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“Disability” is increasing…why?

Are we suffering traumatic injuries from falling trees, collapsing scaffolds, dangerous industrial machines?

Is it because so many of us work at jobs requiring intense physical labor, and we are working long hours long past middle age?  Conversely, is it the very sedentary nature of many jobs that saps energy and wastes muscle?

Could it be we are just living longer than we ever have, and our bodies, programmed by evolution to live long enough to procreate, just aren’t built to stay strong, flexible, and resilient for decades?

Or are we way too fat, get far too little exercise, eat lousy food, and blame everyone but ourselves for the consequences?

Is it the continuing high unemployment rate and dearth of good-paying jobs?

And/Or – and here’s the scary thought – is it the definition of “disabled” that’s changed – both the public one and the way some view themselves?

This is becoming an increasingly critical question – as the number of Americans on Social Security for “disability” has increased rather dramatically – doubling from 1985 to 2005. In 1984 2.2% of the working-age population was receiving Social Security Disability Insurance (SSDI); 4.1% was in 2005.  This increase was, according to a paper published by the National Bureau of Economic Research, driven by a change in the definition of disability:

The most important factor is the liberalization of the DI screening process that occurred due to a 1984 law. This law directed the Social Security Administration to place more weight on ap-plicants’ reported pain and discomfort, relax its screening of mental illness, consider applicants with multiple non-severe ailments, and give more credence to medical evidence provided by the applicant’s doctor.

These changes had the effect of both increasing the number of new DI awards and shifting their composition towards claimants with low-mortality disorders. For example, the share of awards for a primary impairment of mental illness rose from 16 percent in 1983 to 25 percent in 2003, while the share for a primary impairment of musculoskeletal disorders (primarily back pain) rose from 13 per-cent in 1983 to 26 percent in 2003.

The number of working-age folks receiving SSDI reached 8.8 million at the end of last year.  That’s about 4.4 percent of the working age (18-64) population, an increase of 0.3 percent over the last seven years.

There’s been an increasing amount of attention paid to this issue; that’s both warranted and appropriate.

Yet I’m reminded of something Jennifer Christian MD told me years ago; “there’s no condition so disabling that there isn’t someone in the US with that condition working full time today.”

So, what is it?

My sense is it is all of the above. Some are really hurting or unable to work at jobs they can perform, others lazy, some dispirited, some enabled by physicians, many just getting older and wearing down, many unable to find good-paying jobs.

What does this mean for you?

Big, knotty problems aren’t fixed by simple answers or assignment of blame.  They are fixed by understanding drivers and the various moving parts needed to assemble solutions. 


8 thoughts on ““Disability” is increasing…why?”

  1. Joe I think it is definitely the relaxation of the SSDI “standards” for disabilityn qualification combined with the employemnt situation. Musculoskeletal injuries may rule out returning to the prior employment requiring physical activity and the injured worker has no transferable skills in todays job market.

  2. It’s the Economy, Before the definition was relaxed, I was told in a Group of about 75-100 Group insurance Underwriters, by A representative of Union Mutual, that 25% of Americans over age 55 would qualify for disability, if Push came to shove. Well guess what for the last 10 years they have been shoving. One also forgets, that if you were making $75,000 a year, and now are forced to work for half that, it impacts your eventual Social Security Benefit.

  3. It’s become way too easy to get accepted by SSDI, and once you are accepted there is no expectation that you do anything to rehabilitate. I’ve seen cases where the worker was convicted of workers compensation fraud for faking disability, yet they continued to draw their SSDI award.

    If you are over 50, work a manual labor job, and have ANY physical limitations you are almost guaranteed a SSDI award. Talk of delaying the retirement age to shore up social security is senseless when people can so easily get on SSDI at age 50.

  4. Physicians are not very educated or willing to manage time away from work. This creates a disability mindset! They allow people to stay out of work too long, often asking them when they “want” to go back to work. We all know the longer you are out, the less likely you are to go back to work!
    A favorite quote I heard at a conference a few years back is, ” You don’t get better and go back to work, going back to work is a part of getting better!”
    Networks need to measure providers on their ability to get members back to work as part of the overall outcome measurement!

    1. I find some of these comments hard to believe, It has historically taken 2 or more years to get approved for SSDI, and speaking as someone whose spouse went on disability several years back. It’s not quite as easy as you think. We specifically asked our Primary care Doctor assistance and his response was he wasn’t qualified. Several other Doctors made similar statements. It’s not exactly like getting a special parking place. Of course in West Virginia, there are no rules.

  5. There are many sides to this story. As a practicing PT I can tell you I see many people that indeed have the functional ability to work. The disconnect happens when you marry that level of function with a low education level, Too often those combined attributes make it more difficult – but dare I say not impossible – to find work, We need to get much better at matching workers to meaningful work. I am sure many here saw the NPR piece on disability in America – not without controversy but thought provoking none the less…..

  6. The answer to the central question is likely ot be “all of the above”. The critical component of the expansion of SSDI however is the growing cost, and the understandable “solution” now being proferred in certain “think tanks”, and Washington “budgeteers”, is to move the system to the state workers compensation programs. This solution is neither possible, nor right-headed, but the fact that it is getting any serious airtime (The Obama Budget for example), should give us an idea as to how little legislators and high ranking governmnet officials, and worse, their staff actually know about the workers compensation system, and that it is in fact a patchwork laboratory of fifty state systems, still trying to get it right after 100 years. This is at the heart of my concern over continuing the effect of continuing regulation writing (ACA) on the workers compensation system. Stay vigilent my frends.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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