration.

It's deliberate.

It's the same strategy as my Republican former governor and legislature used with the DMV:

Find the point-of-sale closest to the consumer and cut staff and close offices to make things as inconvenient and maddening as possible. The majority of the American electorate will react as they are programmed ---- the gummint is stealing my money for this? Cut taxes some more, rince and repeat with the cuts at the point-of-sale.

The electorate gets it good and hard and I hope it hurts.

I've got a brother in very bad shape who recently received disability from Social Security. For very good reason.

That doesn't stop him from grumbling about taxes and the gummint.

The country is a sickening mix of whining put-upons and war mongers.

One more person whines and I'm unilaterally cutting my taxes to zero. The electorate and the hard cases in the NRA can whine into my gun barrel.

[Gary Farber]

"It's intended to scare off people who lack the determination and/or outside resources to continue."

That's the one-sentence description of "welfare reform," in most places, for the most part (there are some exceptions, and not to disagree that the previous system was broken and needed fixing -- but simply driving people away isn't a fix, save politically), as well.

Having just seen season 4 of The Wire, the language fresh in my mind for this is that it's simply all about juking the stats.

In the case of government aid to the poor, it's all about enabling the politicians to brag that they've brought down the numbers, so less money can be spent, and more "success" claimed.

(If the people aren't on the rolls taking welfare, or food stamps, or disability, or whatever the program, we know they're doing great, so it's all success! Hurrah! End of story. After all, you don't see people dying in the streets, do you?)

Success isn't helping people.

Success is being able to claim that the people no longer need help, because you no longer see them, because you've mostly put your hands over eyes, and not looked at what getting those numbers down actually means to the human beings involved.

(Setting aside the small number of actual fraudsters, of course, and also arguments about precisely which sorts of programs are most effective, or less effective.)

Of course, we're talking about government programs to help the poor. If we're talking about government welfare for farmers and corporations, then politicans love to brag about how much money they've been able to send to their states, because we're talking votes and campaign contributions!

Besides, everyone knows that the poor are mostly either members of a dysfunctional black culture, or are illegal Hispanic immigrants, or at best, they're just white alcoholic crack-head trash, so they certainly don't deserve anyone's help. (Middle-class people who snort their coke are so much less scary! And besides, they have private insurance, like God intended!)

Help is for wusses, anyway. It's un-American. Buncha socialists, if ya asks me.

[Nate]

I wouldn't be surprised if this were at least partially deliberate. I've met a lot of people who are convinced the government can't even manage to send out a check monthly competently, despite the fact it can and does.

However, some of it's also probably just based on stupid ideology. After all, if you don't believe the government should be helping people in need, what incentive do you have to make the program work properly?

[bc]

My first thought on the "throw more money at it" solution is: and you think the government is capable of running health care? Can you imagine the backlog of appeals from denied health care procedures?

Secondly, it seems that while adding more judges might help, it looks like an input problem. "Appeal" seems to be a misnomer because the appeal is the first in person hearing a person has from my understanding. All that precedes it is a paper application and a reconsideration of that paper application. The biggest problem is probably "garbage in" with the applicants filling out their own forms and not doing a very good job of it. Logically, a desire to deny applicants is only one of several possibilities, another being the typical application sucks.

It doesn't make a whole lot of sense to set up a system that requires a judge to get a good decision. 1/2 to 2/3 of the initial denials being overturned on appeal is way too high. It implies that the initial process is ridiculously inefficient and delays awards to those that deserve them.

I say fix the "front end" of the system (initial application), not the back end (appeal)! Adding more judges seems like putting in more pumps when the dike bursts rather than fixing the dike (o.k. bad analogy since it implies SS intentionally denies the deserving, which I am not necessarily saying). It may be as simple as providing better assistance to all applicants.

Further, it is interesting to note the increase in applications is far out pacing population growth. Why only 1.2 million in 1999 and over 2 million in 2004? Certainly not that many more people are disabled? I don't know the answer, but that seems to be a huge problem.

My own anecdotal evidence is that there are a lot of recipients in my area that are not disabled under the fed definition receiving benefits. That implies a lot of applicants that are not deserving getting in the way of deserving applicants. While the commissioner says outright fraud is "rare," I guess that depends on what the definition of fraud is.

[Jesurgislac]

bc: and you think the government is capable of running health care?

Why do so many right-wing Americans think their government is so much more incompetent than the government of any other developed country anywhere in the world? You know, it's not as if health care for all is a brand new experiment, as it was in 1948 when the NHS was set up in the UK. For sixty years now, every developed country except the US has been adopting cheaper and more efficient systems of health care, and as a result, every developed country in the world has a far better health care system than the US, that costs much less, than the US's inefficient and expensive market driven one.

And a routine excuse why the US has to have a market driven health care system is that the US government is just not capable of running it. It's a marked inferiority complex on the part of Americans who are normally bullishly patriotic about everything else American.

Weird.

Can you imagine the backlog of appeals from denied health care procedures?

Given an efficient health care system, what need would there be for a backlog of appeals? The US already spends twice as much on health care as any other country, and no other developed country has a significant problem with denied health procedures. Put that money into an efficient system - the other countries have already done the hard work of figuring out how to develop an efficient system - and the US health care system might even come to be among the best in the world, instead of the worst among developed countries.

My own anecdotal evidence is that there are a lot of recipients in my area that are not disabled under the fed definition receiving benefits.

And you know this how? How do you know what benefits they are receiving, and how do you know they are not disabled? Because unless you're about to tell us that you know because you have access to their federal records and know they are claiming a disability they don't have (in which case why are you letting this fraud go on?) I see no reason to take this kind of sweeping claim at all seriously.

[Anarch]

My first thought on the "throw more money at it" solution is: and you think the government is capable of running health care? Can you imagine the backlog of appeals from denied health care procedures?

Capable? Sure, especially when the class of people affected have more political clout than Big Poor.

[Bruce Baugh]

Jes, I'm in overall agreement, but I wanted to note that one particular part of bc's claim is likely true, though it doesn't support their argument. It is in fact very difficult to avoid violating the limits on approved poverty for SSI and the other low-end benefits if you ever make any money at all, or ever have any assets of significant value, just as it's hard to establish eligibility for them if you ever have any period of time when you can do regular work (even if it's like 1 day in each year). But this is a sign of bad standards, not of widespread fraud in the sense of behavior that is worth putting a stop to. Better standards that take realistic account of what being poor and disabled are actually about would require much less policing and still be dealing with real needs. That is, it's another argument against badly run and partial care, and in favor of sensibly funded and universal care.

[Anarch]

Jes: That's the beauty of simultaneously ruining government while claiming it's ineffective...

[Gary Farber]

"It is in fact very difficult to avoid violating the limits on approved poverty for SSI and the other low-end benefits if you ever make any money at all, or ever have any assets of significant value,"

Indeed. One can't have more than $2000 in assets, counting every dime and assert physical or intangible that can be evaluated, including your home and any vehicle. And any income, including gifts, family, friends, etc., simply gets that amount subtracted from your maximum of $637 (next year; right now it's $623) a month SSI.

There are more complications, but it's pretty strict. And, of course, they re-evaluate you every few months to make sure all your paper is in order, which for a lot of people also helps them get knocked off the rolls, if they have any kind of mental problems that interfere with them punching all the paper correctly, making all their appointments, getting around, and so on.

But why would that ever be any for an indigent disabled person?

[Gary Farber]

"And any income, including gifts, family, friends, etc., simply gets that amount subtracted from your maximum of $637 (next year; right now it's $623) a month SSI."

Oh, and a lovely touch is that if you live with anyone else in any circumstances whatever, -- family, roommate, group home, charity, whatever -- anything that's judged as therefore lessening or sharing your expenses in any way, including sharing food, also gets subtracted from your SSI.

[Jesurgislac]

Bruce: It is in fact very difficult to avoid violating the limits on approved poverty for SSI and the other low-end benefits if you ever make any money at all, or ever have any assets of significant value, just as it's hard to establish eligibility for them if you ever have any period of time when you can do regular work (even if it's like 1 day in each year).

I know that, Bruce: but bc's claim was that these people are not disabled.

I have a friend whose husband is disabled: none of his disabilities are visible to anyone who sees him in ordinary clothes, but he is medically disabled and cannot hold down any kind of full-time or part-time job. He's on full disability benefit, and has been for some time, and in the UK, this requires regular visits to doctors to prove that a person listed as permanently disabled is still permanently disabled.

But, if you meet him on the street, or see him driving a car, you might well think "This man is not disabled: why is he on full disability benefit?" And if you've been lied to about how much money full disability benefit amounts to, you might (if you heard about him earning some money by a few hours driving - which he can do, though not on a regular basis and on the understanding that he can't commit to being available for more than a few days in advance) - you might scream "benefit fraud!" rather than "Good, now they can eat better for a few days".

[Bruce Baugh]

Oh, absolutely, Jes. (I'm one of those not-always-visibly-impaired people myself.) No quarrels here, at all.

[bc]

Jes:

And you know this how? Fair question. One of the purported disabled is the opposing party in a case I'm involved in. I have legal access to his medical records. The man is avoiding his child support claiming disability due to a neck fracture. Yes, he broke his neck 30 years ago and it apparently didn't heal quite right. Yes, I'm sure it limits his professional football career. He's now in his 50's and finds time to play drums in bands, work on cars, sit for hours on the internet, attend Woodstock throwback events like Burning Man and work for 10 hours a day there but he can't do a stitch of work to support his two kids.

On the other hand, I have a client that from all outward appearances is fully capable of working but cannot due to mental health issues and just got her disability claim approved (on appeal no less!) I can appreciate the distinction.

But the number of people not working and drawing disability checks in my area is astounding. I know this from my work and from the simple fact that it is talked about here. I did not see the same rate in my practice in my former state. It was rare. Here it is not. And when I see those that I know are drawing doing activities that indicate they can work it is a bit troubling.

OTOH, I think the discussion regarding income standards is a good discussion as is the discussion regarding how to fix the system (which was my main point). It seems from the tenor of the discussion that most here would quibble with the decisions of the ALJ's, who even after a hearing deny what amounts to a third of original applicants. With the total number of applicants over 2 mil, that means they have to hear 300,000 plus non-qualifying cases per year? It is an impossible task for the number of judges and a solution needs to be found.

And I appreciate those that bypass the inefficiency of our bureaucracy and donate directly to those in need.

[Jesurgislac]

bc: And when I see those that I know are drawing doing activities that indicate they can work it is a bit troubling.

Again: unless you actually have access to their medical records, you don't know whether the activities they're doing are actually a real indicator of whether they can work. The husband of a friend I mentioned earlier has had people tell him (disapprovingly) that if he can't do heavy labor he can at least hold down a desk job: which is actually also physically and mentally impossible for him - for a couple of reasons which he prefers not to discuss with people he doesn't know very well. (Nor should he have to: the only people he has to be that open with about what his disability does and doesn't prevent him from doing are the officials and the medical examiner at the disability benefit office.)

As for the man with the neck injury: yeah, maybe he is using it as an excuse to avoid getting a job to avoid paying what he owes on child support. (And maybe not: I know people who have had trouble with spinal injuries that has recurred over 20 years.) The notion that you can argue out from one client that other claimants are committing fraud? Nope.

There are two added factors, in the UK, though: during the 1980s, when Margaret Thatcher was keeping unemployment levels and taxes high, it became relatively easy for someone to go on disability benefit, because on disability benefit, they didn't count as unemployed. Ten to fifteen years later, the Labour government was trying to get people back to work from disability: but someone who has been registered disabled for even five years will find it very difficult to get another job. None of this applied to people with severe levels of disability (and you cannot tell how severe someone's disability may be just by looking) but if the same kind of thinking applied at any point in your new region, some people may be in receipt of disability who could hold down a job - because at some point in the past, some agency decided it was better to put them on disability than to count them as long-term unemployed. There are ways round this, but they most of them involve heavy investment in training and work experience programs: merely cutting disability benefit will do nothing effective.

[bc]

Jes:

I don't necessarily disagree with you. I am not trying to claim one case of fraud (or the many that I think I see) means the system is rampant with fraud. I qualified my comments. Likewise, you cannot point to one truly deserving individual and say the system is free from fraud or close to it.

The only evidence I see is the increasing number of apps and the number that are in fact turned down even after a hearing. Some may simply not qualify but have a legit injury or disability, just not sever enough. Some, I suspect, want a free ride however small that might be.

Just out of curiosity, what do you think is the cause of the rapid increase in applications? I haven't looked into it to see whether aging has something to do with it or not. I haven't seen any allegations of the sort you describe in Thatcher's UK.

[Jesurgislac]

bc: I don't necessarily disagree with you. I am not trying to claim one case of fraud (or the many that I think I see) means the system is rampant with fraud. I qualified my comments.

Yes, and I appreciate that.

Likewise, you cannot point to one truly deserving individual and say the system is free from fraud or close to it.

My reason for pointing out my friend's husband - who isn't the only person I know on disability benefit - is that he is an excellent example of how someone can be physically disabled from working, and that disability will not be visible unless you have an intimate acquaintance with him. Merely saying "I see these people around all the time and they're not disabled" cuts no ice, therefore.

Just out of curiosity, what do you think is the cause of the rapid increase in applications?

Economy going to hell in a handbasket, I should think, plus increasing power of conservative attitudes to employees.

When there's high employment, a person with a light disability may find it possible to get work, or be able to work part-time. The worse the economy, the less likely this becomes. The more conservative ideas are in force, the less likely an employer is to take the "politically correct" attitude that it is worth hiring someone with a disability even if they will need some help to do the job. In a bad economy, with more conservative employers, the more people are likely to need to apply for disability benefit.

[Doctor Science]

I know several USans who are caught in the disability-application morass at the moment. In addition to the factors Jes mentioned (bad economy, conservative employers) I people who might not be disabled, or not so severely disabled, if they had been able to afford timely medical care.

[David Moisan]

ISTR a blog entry by an economist a few years ago that implied that SSI recipient statistics were used to "manage" the unemployment rate, which is usually under-measured. People on SSI weren't counted against unemployment or so he thought.

That's not to say, and I don't want to imply, that SSI recipients don't have disabilities.

I am a member of my town's disability commission, and I think about this constantly. A scenario I fear is a recession or depression that discourages businesses from providing the accommodations that people with disabilities need to be able to work. Such a recession would also put pressure on the SSI numbers--SSI recipients are reevaluated regularly both on economic grounds and medical grounds.

Recipients might someday get a letter from SSA that goes "we have determined that you are able to work". Now try finding it! They can't find work? If you're the state welfare agency, excuse me, "Department of Transitional Assistance" (I'm in MA), congratulations, you just had more people at your door! Our state rehab agency is chronically underfunded and there is a long waitlist. In the end, the best that a former SSI recipient can hope for is "any" job, whether they're suited for it or not.

I'm lucky to be working in IT myself; I have multiple disabilities and while I am a VERY proud man, when I have to do "regular" office work like reception duty (that I otherwise like), I am reminded very painfully of my limitations.

Not all employers would be understanding. Not when there are able-bodied people who can work for less.

[ardiril]

"what do you think is the cause of the rapid increase in applications?"

After 9/11, many people lost jobs, and of those, many (eventually) applied for disability. Some may have been slacking, but many were people who had been clinging to their old jobs despite their poor health situations.