Why I’m skeptical of the growing number of disability beneficiaries

My office consultation for the 50 year-old woman was her complaint of chest pain. I could not help but glance at her insurance and it was for Medicare. I have always been fascinated with what types of disability people have which qualifies them for Medicare and SSD, (Social Security Disability), before the usual age of 65. To say that I have observed bizarre and inequitable awards would be a gross understatement. In this case, my patient was on disability because of hepatitis C. Really?

Now despite being a cardiologist, I know a thing or two about hepatitis C infections. You see my deceased wife died from it, in 2004, along with an unhealthy dose of alcohol abuse. CDC data from late 2012, placed the number of people in the US with chronic Hepatitis C infections at 3.2 million. My patient had gone through interferon therapy, had chronic elevation of her liver enzymes, but was not jaundiced, and was gainfully employed as a massage therapist. Her liver had never failed.

If you guessed that this case was unusual, you would be wrong. I have seen hundreds of middle-aged patients who appear healthy enough to hold down a job, yet are receive Medicare and SSD for diagnoses like fibromyalgia, chronic low back pain, post –traumatic stress disorder, multiple sclerosis, and chronic fatigue syndrome, (to mention just a few.) And yet the truly disabled often have a difficult time qualifying for these benefits. I have many patients who at young ages cannot work, although they might want to, due to advanced and severe heart disease. They never get SSD before they died. I do what I can to help these folks with forms, attestations, etc.; but in my experience they don’t get it until they retain a SSD attorney to help them appeal denials and navigate the bureaucratic morass of applications and hearings.

SSD should not be confused with SSI (Social Security Income). The latter is dependent upon income, and the former is not. All one needs to qualify for SSD is a “legitimate” disability.  What is a disability? Disability is defined by the ADA (Americans With Disabilities Act) as ” … a physical or mental impairment that substantially limits a major life activity.”  Like any other federal law, the more precise definitions are crammed into thousands of pages.

To qualify for SSDI (Social Security Disability Income) the following requirements seem reasonable.

  • they have a physical or mental condition that prevents them from engaging in any “substantial gainful activity” and
  • the condition is expected to last at least 12 months or result in death, and
  • they are under the age of 65, and
  • generally, they have accumulated 20 social security credits in the last 10 years prior to the onset of disability (normally four credits per full or part of a year); one additional credit is required for every year by which the worker’s age exceeds 42.

However, in practice, people who are determined to seek SSDI, and their attorneys, finds ways to influence physicians’ reports and “game” the system.

When I see patients who have private, or commercial insurance, through their employment, I am often asked to “re-certify” them after a few years. I have never been asked to do that for a SSDI beneficiary. So it may be hard to initially qualify for SSDI, and then automatically Medicare 24 months later, but once you’re in, you’ve apparently got it until age 65.  And unlike private disability rewards, no one from the government will be snooping around the SSDI beneficiary’s home to see evidence of fraud, like washing their car, playing golf, fixing a roof, hauling hay, etc.

The fraud and the inequities of the system are staggering. How much? At the end of 2011, there were 10.6 million Americans collecting SSDI, up from 7.2 million in 2002. In a 2006 analysis by economists David Autor and Mark Duggan wrote that the most significant factor in the growth of SSDI usage had been the loosening of the SSDI screening process that took place following the signing into law of the Social Security Disability Reform Act of 1984. This act directed the Social Security Administration to place more weight on applicants’ reported pain and discomfort, relax screening of mental illness, consider multiple non-severe ailments to be disabling, and give more credence to medical evidence provided by the applicant’s doctor. These changes had the effect of increasing the number of new SSDI awards and shifting their composition towards claimants with low-mortality disorders such as mental illness and back pain. Autor and Duggan argue that because the definition of disability adopted in 1984 is quite broad, the SSDI program often functions in practice as an insurance program for unemployable people. (And I would add to that the sometimes “I don’t want to work” people.)

I will continue to fight for the needy cardiac patients who can’t work. However, I continue to remain skeptical of a large, and still growing number of SSDI beneficiaries, who could work, but choose not to due to physical and mental issues that many of us endure while holding down full-time jobs.

David Mokotoff is a cardiologist who blogs at Cardio Author Doc.  He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.

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  • ninguem

    The fraud is tremendous, the variation in judge rulings is all over the map. Disability if going to bankrupt the system before Medicare does.

    • Payne Hertz

      There is nothing there to bankrupt. All benefits are paid out of current receipts from the FICA tax on a “pay as you go” basis. The surplus is deposited in the Social Security Trust Fund. The Fund has over $2.3 trillion and can easily cover any shortfalls in revenues versus payments. Even if the Trust Fund were drained to the last dime, shortfalls in revenues versus payments could easily be covered by raising the FICA tax or reducing benefits.

      You have presented no evidence of fraud. Variation in judge rulings is not evidence of fraud in SSDI any more than variations in judge rulings is evidence of fraud in criminal or civil cases.

      • Mandy

        “All benefits are paid out of current receipts from the FICA tax on a “pay as you go” basis.”

        This simply is not true.

        “The projected assets of the DI Trust Fund decline steadily, fall below 100 percent of annual cost by the beginning of 2013, and continue to decline until the trust fund is exhausted in 2016.” [source: Social Security Trustees Report released April 2012]

  • Noni

    1 in 10 Americans are currently receiving some form of disability benefits. The country can’t afford to support all the people who choose disability benefits as a way of life.

    • C.L.J. Murphy

      One of the (admittedly, few) lessons I remember from my long-ago undergraduate Econ classes is that when you subsidise something, you get more of it. There’s a line between a caring, compassionate country providing a safety net for the truly helpless; and rewarding and therefore incentivising acquired helplessness. It looks like America (as well as many other Western countries) has crossed that line. It’s hard to see how a trend like this can be turned around without it all ending in tears.

      • SarahJ91

        And one of the lessons I learned from my job in a voc rehab agency the also did SS disability determinations is that SSDIB applications always spike in a recession and recede when the economy gets better. It really IS the economy, stupid.

        • Confused

          So you admit that these people aren’t actually disabled? That they’re just unemployed, and would prefer to game the Disability system so that they’ll get a free ride for the rest of their lives, rather than be expected to keep looking for a job?

          If one is disabled, one is disabled. If one is capable of working, one is capable of working. How does a bad economy “cause” more people to become totally and permanently disabled?

          Since when is “Like tens of thousands of others, I’ve lost my job during the recession, but I’m tired of filing out job applications so I’m just going to let everyone else pay my way for the rest of my life” qualify as a “disability”?

          • SarahJ92

            No, not at all. I read their files. They were able to struggle along and were often carried along by sympathetic employers during the fat times.

            Stress also does make everything worse, including disabilities. People with disabilities have less of a margin to work with before their resources are exhausted.
            You have a very black and white world view in which people’s physical conditions remain statics and job requirements remain the same in all economic conditions. This is not realistic.

          • Suzi Q 38

            I think that Gust should try progressive and non-remitting MS fo awhile. He can wake up and try to struggle out of bed, only to fall to the floor because he had no feeling in both feet. His legs are no longer weight bearing.

            He skips work for a week or two, but comes back in a wheelchair. He can’t do his job as well, because it is physical and requires carrying samples to customers, driving, and getting in and out of cars.
            After a couple of months, the employer hands him a pink slip.
            Now he has lost his medical insurance and can’t pay his doctor.
            You bet he should file for disability.

            Oh, and 6 months later, the right hand no longer, works, then the left. Now his wife or another family member gets to change his diapers and feed him.

          • Guest

            I doubt that all 14 million Americans on SSDI are as dramatically and obviously disabled as your straw man is, Suzi Q.

          • Suzi Q 38

            “Straw man” as you call him is very real.
            But there are a lot of losers that take advantage of the system.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Not all 14 million Americans are getting SSDI. Others are getting SSI, and some of those are getting a combination of both.

        • http://www.facebook.com/mdoino1 Mari Doino

          I am on Disability, thanks to Doctors ignoring my symptoms and attributing them to my Gender! even though I receive SS 700.00$ a Month, barely enough to survive. I tried to return to work using the Local NM Voc Rehab. It was a joke!

          My Caseworkers were beyond incompetent, they decided that my spinal chord injuries were a mental health issue. I had a job, they were to provide accommodations. The only Accommodation I requested was an ergonomic work area, this included a longer chord for my monitor and a better chair! My caseworker went to my Boss and told him to disregard it because I had “Emotional Problems”. I had no cartilage my neck so tweaking it at the computer 8 hours a day did not help. I was often in tears from the pain. I also have a broken tailbone that went undiagnosed this caused an incredible amount of pain and

    • Payne Hertz

      Becoming disabled is not a “choice” or a “way of life.” Please explain how that works. At $130 billion a year, SSDI benefits are a small fraction of the overall federal budget, and easily covered by FICA taxes. The benefits are modest, and well below the federal poverty line for an individual, let alone a family.

      No one in his right mind would “choose” to be disabled. Even as a doctor, you are but one “slip and fall” away from finding out the hard way just how tragically wrong you are. In the meantime, disabled people are the ones who have to pay for the medical profession’s preference for medical folklore over reason and facts.

      • Mandy

        “SSDI benefits are a small fraction of the overall federal budget, and easily covered by FICA taxes.”

        No, they are not. More is flowing out from the Disability coffers than is flowing in, and in three years — by 2016 — the SSDI “trust fund” will be bankrupt.

        As others have said, this is the very definition of “unsustainable”.

      • DKDMD

        In my practice (family practice) it is a way of life for many people. They manipulate the system, taking away from those who truly need the safety net.

        • Payne Hertz

          I’m sure that’s what you want to believe, but the fact you want to believe it says more about you than it does about them.

          If your criteria for determining this belief is as scientifically sound as the one the author uses (they look healthy, therefore can’t be disabled) I fear that maybe it’s the way of life you’ve chosen that’s in error.

        • Naithom

          So if you are their doctor and you have knowledge that they are abusing the system, what are you doing about it? The SS boards get their information from the people’s doctors, like you. So, did you tell the SS that they were healthy and stop them from getting benefits they didn’t deserve or did you send in the paperwork and take the money? By law you have to report it if you suspect fraud. Or are you just taking the taxpayer’s money while acting all conservative on talk boards?

      • Confused

        “No one in his right mind would “choose” to be disabled.”

        If you offer people free money and free healthcare for life, without ever having to bother to work another day in their life, of course there are going to be those who jump at the chance. DUH, people like Free Stuff.

        Not everyone who works for a living is 100% fit and healthy. Most of us have something wrong with us, one way or another. Most of us just put up with it… although it looks like an increasing number decide not to.

        • SarahJ92

          May you never become disabled. But if you do, prepared to be shocked when reality hits you.

      • John Henry

        No one said one “chooses” to be disabled. That isn’t the point. The problem, and the point of the OPs post, is the people who choose to claim to be disabled when they really could work but would rather not and instead collect a government check as so-called “disabled.” Those who feel nothing should be done to root out these fraudsters and malingerers do the program as a whole a disservice. They should be first to insist the program be preserved for those for whom it was intended instead of being abused by those who are tired of working or tired of having to look for work.

    • Mike M.

      “1 in 10 Americans are currently receiving some form of disability benefits. The country can’t afford to support all the people who choose disability benefits as a way of life.”

      All you’ve done is state the obvious, yet look at the reactions. I despair.

  • Vicki Ivancevic

    Hmm….and here I am, in ESRD and on dialysis, working forty hours or more a week to keep a roof over my head and my husband and I insured. I’d like to know how these people can live on SSDI because if I quit and went on SSDI, we’d lose our house. I guess I’ll just go on working until I drop while others get to coast along in life.

    • Barry Nuechterlein

      Hang in there! You are a good person, doing your best to contribute, and making an effort. I hope for the best for you.

      The way that people are able to do this is that they just give up on any kind of decent life. It’s sad. Tragic. ESRD is tragic, but seeing a human being reduced to apathy and surrender is even worse. Not to minimize what you are going through, but your will to live and work in the face of it is laudable.

      I once was told something by a Polish friend who had travelled to Cuba.

      In rural Cuba, there are places where, three times a day, a little cart comes through the village, and dispenses meals to everyone. They ring a bell, and people come running from all over to get their pathetic ration of state-supplied glop.

      People just sit around, without hope, and are maintained in a state of abject dependency. They don’t even have the ability to cook their own food. Everything is provided by the state. Housing, food, etc. It’s a pretty awful standard of living. These people are intellectually and spiritually reduced to the level of a zoo animal. They just give up. They die inside.

      There are parts of the U.S. where people aren’t that far behind. The difference is that it’s better hidden. Instead of a trolley dispensing gruel, they get a check. Instead of being restrained by remoteness and repression, they are restrained by prescription drugs, liberally dispensed by pill-mill docs.

      If you are willing to give up on any kind of planning or forethought, any kind of hope for a better life, any kind of dignity, you can “exist” off the state. As long as you don’t make waves, and don’t ask for more than barely surviving at a third-worldish level. These unfortunate people don’t care about losing their house–they just kind of drift from rented hovel to rented hovel, and any idea of ownership or responsibility has been drained from their mind.

      Good on you for trying to do better. You have my respect, and my admiration!

      • Vicki Ivancevic

        Hello Barry! Thank you so much for your reply. It’s been a
        long slog these last two years. ESRD is not easy and I feel awful for those who are elderly or who are otherwise unable
        to be their own advocates, because you better believe there is no one who will advocate for you. Just navigating through Medicare (not something I ever thought I would have to do in my 40’s!) and employer group health insurance is painful enough, not to mention the actual living with this disease day to day.

        I guess my biggest gripe is that there is a pendulum swing
        between “be completely dependent on the government” and “get absolutely no help whatsoever”. I’m not asking to live the “welfare” life because I know I would be abjectly miserable if I couldn’t work and contribute to society. However, what
        chafes my hide is the fact that since I *am* working and not on any sort of aid, there is absolutely *no* assistance for which I qualify. It would be great if there was a place or agency to which I could turn that could provide short-term assistance for a reasonable cost. I am not looking for handouts, just a little boost every once in a while when I need it. It would be so much better than having to rely on the whims of friends and family.

    • Suzi Q 38

      Not very many people will hire you if you are in a wheelchair with an MS diagnosis and can’t make it to work because you have gotten worse and arms aren’t working, either. MS is very tough to diagnose and to treat.

  • NormRx

    I had one doctor in my territory that was know as the disability doctor, he was so well known that I had doctors that were located over 150 miles away ask me about him. Most of this doctors patients came from referrals from attorneys that handled disability cases.
    I also have a friend that is an account and was on temporary assignment at a SS office, he told me that most of the time when a person applied for disability it was denied, the person then hired an attorney and then their disability was approved, after all it wasn’t their money.

    • ninguem

      The WSJ ran a series on this two years ago.
      NPR picked up on it this past week.

      And yes…..it’s turning into a cottage industry of the right doctor and the right judge. The pattern of decisions varies all over the map. There are some disability determination judges who rule for disability nearly 100% of the time.


      The cost is skyrocketing, and is set to bankrupt the system, Even ten years ago, everyone thought Medicare would bankrupt the country, but disability may yet overtake Medicare.

      • Noni

        Thanks for sharing these articles. I had no idea there was an exposé 2 years ago! Yet the number of claimants and those receiving SSD has increased nationally since then.

        The other very important thing for all taxpayers to consider is that whenever someone applies for SSD, all of the reviews and doctor’s visits are paid for by the social security department (ie, the gov’t, ie you and I). Every appeal is funded by you and I. Attorneys who get involved get their payment when benefits are approved. This is also subsidized by you and I.

        • SarahJ91

          SSDIB claims have ALWAYS gone up in recessions. It’s part of the economic picture. In my agency we could always predict the beginning and end of a recession because certain of our clients were laid off first and hired back last.

          In case none of you have noticed we’re in the midst of a terrible recession so yes, you will see a spike–as you always do–in applications. If you want this to go down, fix the economy. Most people prefer to work, but even more they prefer to eat so they do what they have to in order to survive.

          • ninguem

            “…..SSDIB claims have ALWAYS gone up in recessions…..”

            and being able to predict recessions and recoveries, etc.

            I for one agree completely. Just recognize it for what it is, a welfare program for large numbers of recipients. Clinton “reformed” welfare programs, most just went straight over to disability.

            Not all of them of course, by any means. I do a half dozen or so disability consultations a week, the whole range comes in.

            When you’ve got counties with one in four on “disability”, strongly correlated with the economic conditions, it’s hard to call it anything but a welfare program.

            Not to discount the ones with clear impairment. I see the whole range every week.

          • Mere Mommy

            You realize that you’ve just killed your own argument? You’re saying that if the economy were better, these people wouldn’t have a problem working. It’s just that when the economy is bad, they’d rather be on disability than on unemployment.

            If we are to believe that someone is truly so medically disabled that they cannot support themselves, that condition should be independent of the vacillations of the Dow-Jones.

          • Naithom

            Actually, no she hasn’t. It’s not unusual for employers to fail to hire individuals with disabilities either because they question whether their insurance premiums will go up. These people are stymied because of health issues and outdated attitudes about people with disabilities. The unemployment levels for people with disabilities are almost 6% higher than for those without disabilities.

          • Barry Nuechterlein

            Disability programs should not be abused as a surrogate for unemployment benefits. Disability is disability. Being unemployed in a crappy economy is not disability, no matter how long someone has been unemployed.

            Putting the disabled into the same bin as the long-term jobless dilutes and perverts the mission of a system that should be designed to help the disabled.

            Maybe another program is needed to help the unemployed, but every person who is doing what you described is robbing the disabled by sucking services and resources away from them. We have to stop trying to pound a square peg into a round hole, policy-wise.

            I have come to the conclusion that the (perhaps unwitting) function of the SS disability bureaucracy is not to help the disabled, but rather to foster and politically anesthetize the largest possible population of dependents. If that is true, who cares whether people are looking for benefits because they are disabled or just because of the bad economy? A serf is a serf is a serf, and provides a job for his/her overseer.

            We need a new disability system that is focused exclusively on…DISABILITY. Not aid for the unemployed.

          • Naithom

            “Folded into the SS disability and given a script for oxy” – Wow. So your assumption is that those who are disabled are all drug addicts? I bet you’re one of the folks who think that those who were abled bodied and couldn’t find a job in two weeks after having been laid off were lazy too, right?

            The unemployment levels for people with disabilities stays about 6-7% higher than that of people without disabilities. Partially because many employers can’t look past the disability to the abilities or they worry that in hiring someone with a health issue that their premiums will go up. Thus during a bad recession it’s not unusual for older employees and employees with health issues to find themselves first in line during lay-offs. And when they can’t get back in the labor force for the same reason and they need medical assistance, food and housing, they are forced to admit that their health issues are keeping them from being able to stay in the workforce.

            That doesn’t make those individuals drug addicts or lazy or someone to look down on. It means that we need an insurance system that is separate from employment and we need to educate employers to look at what people can do instead of what they can’t.

            We also need to educate the public so that they don’t automatically judge groups of people and make false assumptions about their situations. Prejudice comes from ignorance.

          • annmarcaida

            As of about 10 years ago, anyone with addiction problems is EXCLUDED from receiving SSDI (long-term disability), although they may quality for SSI (supplemental security income).

          • Barry Nuechterlein

            Good job trying to divert the discussion away from the point that too many unemployed people are using disability benefits as a replacement for unemployment benefits.

            “So your assumption is that those who are disabled are all drug addicts?”

            Nope. Said no such thing. What I referred to were the large number of bogus disability claimants who are actually jobless and fall into the pill mill/”disability” culture that is, in fact, quite rampant. Visit the Ohio River Valley, or northern Florida, and look around if you doubt this.

            “I bet you’re one of the folks who think that those who were abled bodied and couldn’t find a job in two weeks after having been laid off were lazy too, right?”

            Now who’s the one making assumptions?

            I think there’s a problem with long-term unemployment in the United States, and the disability system is being abused to anesthetize the chronically unemployed. Because people get mis-directed into this system, they are not agitating for the economic reform and social reform that needs to occur, and the truly disabled are being deprived of benefits by the bogus claimants.

            Stop trying to divert. Inability to construct an appropriate argument comes from ignorance, too.

          • Naithom

            “the large number of bogus disability claimants who are actually jobless and fall into the pill mill/”disability” culture”

            So, you have documentation on applications that are fraudulent? Or are you claiming that disability judges are corrupt and assisting in people commit fraud and have proof of that claim? What evidence other than your opinion do you have of this statement? What direct experience do you have in what goes in for a success claim? I suspect very little.

            I have worked with the disabled for over a decade and each SSDI claim is different. Some have one obvious disability, some have several lesser disabilities which stacked together are the deciding issue. Some people have disabilities which aren’t going to be obvious to some random individual observing them but are serious enough to negatively effect their ability to acquire and keep gainful employment. And then there are the medical disabilities that some individuals want to continue to treat as “punishments from G-d” like this was the 18th century. (And AnnMarcaida is correct to a point, chemical dependency cannot be the sole basis for receiving SSDI though it can be included as a medical issue when there are other medical issues or if the chemical dependency has caused other serious medical issues.)

            The point is that individuals who are granted SSDI are not stealing your money or gaming the system. These are not chronically unemployed individuals (the term which proved to me that you weren’t truly familiar with the process) as the very first thing these people have to prove is that they have had enough employment over a period of time. SSDI beneficiaries have worked hard and had money put into the system – their own money, by the way, in case something medically happened to them.

            By attacking people on SSDI you are attacking the medically disabled for utilizing THEIR OWN MONEY which was put away using the Social Security system.

            And of all the individuals who apply for SSI, only 35% of them receive approval when they apply. Of those that continue to reconsideration the numbers are even lower. Depending upon the state, between 7 – 25% of those are approved. By the way, Kentucky’s reconsideration rate when last checked was 7% as of 2010 and Ohio’s was around 10%. These individuals have to provide medical documentation that “He or she must be unable to engage in substantial gainful activity (SGA) due to a medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months.” (www.ssa.gov)

            So you have an individual who has been out of work for at least a year – they apply for disability and have a 65% of being turned down, which takes about 6 months between getting the medical appointments, filling out the paperwork, waiting for the determination. Then, if you are in the percentage that decide for reconsideration, you have a 7 – 20% of being approved. And that takes about another 6 to 9 months. About 2 – 2 1/2 years without income, all for the luxury of the benefit of living off of $800 – $1200/ month.

          • Barry Nuechterlein

            So, you work in the system. That explains much. I can say this no better than a great writer did:

            “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” –Upton Sinclair

            We need a new disability system. This one stinks. I stand by my position.

          • Naithom

            Yes, I willing work for little pay to help disabled people lead independent lives while you are a gas passer who wants to get paid the big bucks while having the least amount to do with the conscious individual.

            I actually deal with the people you are denigrating first hand and know the circumstances they have actually dealt with while you complain because of your second-hand rumors and Fox News.

            I stand by my position.

          • Barry Nuechterlein

            Very good. Play the martyr, and fan class resentment. You have still lost the argument. You stand on sinking sand.

          • http://www.facebook.com/sujana.pulivarti Sujana Pulivarti

            you have obviously not faced long term unemployment. i pound the payment everday; no luck. having a job means you are worth something and if you don’t; you are worthless. i always have had severe depression (since age of 13). i have two advanced degrees from great schools and i’m a fighter. i need to be on medicaid or else i have to fail for bankruptcy. you have no idea how self-stigmatizing it is to have a mental illness. i would rather die than go on permenant disability; it’s a death sentence. most people who have disabilities want to work; people like us have had to learn and accept that normal people take advantage of. I will never get married, I will never have children, or real friends. i have watched two of my law school friends spiral into deep depression. One of them tossed herself off the bridge, the other took an anti-emetic and swallowed rat poison. people are really insensitive.

          • Barry Nuechterlein

            First of all, I’m sorry to hear about your misfortunes. Being unemployed is awful, and suffering from depression is awful. I take no joy in anyone’s suffering. I certainly don’t want anyone to kill themselves, as your friends did. The law schools have sold a generation of young people a bill of goods, and that’s sad. A law degree is unfortunately basically useless in the present job market, and many went heavily into debt to go to law school. Most of the undergraduate degrees that funnel people into law schools are equally unhelpful in the job market. Seven years lost. Terrible.

            Deep breath.

            The problem is, and I’m sorry to say it, those are not relevant points to this topic. Neither is my own past employment history, or that of my relatives, which I might add you know nothing about. The world is full of pain, but the issue is not human suffering but the skewed and distorted nature of a system that fails many disabled people and harbours a large number of people who are not disabled, but rather unemployed. My goal is not to be sensitive. It is to get a point across. That point is that the system is screwed up, and a lot of people are mis-using it.

            I can be labeled “mean” or “insensitive,” but that really doesn’t change anything. I am unperturbed by those labels. I believe I have another label, which is “correct.”

            The problem with the system is that it is not properly designed, and is not organized in a way that truly helps people, long term. What you said about permanent disability is true–it is a social and economic death sentence. That’s one of the reasons I despise the system.

            I don’t favour letting the disabled starve. What I am disgusted by is the way the system works to discourage any attempt to get people off disability, and winds up as a “welfare of last resort.”

            Maybe there needs to be a better way of helping get the unemployed back on their feet. Re-directing them into the disability bureaucracy is not it. Disability should be for the disabled.

            As I have travelled through life, my contempt for the “helping bureaucracy” has grown. Many people working in the system are doing real, long-term harm to their clients and broader society. They are sapping the economic foundations of the civilization that needs to thrive to take care of the truly disabled.

            I hope you recover from the troubles you have suffered from. Try not to take this stuff personally; I don’t direct it at individuals, or mean to belittle anyone’s pain. I wish you well.

    • SarahJ91

      Um, you do realize that the folks in SS Disability Determination Units are well aware of these guys, right? I worked in the agency that had the DDU for my state. We all knew who these docs were. Their evaluations actually prejudiced their patient’s cases and worked against them.

      The reason attorneys have such a high hit rate is multi-fold. The regs are so complicated your average person simply cannot understand them. Frequently applicants leave out important information that would actually work in their favour. Many, many applicants feel so godawful about applying they minimize their problems. I’ve seen it in my former career in that agency. The lawyers also only work on cases they are likely to succeed with as they work on contingency.

      • http://www.facebook.com/dc.engster Diane Engster

        This is the first response that seems based in reality. I am both an attorney and a person with multiple disabilities. In my lifetime, all of the people I have represented have been severely disabled and exactly fit your description. In fact, I know several people who would qualify who haven’t applied because of shame and embarrassment. One person I knew commited suicide over the frustration of waiting for decisions in multiple appeals.

        In order to make accurate judgements about a person’s disability, you need to know the person well. Most people try to hide their disabilities and therefore make every attempt to appear non-disabled in public. You may be seeing them appear able for a few hours or on specific days but you don’t realize that it might be because of taking medication or that they trade a few hours of normalcy, for many more hours of pain, dysfunction, further injury, exhaustion, and/or inability to function which they experience in private.

        As people age, their ability to make these trade-offs may diminish. And many times people with disabilities may be able to work because of flexibility in their work situations and reasonable accommodations provided by employers. When there are fewer employment opportunities, it is harder and harder to find the more flexible jobs which readily offer accommodations.

        And serious economic pressures also usually results in more psychiatric distress which can become debilitating and also exacerbate co-morbid physical disabilities.

        I would believe more of the opinions in this thread if people said that they actually knew the details of several people who they know are receiving SSI or SSDI, which btw, have the same disability requirements which the original writer doesn’t even realize.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          Even if the others in this thread said that they actually knew the details of several people who they know are receiving SSI or SSDI that still would not change the perception of the public majority’s view of the situation. This is especially the case for those who have “invisible” disabilities that because they look like there’s nothing wrong with even though there actually is.

  • John Henry

    The abuse has to be stopped. Anyone on disability ought to have to face a review panel annually to make a re-determination of eligibility. No more favorite judges or doctors, either. The CMS has a responsibility to do better on behalf of its program responsibilities. There is a fiduciary duty here. Empanel a group of experts to do qualifying evaluations. Special masters should be doing the adjudication and there should be legal representatives of the government–the solicitor general’s office or its designee–in any hearing before a court where facts in question are presented by applicants and their attorneys. As is, the disability program is stinking with fraud and abuse.

    • karen3

      CMS has no role in reviewing disability claims of any sort. If you want expert panels, expect it a lifetime to review people. Initial claims processing for people who have worked all of their lives can take 2-3 years. There are hearings, at about the fourth level of review when someone has been turned down.

      • http://www.facebook.com/dmokotoff David Mokotoff

        By the way, I have never seen anyone get SS and Medicare disability on their first application. This would include patients with less than 25% of their heart. They often die before they can mount an appeal. Sorry if I sound jaded, but perhaps that’s the government’s strategy.

        • querywoman

          Are you referring to the patients in your own specialty? If that’s all you know, then it’s limited knowledge.
          I got Social Security on the first try, and many people do. I have Asperger’s Syndrome and had worsening sensitivity to noise. For years, I worked with repeated ear infections, sinusitis, neck spasms, developing diabetes, etc., and I had two long time employers who got sick of my repeated absences and medical appointments.
          Before I stopped working my last long-term job, which I held over 9 years, I had tried going to grad school for a year in another field. I needed to go on insulin that year, and couldn’t deal with it due to all my health problems.
          Then I lost that job after my FMLA ended, as they had no quiet jobs for me. I tried another full-time job for almost a year and a part-time job for 2 months.
          I gave them a last 15 year job history and documented why I could not do each job. Also, how the Asperger’s impacted my life, with noise in grocery stores making it hard for me to shop. Oh, and noise and stimuli do run up my blood pressure!
          I had tried retraining myself and tried 2 more jobs and couldn’t do it.
          One Social Security doc told me she did not know how I had worked for so long.

  • C.L.J. Murphy

    America’s “Victim-Industrial Complex” is going to bankrupt her.

    • Barry Nuechterlein

      Look like that job’s just about done. Get ready for a rough landing. :(

  • ninguem

    Critics repeatedly say that disability determination is a medical process.

    That is absolutely not true.

    Disability is an ADMINISTRATIVE process. I do several every week. Physicians are specifically NOT allowed to say “the patient is disabled” or “the patient is NOT disabled”.

    If I made any such comment, one way or another, I would get my hand slapped by the Disability office. Naughty, naughty. The doctor’s job is to determine IMPAIRMENT, which is not the same as DISABILITY.

    Franklin Roosevelt’s IMPAIRMENT was his paralysis, whether polio or, as some say, Guillain-Barre syndrome. His job (President of the USA) was not affected. Some historians might take issue about his performance.

    If FDR’s job was “dancer” or “waiter”, he may have been disabled. He was not disabled from his job as President of the USA.

    • Payne Hertz

      Right, this is why you are required to have a detailed disability evaluation filled out by a doctor…because it’s all administrative.

      FDR was a multi-millionaire with hundreds of people in and out of government to assist him with everything from writing speeches to putting his clothes on. He did not have to cook his own food, shop, wash his clothes, clean the house, take the car in for repairs or do any of a thousand things a normal disabled person has to do. I am sure many people on disability could work at least part time if they had their own trust fund and personal entourage and were required to do little more than give speeches.

  • karen3

    this is not SSDI, which the writer was complaining about, this is SSI. different program

    • Mandy

      To channel Secretary of State Clinton, “What difference, at this point, does it make?!” They are all people who have been deemed so “disabled” that they will need to be financially supported by the ever-dwindling number of people who work for a living, for the rest of their lives. I don’t know the details of all the various welfare programs out there are well as you appear to do, but I do know that there’s a limit as to how many strangers people like me can afford to keep carrying.

      Every month, 14 million of y’all get a chunk of our paychecks on account of “disabilities” which, to be honest, sound kind of flaky. As the NPR program pointed out, the numbers are skyrocketing “even as medical advances have allowed many more people to remain on the job, and new laws have banned workplace discrimination against the disabled”. And by the looks of things, those numbers are just going to keep going up.

      It’s unsustainable. As others here have said, it’s going to break us. What do we do?

      • karen3

        If you are one of the six working people who will experience disabilty in your lifetime, you will be glad that the same benefits that pay for your retirement will pay for your disability. But it does not pay much, so be sure to have private insurance too. And be glad for Obamacare, because otherwise you would get to pay COBRA for the nearly 36 months that it takes to get Medicare benefits, and you will wait more than a year, not working, to get your first check. The people you are not happy about are on SSI, which is a welfare program, gives people free phones, free haircuts, etc. You get immediate payments, immediate health care and its for people who haven’t worked. Get the point?

        • SarahJ91

          Agreed about the amount of this so-called largess. I get about $800 a month. My retirement benefits will be the same. OBVIOUSLY I would have been much better off had I been able to work. I will never regain that lost income and it will haunt me to my dying day.

          • Mere Mommy

            “Agreed about the amount of this so-called largess. I get about $800 a month.”

            I’m sorry, but if you’d like even MORE of my family’s hard-earned wages, you’ll have to ask nicely. We don’t get ANY free money or free medical care, you know, and it’s hard enough for WORKING families to make ends meet as it is.

          • Guest

            “I will never regain that lost income and it will haunt me to my dying day.”

            Those of us whose paychecks are docked to keep 14 million allegedly “disabled” Americans in the manner to which they have become accustomed will never regain the income we have forked over either. “Just Saying!”

      • SarahJ91

        No, we get a chunk of what we paid into the system. I worked and paid for the long term disability insurance that is SSDIB from the age of 16 to the age of 42. Get your facts straight.

        • Confused

          “No, we get a chunk of what we paid into the system.”

          And you get a chunk of my ay check, and everyone else’s paycheck, when WE work for a living desite our bad backs, Hep C, depression, high blood pressure, etc.

          If you “retired” at the age of 42, because of “disability”, you will be living off Other Peoples’ Money for 30 to 40 years. You DID NOT pay that much into Disability, I promise you.

          • karen3

            The odds are someone who is on SSDI will not make it until it would be time to get their social security retirement benefits. In fact, one out of five people who get SSDI die before Medicare kicks in — because they don’t have any medical insurance and they are sick.

        • beckster555

          Sarah – Speaking in numbers, how many years have you worked and approx. how much have you paid into the LTD insurance? Like you, I LOVE facts / numbers!!

  • http://twitter.com/darbsnave darbsnave

    If I recall the NPR story correctly, states are encouraging patients on Medicaid to apply for SSD, as then their Medicaid payments decrease. As I recall, and my recall is none too good, states hired companies whose job was to qualify their Medicaid patients for SSD.

    • karen3

      There is no such program as SSD. There is SSI (welfare) and SSDI (worker benefits). States are the approvers and payers for SSI, not the advocates.

      • Mandy

        The NPR program referred to it as “Social Security disability” – for instance, “The PCG agents help the potentially disabled fill out the Social Security disability application over the phone. And by help, I mean the
        agents actually do the filling out.”

        Perhaps some of us aren’t as well-versed in welfare-ese as others are, but the point is that these are people getting money from Social Security because they’re too “disabled” to work.

    • querywoman

      I think I understand this now. In Texas, Medicaid is not very generous. My understanding is that Medicaid is half federal and half state money. So, if a state has a person on Medicaid who it assumes may be eligible for RSDI or SSDI (the Soc Sec for which a worker pays into a system,” t then the state wants the person to apply for RSDI/SSI, so the cost will be shifted to Medicare. Medicare normally starts 2 years after a person becomes Soc Sec disabled.
      If you check state government handbooks, you will probably find that the Medicaid is legally required to pursue all income and resources, and that includes potential RSDI/SSDI.
      I am aware of hospitals that contract with legal firms to assist patients in the disability process. Why? It’s cost effective for the hospital and increases the possibility of getting federal health care reimbursements.
      That’s the way the system is, and I don’t expect it to change.

  • MR, retired nurse.

    I have a titanium rod for an upper arm now. Have tried getting my old job or any job suitable to my training back.
    Can’t lift or reach, so can’t be a bedside nurse who lifts patients!
    SSDI was paid into all my working life since age 16! I also was old enough to get regular SS. The advocate was paid for by the private insurance, who has now denied continuing.
    This is not exactly the kind of retirement I planned!
    I agree there may be some fraud, but it’s in Medicare,too! I’ll review charts for anyone who would have me!

  • civisisus

    “In a 2006 analysis by economists David Autor and Mark Duggan wrote that the most significant factor in the growth of SSDI usage had been the loosening of the SSDI screening process that took place following the signing into law of the Social Security Disability Reform Act of 1984. ”

    Hmmmph. Which of our Communist/Socialist loser Presidents’ signatures is on THAT legislation?

    oh, wait….

    • Sam

      In 1984 we had a split Congress (and remember that it is Congress which is the Legislative Branch, they write and pass what become our laws): the Republicans controlled the Senate and the Democrats controlled the House.

      In any case it should be obvious to anyone that this is not a partisan issue. No one party could have screwed things up this badly on their own. All the Congresses for the past 30 years, plus society in general, share the blame. And it’s going to take a massive bipartisan effort to fix it, as well. So let’s stop point-scoring.

    • Mere Mommy

      You’re insinuating that this is a Republican president’s fault. In which case, we have had 13 years of Democrat presidents since then. Do they bear no blame for having done nothing to fix things?

  • Payne Hertz

    The mere fact that someone “looks healthy” does not mean they are not disabled. Does this even need to be said? I’ve seen women who were in so much pain they attempted suicide to escape it, yet were attractive, well-groomed and healthy looking.

    Chronic low back pain is the number one cause of disability in the US, so it is kind of hard to make the case it isn’t grounds for disability. Standards for receiving SSDI for low back pain have been tightened, not loosened, and you now have to have objective evidence of a spinal abnormality or other source of pain. There is little correlation between spinal abnormalities and pain, and most people with low back pain do not have objective evidence of pain, meaning most will now be frivolously denied benefits based on criteria that are not scientifically sound.

    The fact that so many people who are rejected for SSDI later receive it on appeal strongly suggests that the rejection process is frivolous and arbitrary by design. A truly fair system would not reject claims based on insufficient evidence, but would give the claimant a chance to acquire that evidence in a timely manner.

    Social Security should be up front about the fact they require detailed disability evaluations rather than just a doctor’s assertion of disability, but they are not. Most people who apply don’t learn this fact until they see a lawyer, by which point they have been rejected at least twice and two years have passed. Few doctors are qualified to give such evaluations.

    Given the obvious bias many doctors have against people with pain and disabilities. it can be hard to find a doctor who will give you a fair and honest evaluation.

    I see a lot of people here making assertions of “fraud” in the system but I see no one offering evidence of such. I see claims that SSDI is going to “bankrupt” the system, but we have been hearing that for the last three decades. There is nothing there to bankrupt. Social Security is a “pay as you go” program and any shortfalls in its obligations can be covered by raising the FICA tax. Even if this were not possible, Social Security benefits could be lowered to account for any shortfall.

    It isn’t like there’s this giant pot of money out there that, once it’s drained, there will be no money left to pay out. It’s amazing this mass media canard still has traction, considering it has been debunked a million times.

    SSDI is said to cost roughly $130 billion a year. By contrast, Medicare fraud by doctors and hospitals costs roughly $60 to $90 billion a year, with fraud for Medicaid involving similar numbers.

    We could pay for current SSDI benefits just by eliminating Medicare and Medicaid fraud. Think about it.

    • PoliticallyIncorrectMD

      I was wondering what percent of general population has to be subsidized (with or without legitimate reason) by the rest of us before you think that something is wrong with the system. Imposing more taxes on the minority that works to support the majority that does not is hardly the solution. Neither should eliminating the fraud in one program be used to pay for the fraud in another.

      • Payne Hertz

        People on SSDI have all paid into the system, same as everyone else. You have to work a minimum of 10 years to be eligible, and since the majority of SSDI recipients are between the ages of 50 and 60, it is certain that most have worked for a lot more than 10 years. The characterization of such people as freeloaders being supported by others is wrong.

        No one here has yet posted any evidence or statistics on the alleged fraud in SSDI. But doctors are the last people who should be screaming about fraud given that the annual cost of fraud in our medical system is estimated at between $250 billion and $600 billion dollars. Not to mention all the waste and profiteering that goes on. You seem to forget that you are being supported on the taxpayer’s back as well.

        We can easily pay for many programs by eliminating fraud and waste from this system, and that is a fact that bears mentioning.

        From what I have seen first hand with this program as a chronic pain advocate for over 20 years, it is extremely difficult even for people with severe disabilities to meet the stringent eligibility requirements for SSDI. Only 40 percent of applications are approved, and this only after a lengthy appeals process for the majority. The idea anyone can waltz in and get a paycheck is complete BS.

        In order to qualify for SSDI, you need a doctor willing to document the specific degree of impairment you are alleged to suffer from. The idea that is it easy for people to get doctors to put their careers on the line and to make false statements on a fake SSDI claim is absurd on its face. Many doctors have attitudes like those expressed here, that everyone claiming benefits are lazy losers looking to cash in, and they respond accordingly when filling out any kind of evaluation. Most doctors have not been trained to do proper disability evaluations.

        Chances are, if you are on SSDI, you deserve to be on it, and had to fight like hell to get it. Let’s can the hateful, misanthropic rhetoric and stick to the facts.

        • JannyPi

          @Payne Hertz–Thank you for your advocacy!
          You are one of the few that notice the effort some of us put into being “normal”, for the few hours we might be able to pull it off.
          I’d like to note that my INSURANCE carrier, that was handling my disability claim required me to apply for permanent disability via Social Security. That way they aren’t on the hook for the entire amount. The attorney was paid $5,300 from my SS award.

          • Confused

            “You have to work a minimum of 10 years to be eligible”


            FALSE. “Generally, they have accumulated 20 social security credits in the last 10 years prior to the onset of disability (normally four credits per full or part of a year)”

            You can get 20 social security credits in 5 years …. and then get a free ride for the rest of your life, because you’re too fat and “depressed” to bother working anymore.

          • JannyPi

            I’m not sure who you’re referring to @Guest. I worked for over 35 years before becoming permanently disabled.
            AND, it’s not a free ride BUDDY! Nor is it enough to live on, especially with high medical bills.

          • beckster555

            Guest – I personally know several people receiving or applying for SSDI. While I empathize their illness since I was in similar shoes albeit not as severe, I do not believe that any of them can *never* work for the rest of their lives. Many fail to realize that they have other aptitudes. It may not be the field they received training in. Many jobs are not labor-intensive, thus just using the computer or talking on the phone is adequate.

            I do believe that many of them cannot work 40+ hours / week and also require time off for medical treatments and recovery. For these reasons in combination to the recession, employers shy away from hiring these individuals because of accommodations needed. To battle overuse of SSDI and other national programs we need to: a) set a uniform, *fair* reimbursement system for medical care, b) encourage employers with incentives to hire, train, accommodate, and retain disabled employees, and c) re-evaluate the status of current beneficiaries – go to their homes, evaluate online profiles, interview neighbors, etc.

            We can’t blame people signing up for SSDI so that they aren’t living on the streets. Nearly all of us would do the same. Also, overhauling the system would require tremendous amounts of effort and resources, but in the long-term is a win-win situation. Disabled citizens can feel they are useful to society and the rest of us wouldn’t feel taken advantage of.

        • PoliticallyIncorrectMD


          • Payne Hertz

            Did you read the report? The figure of $4.5 billion in improper payments is for Social Security retirement (OAS) and Disability (SSDI) combined. So out of a total of $725 billion in payments a year, $4.5 billion or. 6 percent is “improper.” That is a negligible amount compared to the staggering amount of fraud your profession pulls off every year.

            Secondly, fraud doesn’t appear to be enough of a problem to warrant its own category. Instead the report lists “computation errors, eligibility errors, non-verification of earnings, and incorrect processing of applications or payments” as the primary cause of the imbalance.

            Even with the most generous (mis)interpretation of the numbers, SSDI fraud is a minor problem.

            “It is important to recognize that improper payment estimates reported by federal agencies in fiscal year 2011 are not intended to be an estimate of fraud in federal agencies’ programs and activities.”

            They are a total of all improper payments, not just fraud.

          • PoliticallyIncorrectMD

            If you don’t like my profession so much cancel your next appointment and get your Vicodin and Percocet elsewhere. Or get a job instead – it can be a very revealing experience.

          • Payne Hertz

            No, I don’t like your profession very much because it’s filled with far too many sadistic ignoramuses and malignant narcissists. I am severely disabled but work in my own home business, and I don’t take pain meds except for quinine.

            You should be thankful our society subsidizes your incompetence and cruelty by forcing people to come to you for pain meds, at which time I am sure you take their money from them but give them no treatment, as most doctors do.

            If it was up to me people could get the meds they need without having to deal with “doctors” but the ebil gummint you hate has given you monopoly control over our lives.

            We pay $2.7 trillion a year for a broken and dysfunctional system that is rated below that of Cuba in quality and is considered the third leading cause of death in the country as well as the number 1 cause of bankruptcy.

            Legislative fiat not only protects you from competition, but from liability for the massive amounts of deaths and injuries your profession causes every year. So don’t lecture me about “responsibility” in a job where you can literally kill multiple people through acts of gross negligence and still keep your job while crying that you are being victimized in the 1 out of 50 times someone actually sues you.

          • PoliticallyIncorrectMD

            I rest my case!

          • Noni

            Good lord! Do you really blame physicians for the poor overall quality of the US health care system? Do you think all physicians are incompetent?

            It’s clear from posts like yours how hopelessly broken the system is. Physicians are frustrated and patients are angry. The only winners in this system are the hospitals and the insurance companies. That said, friends who’ve practiced in other countries suggest the grass is not always greener! Other countries have their own problems with healthcare.

            I am a physician, and it’s heartbreaking to hear your assault on physicians. Most of us are just people like you trying to provide for ourselves and our family. Most physicians I know are NOT incompetent and do not set out to hurt people. Many of us use this board to vent frustrations, but I don’t know any who really view patients as evil or the bad guys.

          • Payne Hertz

            Yes, I really blame physicians for the epidemic of iatrogenic death and injury in this country, though they are not the sole cause. Who should I blame, gremlins? Every time a doctor commits malpractice it’s always someone else’s fault, isn’t it? The government, trial lawyers…”disgruntled” patients is the term you used in a recent thread. So much for “personal responsibility.”

            The doctors on this thread came here to spit in the face of disabled people. Do you have any idea how degrading it is for people who have struggled a lifetime with the living hell of being disabled to be told that it is a “lifestyle choice?”

            But that’s okay. When doctors spread their hate and venom against patients in medical blogs, it’s just “venting.” When a patient responds with the truth about this system, it is an “assault” on your profession and “proof” of what is wrong with it. What incredible hypocrisy.

            The difference is I can back everything I say about this system with studies.
            So far, no one here has offered any evidence of disability fraud, its prevalence, or the repulsive notion that disabled people somehow choose to be disabled as a lifestyle. This is clearly something many doctors want to believe, and I think fair-minded people have a right to question why.

            I like to believe that there are many doctors out there who are competent, caring and compassionate. I have certainly met a handful myself. But I have to wonder why these “good doctors” are silent when their more poorly socialized colleagues act up in public forums, disgracing their profession and alienating the thinking public. They can respond under the cover of anonymity, so you have to wonder if its fear or denial that keeps them silent, or is it indifference or agreement?

          • Barry Nuechterlein

            “No, I don’t like your profession very much because it’s filled with far too many sadistic ignoramuses and malignant narcissists.”

            I can’t deny such people exist in Medicine, but any realistic observer will note the human species is richly endowed with such individuals, in and out of Medicine. Some doctors are bad people. True. Some patients, unfortunately, are bad people. Some disability claimants are also bad people. I think many people in all three groups are not that awful. Maybe a mixture of good and bad. I’d say I’m a mixture of good and bad. I have better days and worse ones, as does everyone. I have made mistakes, and (hopefully) done a reasonable job of admitting them and trying not to make them again.

            I share your frustration with the system, which is why I left the U.S. system to work in another one seven years ago. What have I learned?

            Most of the problems in the health care system are caused by human nature, and it is amazing how, no matter what one does, the same exact problems in slightly different guise appear in a universal, socialized system. The best way to reform a system is to be realistic about human nature, and try to create restraints on common abuses. Like, say, cover-ups of medical malpractice, or use of the disability system as a surrogate for unemployment benefits.

            I would argue that, like the health care system, the disability system is seriously flawed, and needs massive reform. I would argue that the disability system is more flawed than the health care system. From the sounds of it, you probably feel the opposite is the case. Still, angrily defending the status quo is not the answer. We need to be honest about where all of us need to change and do better.

            I hope you find relief from your suffering, and can let go of your anger, someday. Maybe, then, your energy can be directed into finding constructive solutions.

            Portraying your adversaries as unspeakably evil monsters doesn’t buttress your arguments, or bring anyone closer to a solution.

      • karen3

        Are you planning on collecting your Social Security Retirement Benefits and Medicare? If so, “we” are all in the same club. If your parents and grandparents collected their social security checks, did you call them leeches every time you saw them???

        • PoliticallyIncorrectMD

          My parents worked well into their 70s in spite of multiple medical problems – just because it was the right thing to do. Having somebody in their 40s applying for the government assistance because they are too “fatigued” to work or are “in pain” is quite different scenario.

          • Elizabeth

            Your parents (and most in that generation) did not have the “entitlement mentality” that so many today have. Once upon a time, people had the good grace to be embarrassed about being on welfare, and they wore their work ethic with pride. Now the victimhood badge is the sought-after prize, and whereas it used to be that we were proud of overcoming hardship, now we compete to win the “poor me” badge.

          • Payne Hertz

            Maybe those people in their 40′s are in worse condition medically than your parents were. Dismissing the realities of chronic pain and fatigue or failing to recognize the fact that illnesses can be more severe in one person than another makes me wonder how the hell you ever became a doctor.

          • PoliticallyIncorrectMD

            I can tell you how: by hard work and taking responsibility…definitely not by looking for excuses and playing a victim. I know it might be a foreign concept for you…just do your best to imagine.

          • Koivy

            And maybe you should do your best to imagine that perhaps some people’s illnesses make them much sicker and much more impaired than your parent’s conditions. As a doctor, you should know that severity, even within the same illness, can be a huge range.

      • querywoman

        My understanding is that the disability process is easier in Europe. I believe that most people in the US get disability because they are ill. Yes, there are some who are just lazy and don’t want to work, but there are not enough jobs out there.
        Long-term unemployment causes depression. We are graduating bright, educated young people in technical fields, while employers prefer to pay lower wages to graduates from Indian and other foreign universities.

        Bright chronically unemployed young adults in Iran often become drug addicts.
        There is another class of people who are often on disability: subliterate American men who didn’t graduate high school. There are very few jobs these men can do anymore, factory work is almost gone, etc. Couple their lack of motivation with their poor literacy, and eventually someone just finds a reason to put them on disability.
        Does the average American employer want these guys working for them? Would the employers really rather give them a full-time minimum wage job or would they prefer to subsidize disability? I was in a social work job, where a mandatory “volunteer” was sent to help me file. He didn’t know his alphabet.
        Without some money, he might be homeless or in prison.
        If Soc Sec is to re-evaluate disability thoroughly every few years, then it would need to hire more employees and to train them, which can’t be done overnight.

  • Payne Hertz

    Thanks Karen, for your usual well-reasoned and concise reponse.

  • SarahJ91

    So… you’re thinking this massage therapist–who is probably on her 9-month trial period and on her way off disability or on her 36-month Medicare coverage after returning to work should, in your opinion, decline the only medical coverage she is likely to get due to her serious chronic disease and… what, exactly? Go without treatment? Yeah, that’ll save us all money in the long run.

    I suggest you learn a whole lot more about the SSDIB system and Medicare before you start judging your patients. Also, you are a cardiologist. When I am seeing a consultant I do not discuss the unrelated disability that caused me to be on SSDIB as that would be an irrelevant waste of time and also none of the consultant’s business.

    • Confused

      When you’re dependent on the State-enforced kindness of strangers, when you’re demanding that working families foot your bills, you ARE beholden to them. A simple “thank you” would be a good start.

  • SarahJ91

    “Most people on SSDI (who have worked most of their lives) are not happy about not working.” Thank you for saying this. Losing the ability to work was one of the most devastating events in my life. I was a workaholic from the time of my first job at the age of 16. I have had the goal of getting off SSDIB since the day I got on.

    Ironically, I lingered on DIB for nearly 25 years due to a medical misdiagnosis and subsequent mistreatment that nearly killed me. I have been patching my life back together since receiving an accurate diagnosis and treatment and am now working two part-time jobs, with the hope of doing more. I will be 65 next month and no one can help me regain those years of lost income, the career I loved or my former dignity.

    It’s easy to judge people on disability but for some of us (most that I know) the loss of a career and a place in the working world is so painful we’re not about to explain it to some stranger we’re seeing for a one-shot consult. I make it a point to not discuss my disability with doctors with whom I do not have an ongoing relationship. It sucks up 14 of my 15 minutes to no purpose and leaves me feeling depleted and defensive.

    • Confused

      “I make it a point to not discuss my disability with doctors with whom I do not have an ongoing relationship”

      They work long hours to pay for your free income and free medical care. It’s their money you’re living off. They deserve the good grace of a “thank you” as well as any explanation.

      • SarahJ92

        What on earth did I say that causes you to think I don’t thank specialists for their services? But that does not entitle an orthopod fixing my broken arm to waste our precious five minutes together to satisfy his curiosity about my totally unrelated disability.

        I can’t believe the level of ignorance and hatred in these comments.

  • http://www.facebook.com/profile.php?id=1412715500 Ed Sodaro

    These possible problems would be solved, in my view, if there was a seamless integration of the Americans With Disability Act and Social Security Disability.

    • karen3

      Because ADA has laughable enforcement. Every single person I know, not employed by the goverment, who has gotten a serious illness has gotten a pink slip to accompany the diagnosis.

      • querywoman

        I asked for ADA accommodations, a quieter work place, and got pink slipped from a state job that had no quieter work place.

  • http://www.facebook.com/murph.busch Mary Daniels Busch

    Are you kidding me? As a CIDP patient ,cousin to MS, I find this article offensive. I worked seven years with my disease until it put me in a wheelchair. With long treatments and horrible side effects, it definitely diminished my ability to work. Not to mention muscle weakness, nerve pain, and fatigue that the disease caused. I can’t believe a physician would even put that these are not true disabilities. You may know about hearts but are clueless about other chronic disabling diseases. Mary B

    • beckster555

      Mary – I’m sorry to hear about your suffering. I agree with you that MS and the like is a truly, disabling illness.

      From the context of the article, Dr. Mokotoff probably saw a patient who got the diagnosis from *another* physician. After all, many in his profession are infamous for up-coding illnesses. For example, a pre-diabetic may labeled a permanent insulin-dependent on claim forms.

      Do you believe that the nearly all of SSDI beneficiaries are never able to work again?

    • http://www.facebook.com/dmokotoff David Mokotoff


      I am not trying to disparage MS. There are many who are truly disabled and suffer with this illness. There are likewise, in my opinion, (and no I am not a Neurologist), who have normal life expectancies and function well, yet are “disabled.” Part of the diagnosis of MS is based on subjective symptoms. My current wife, who suffered terribly with trigeminal neuralgia, was almost given a MS diagnosis.On massive quantities of neuro-active drugs,
      she never considered filing for disability but continued to work as a single mother and support two children.

      David Mokotoff, MD

  • BearWithMS

    So does Dr. Mokotoff think people with multiple sclerosis are faking it?
    I am a nurse who was diagnosed in 2006 with the disease (in my late
    30s), and I can no longer work. It not only robbed me of my career, but
    it also robbed me of my mobility and advanced education. Thankfully, I
    purchased a LTD policy while I was working to supplement SSDI. I’ll tell
    you what: I’ll trade my disability, pain, mobility issues and cognitive
    problems to go back to work in a heartbeat. Too bad the doctor seems to
    “know” what a disease looks like and who should or shouldn’t be
    gainfully employed. Perhaps if he traded with me for a day, he wouldn’t
    feel the need to judge.

    • Valentijn

      He seems to be expressing what used to be the common view of MS held by the medical community. The cause of symptoms was unknown, thus were “medically unexplained symptoms”, which many doctors assume to mean “psychosomatic disorder”. Peptic ulcers suffered a similar history of being treated as a psychological problem, until it was proven that a certain bacteria causes it.

      Of course, there’s been a ton of research in the past several decades establishing that the symptoms in MS are not unexplained (even if the ultimate cause isn’t really pinned down yet). Thus even the “unexplained = psychosomatic” doctors should be aware that they’re expected to treat MS patients as if they have a real disease now.

      So my best guess is that he hasn’t bothered reading a medical journal in the past 30 years or so.

      • MTRM

        MS can be diagnosed. It shows up on films. So do ulcers. They are real things. “Chronic” “fatigue” and “chronic” “pain” are about the subjective feelings and self-described “symptoms” of “patients” ….. a vast number of whom are overweight and unfit by the way.

        • Valentijn

          ME/CFS is not chronic fatigue. I am not fatigued, and most of my pain is under control. We get several symptoms which might be broadly and sloppily described as fatigue, but please try to ignore the name used in the US – it is highly inaccurate and non-descriptive of the actual disease and symptoms.

          ME/CFS abnormalities also show up on several tests. One problem is that there is no test which is particularly specific to ME/CFS. The other problem is that the testable abnormalities found in ME/CFS rarely show up on the standard panels ordered by doctors when presented with a patient who has our symptoms.

        • http://www.facebook.com/dmokotoff David Mokotoff

          Sorry, but PART of the MS diagnosis is based upon “subjective symptoms.”

      • Guest

        Remember the hundreds of thousands of Americans who used to be on the dole-for-life because of ulcers? Oh, wait. Yeah, no. Bad analogy.

    • http://www.facebook.com/dmokotoff David Mokotoff

      I don’t doubt the validity of your diagnosis. I am sorry for disparaging the MS diagnosis; although part of the diagnosis is based upon the patient’s subjective symptoms. I don’t need to trade places with you. My current wife suffered with trigeminal neuralgia for years, and took massive doses of neuroleptic drugs which made her ill, all the while working full-time, and raising two children as a single mother.

      • BearWithMS

        Well, it’s a damn good thing you’re not a neurologist if you believe this is mostly “subjective.” Perhaps next you’ll tell me the MRI results are subjective, too. Don’t bother responding when you don’t know shit. They actually gave you a medical license?

      • http://twitter.com/Katiissick Kati Debelic

        So now the man got respect for trigeminal neuralgia.

        • Suzi Q 38

          A convenient respect.

      • Suzi Q 38

        Yes, but so is a lot of other conditions. For MS…evoked responses, lumbar puncture, brain MRI’s. Spine MRI’s???
        Blood tests? Do these “ring a bell?” I wouldn’t wish it on you, but I was given MS as a possible culprit for my leg and arm weakness and tingling. That time will be the test if I can do anything for myself in the future or not.
        Have you checked wikipedia and looked up the bio of Annette Funicello, actress? Right now, see is alive, but not well, in a bed.
        She can not make voluntary movements or speak. She communicates by blinking her eyes. She hasn’t been able to work for decades.
        I am 56, so mine could possibly be the primary progressive MS, if I have it. This is not the type that comes and goes. You get it and it hangs on, slowly or quickly robbing you of body function slowly or quickly, however it chooses. You start out barely walking, then move over to a cane, then walker, then wheelchair, motorized wheelchair, then bed.
        You have no control, it controls you, unless the drugs work. Sometimes they do, sometimes they don’t.
        Employers aren’t always understanding. Sometimes they make your life miserable if you stay. They don’t like the flare-ups, the missed time off, the doctor’s appointments.
        Some people do not have understanding spouses. The spouse gets tired, fed up with it all and leaves you for someone else.
        Your children hide because you are way too much work for them.

  • http://twitter.com/Katiissick Kati Debelic

    I am totally appaled that Kevin MD accepted this article as it reveals Mr Mokotoff has much hate for patients with the most neglected diseases namely fibromyalgia, myalgic encephalomyelitis (sadly known as chronicfatigue syndrome) and to a lesser extent multiple sclerosis.

    Mr Mokotoff claims he is a MDhowever he shows no compassionfor patients who are sick in an era where disability is seen as sloth when disability is the last resort.

    See, patients like me got sick often overnight, when their lives couldn’t be more fullfilling. I got sick at age 39. i loved my job as a RN and used all of my holidays traveling the world on a seat of a (pedal, not motor) bike. The physician who supported my disability proved through exercise test and neuro cognitive test that I could not viably perform my duties as a nurse nor any other occupation. She also says that patients with ME /CFs are just as sick as patients with progressive MS, congestive heart failure or end stage AIDS.

    Mr Mokotoff should educate himself about these diseases that get no respect, and understand that until this crazy guy drank up live bacteria and proved they caused stomach ulcers, patients were treated for type A personnalities.

    Hickie I, Davenport T, Wakefield D, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ. 2006;333(7568):575.

    Light AR, Bateman L, Jo D, et al. Gene expression alterations at baseline and following moderate exercise in patients with chronic fatigue syndrome and fibromyalgia. J Intern Med. 2012;271(1):64–81.

    Rowe PC. Orthostatic intolerance and CFS: new light on an old problem. J Pediatr. 2002;40(4):387–389.

    • Guest

      “patients with ME /CFs are just as sick as patients with progressive MS, congestive heart failure or end stage AIDS.”


      • Valentijn

        People on the severe range of ME/CFS (please read the Canadian Consensus Criteria to see what it really is) are bed bound, and require constant care for feeding, using the bathroom, etc.

        I’m primarily housebound. I can get out with help, but can’t walk far before my legs stop working. So I’m only a moderate case, sometimes borderline severe during very bad spells lasting 1-4 weeks thus far where I was mostly bed/couch bound due to severe orthostatic intolerance.

        Prior to fighting tooth and nail to get orthostatic intolerance symptoms treated, I was unable to sit up much, and my limit was about 5 minutes of standing. Some evenings I was able to make dinner for me and my fiance if I planned carefully and started a few hours early to avoid standing up too long, and only used pre-chopped meats and vegetables. After a few minutes of prep work, I’d have to lay down for 30 minutes or so before going on to the next task.

        The quote above is referring to ME/CFS patients as defined by the CCC. Not fatigue patients.

        • Guest

          Fat, lazy, attention-seeking and desirous of drugs is now a medical condition worthy of government freebies.

          • Payne Hertz

            Nice troll

          • Payne Hertz

            I find it amazing my posts get censored here when crap like this is allowed to stand.

          • http://www.kevinmd.com kevinmd

            Posts get automatically deleted after a certain number of flags.

            You are welcome to flag any objectionable comments.


    • http://www.facebook.com/dmokotoff David Mokotoff

      I am a medical doctor, not a mister, thank you. I am not heartless. If you read my article you would see I go the extra mile for cardiac patients to get their disability when they qualify. In fact, I often initiate the process for them and spend countless unpaid hours filling out reams of forms to assist them, and their attorneys, in this regard.

      • annmarcaida

        I don’t doubt that you are kind to your cardiac patients. But those with auto-immune diseases are terrified of doctors like you. With the auto-immune epidemic (yes, it is real), the days of being able to determine disability with a glance (or with a quick physical exam) are long over.

      • Payne Hertz

        “I am a medical doctor, not a mister, thank you.”

        Good grief.

        After a fact-free hatchet job like this against disabled people, you expect people to respect your title? Get over yourself, mister.

      • http://twitter.com/Katiissick Kati Debelic

        i give due respect to those who deserve it.
        Since you are helping your own cardiac patients getting their disability, why is it that you have to judge other patients getting theirs?
        i really wish you walked in other people’s shoes for a day.

        Patients with fibromyalgia and myalgic encephalomyelitis are not lazy, not faking illness in order to get benefits. They are very sick and science has not quite figured it out. People like you Mokotoff like to think you know it all and got superpowers and that these illnesswould never happen to you or loved ones. Wait till it comes your turn and get a taste of your own medicine.

      • querywoman

        Cardiac patients are not the only ones entitled to disability. You have tools to measure cardiac processes and chemicals that you trust to alter the processes. Generations have lived and died on this earth without the blood pressure cuff.
        When an illness presents without a reliable measurement tool, it does not mean that is psychosomatic nor that it cannot be disabling.
        I lost a grandmother to pellagra, a disease that has almost disappeared in the US due to Vitamin B6 supplementation after increased understanding. Yet, my understanding is that there is still no test for B6 deficiency, and that it can only be diagnosed through symptoms and response to supplementation.
        The current medical profession does not know all about every condition, including stuff like MCS, and it never well. New problems like HIV will always pop up.
        Yet, the diagnosis de jour for misunderstood diseases is psychosomatic and use psych drugs.

      • querywoman

        You are a MISTER as well as a DOCTOR. I often see news reports about women doctors in court that refer to them as Ms. So-and-So instead of Dr. So-and-So. The correct courtesy for title for a man, if one does not know has another title like “Doctor” or “General” is “Mister.

    • Suzi Q 38

      Hi Kati,
      I agree with you. I “went off” on Dr. M too.
      On the other hand, there are people that abuse “the system.”
      They are walking around, enjoying life, and using the disability as an “early retirement” of sorts.
      If there are liars and cheaters, shame on them.
      It makes a bad name for others that are legitimately disabled.

  • Mike M.

    It’s obvious that the Welfare Industry does not appreciate the people whose money they live off daring to criticize or even question whether their money is being allocated appropriately.

    It’s like getting between Michael Moore and a free all-you-can-eat buffet. LOOKOUT.

  • Valentijn

    Wow, I didn’t think there were still dinosaurs out there believing that MS isn’t a real, disabling, and deadly disease. Looks like someone’s missed out on a couple decades of research.

    For me it’s ME/CFS. I live in a foreign country as a resident, where I’m not eligible for benefits. Yet I have it, and it’s highly disabling. Despite dinosaurs such as the one ranting above, I have managed to get one of the most disabling symptoms treated, and can now sit upright and think clearly all day – you see, it’s extremely disabling when your pulse pressure is so low that you could easily be confused with a congestive heart failure patient, or someone suffering severe blood loss.

    And as far as looking fine one day or being able to do things – in ME/CFS we get post-exertional malaise (PEM). That means that we can do a bit one day, and then get extremely ill about 24 hours later, usually lasting days or weeks and sometimes triggering a long-term relapse. Slowly vacuuming the living room and kitchen is enough to trigger PEM for me, or taking a shower. I might be able to work a few hours one day per week, but would then be sick for the next 2-3 days and essentially unable to take care of myself. But hey, if you wanna hire someone with my limitations anyway, I say go for it!

    • Guest

      Are you overweight?

      • Guest

        I wonder what the average BMI of those on “disability” is? Especially for the more nebulous claims.

      • Payne Hertz

        Are you an asshole?

  • Newell Young

    I read this thread with great interest. There seems to be a pattern of moralizing that decreases relative to the amount of knowledge one has about the details of the program(s) in question. Thanks to those of you who provided clarification about common myths and misunderstandings. I agree that people have to be pretty desperate to seek out career disability status, and I don’t wish that on anyone nor do I envy their modest income after the determination is made. I’ve often thought that we would save a lot of money if we didn’t work so hard to PREVENT people from accessing the disability THAT THEY HAVE PAID IN TO THE SYSTEM. Also, because less than 2% of Disability recipients ever go off once they are on it, the “System” provides various incentives to encourage people to work while they are still ON by not penalizing them for working for the first 9 months of new employment. But it’s a safety net, and people will use it if they need a net, and sometimes to avoid meaningful work. I don’t wish anything but additional support for those folks, because it’s a pretty sad place to be, if that’s all you want/expect from life. The moralizing and judgmental attitudes are certainly not going to help nor incentivize people to change. But you can’t productively impugn people from taking advantage of a system to meet their needs. You have to change the system to disincentivize people from meeting their basic needs in that way. But saying or thinking people SHOULDN’T be meeting their needs in that way is not going to get you anywhere.

  • joel

    well you may know about Hep C, but you clearly dont know much about those other diseases you mention. Ironic actually, that people with ME/CFS often have heart problems as part of that, but you clearly dont know a thing about it. Surely the answer to getting the equality you desire, is not beating up patients with other serious diseases? Where is the logic in that?

  • http://www.facebook.com/profile.php?id=577909792 Carol Wright

    There was expose on this whole scheme this past week on NPR, multi part series. When states were required to move welfare recipients off welfare and getting them back to work, the states themselves started to move these people to federal disability program. There is a recruiting company to help them do this, doctors favorable to finding or making up conditions, etc. It is quite a scandal, I think, and should have major crackdown.

    There are lawyers who specialize in getting disapprovals overturned. It is quite a business. It is very prominent in the southern states….ahem the REPUBLICAN STATES. The figure quoted was now over fourteen million. Sure other comments below have more details.

    Anyway, the series should be easy to find on NPR.

    • CRT1981

      One of the posters above supplied a link to the NPR series in their comment. Another of the posters above suggested leaving partisan politics out of it, I agree on that too, the blame game just fosters divisiveness so let’s just accept that there are cheaters who would cheat regardless of who they vote for, what we ALL need to do is work together to find a solution whereby the GENUINELY disabled still get all the care and assistance they need but the rorters are kicked out of the game.

  • drjoekosterich

    This is a problem in other countries too including Australia. Doctors are often caught in the middle and have no support in trying to make determinations which are correct whilst not leaving themselves open to patient complaints/litigation.

    • Guest

      And from what I understand, in Australia there’s not even any pretense of paying into any kind of social security or disability “insurance” fund. Anyone can claim, regardless of whether they’ve ever worked a day in their life or paid a single penny of taxes. It’s lucky they have so much wealth (oil, gas, coal, iron ore, etc) to dig out of the ground and sell!!

      • drjoekosterich

        Yes you are correct.Payments come out of general taxation revenue. And yes it is fortunate that mining supports the economy. If not we would be like Greece

      • querywoman

        People in this country, even a baby, can get SSI, or Supplemental Security Income, without having paid a single penny of work-related taxes. SSI is not tied to work, and it is considered welfare and funded differently than RSDI/SSDI. We also have wealthy soil in the US.

    • PoliticallyIncorrectMD

      Very well said.

  • Barry Nuechterlein

    Thank you for raising this important topic!

    This is often not a medical issue, SS disabilty is just the replacement for unemployment benefits for a lot of people. It’s a sad commentary on American society in two ways:

    1. A lot of people who want to (or at one point wanted to) work and be productive have become so frustrated, discouraged, and hopeless that they have given up trying and are instead “gaming the system.”

    I know some of these people. They got laid off from a good job, tried to find work for a couple of years, had no luck, and got depressed. They threw up their hands and just started scanning around for a way to keep the government aid coming when their unemployment benefits ran out. Some of them also turned to drink or pills, and are sad wrecks of their former selves. The rust belt (and a lot of other regions) are full of people who have basically given up living and are just existing until they die. Living ghosts. It’s horrible. The Ohio River Valley is an example of how economic decline, prescription drug abuse, and the system have aligned to wreck lives.

    This is the partly a consequence of political decisions to under-fund education and vocational re-training at the same time low-to-mid-skilled jobs have been shipped overseas to please the business community and Wall Street. That’s where the conservatives have gone wrong.

    2. The government has taken the path of least resistance, and is fostering this permanent class of dependent, hollow-eyed, lost souls. Instead of coming up with policy solutions (job re-training, putting money into services that help connect people with jobs and relocate to places where jobs are, etc.), and back-to-work schemes, it’s easier to just cut them a check and turn away.

    This also keeps political pressure on to keep an army of tax-fattened welfare bureaucrats and disability administrators on the public payroll. This is a kind of welfare too, for university-educated, well-connected individuals who can arrange a civil service job in the “helping bureaucracy.”

    That is where the left has gone wrong.

    So, what you have is a perfect storm. To please their owners on Wall Street, conservatives have hollowed out the greatest manufacturing economy in the world and turned a huge chunk of the U.S. population into welfare-seeking, drink- and drug-addled, unemployable zombies. The liberals have rejoiced, as this has provided a population for them to wring their hands about and “help,” thus guaranteeing lots of “work” for those who administer programs to dish out public aid.

    This will continue until the system collapses, because it’s beneficial to both “free trade” conservative business/financial types, and self-righeous liberal “do-gooders” who have worthless degrees from foofy liberal arts colleges.

    What physicians are seeing are the horrible consequences of awful, self-serving social and economic policies dreamt up by the financial and academic elites who are currently in a struggle to define whether the U.S. will become a grim, lawless, and third-worldish playground for capital or a welfare plantation full of oxy-contin addicts.

    Unless some social or political forces align to re-invigorate the population and develop some better policy solutions, things are going to get a lot worse before they start getting better.

  • sdaniels@markhofflaw.com

    This article is a horriffic attempt to further the negative misconceptions about the majority of individuals receiving disability benefits. You completely disregard that to meet the criteria for a finding of “disabled”, the agency, or a Federal Judge, must analyze that individuals past work (last 15 years), and their ability to adjust to other forms of work based on their age, education level and skillset. Before you generalize that the system is wrought with fraud, maybe you should understand exactly how a person is found disabled and the circumstances surrounding their claims. Based on your poor attempt to voice an irrational viewpoint, I hope you don’t generalize your patients symptoms and chalk them up to be plain old hypertension. I’d be happy to educate you on the laws and regulatsions of the disability system should you have questions.

    • Noni

      And you work for a law firm that helps people collect social security disability. Of course you’ll find this article offensive.

      • sdaniels@markhofflaw.com

        Noni – what I find offensive is the generalization that people on disability benefits have somehow defrauded the system based on the unethical practices of attorneys. As a practicing attorney who represents the disabled, I operate ethically and have never “gamed” the system, as the author so eloquently put it. Responsible journalism requires an author to do research and actually state facts. Only then can the author provide rationale commentary based on facts.

      • Payne Hertz

        I haven’t seen an iota of evidence in this thread to back any of the claims of people “faking” disability claims, or an estimate of the prevalence of such fraud.

        I have seen a lot of hateful, derogatory things being said against people for the “crime” of being disabled and looking healthy, or being young, or some such nonsense.

        The hatred, bias and the bigotry here are unmistakable. Like all forms of bigotry, hatred of disabled people says more about the people who have some psychological need to believe it than it does about the targets of the hate.

  • Clara T.

    A house-dog doing nothing but lazing around will become obsessed with his fleas, biting and scratching and yelping and turning them into the main thing his life revolves around, and he will soon become the most miserable cur in existence. A dog who’s busy hunting and working and earning his keep hardly even notices them.

    Too many peoples’ lives seem to revolve around their trumped-up “disabilities”, and they get rewarded for that both in a financial sense and in the sense that 21st-century America has become a cult which worships “victims”. And of course, the “chronic” “pain” “victims” get all the free opioids they can eat; the self-proclaimed “chronic” “fatigue” “victims” get to indulge the self-indulgent laziness which most of us would love to indulge, if only we could at someone else’s expense. Maybe if we were to stop rewarding self-obsessed self-proclaimed “VIIIIICTIIIIIIMS!” who don’t even have the diagnosable equivalent of fleas, if we were to disincentivize their choice of not bothering to work for a living anymore, it would be helpful all around.

    I have had MS for 4 years now and know for a fact that I would be far worse off if I stayed home on welfare and watched TV and lazed around all day every day. I would be like that dog fixating on his fleas.

    • Koivy

      Are you suggesting that other MS patients are just being lazy and are nowhere as hard working as you? That they simply *choose* disability? I certainly hope that your MS is not progressive and disabling enough to make it that working is no longer a choice for you, but if only you could spend a week in the shoes of someone whose MS is worse off then you, then maybe you could learn some compassion.

      • http://twitter.com/wellmike15 Michael McNeil

        Take your head out of the sand. If you missed her point and think she is not compassionate, you need to get your head checked.

  • Guest

    Pigs advocating for free unfettered access to the trough? Hard to believe!


  • http://www.facebook.com/profile.php?id=1257300038 Kim Webb Palacios

    This American Life had a great episode on disability a few weeks back. It did a wonderful job of discussing the arbitrary classification of disability and also the government’s role in letting so many dubiously qualified people collect.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Is this episode online for anyone to watch? If yes, would you please post the link to it?

      • Elizabeth

        A few readers here have posted the podcast & transcript link already. It was a radio program (NPR) not a TV show (PBS).

  • annmarcaida

    How ignorant of you to accuse people with autoimmune illness (MS, CFS, and Fibromyalgia), of faking disability more often than people with other diseases simply because they don’t “look” sick. Most autoimmune disease is invisible– but I would have expect a doctor to know that.

  • Charlotte

    I, too, didn’t think people would file for disability unless they were really disabled. Now I live in government subsidized housing for the elderly (me) and disabled, and you wouldn’t believe all the young people who live here. My eyes have been opened. Some are disabled. Most are lazy.

  • http://www.facebook.com/dmokotoff David Mokotoff

    I had no idea this blog would have stimulated such a large and passionate response, but I should have. To those who took personal offense by my characterization of certain illness as less than “real”, I apologize. However, if you could follow me for a week, and witness the abuse of the system where the truly needy, and disabled, are stonewalled and pushed aside, you’d be angry too.

    • Elizabeth

      I thought it was a very well-written blog post by a professional who’s certainly in a good position to give his own perspective on this very topical issue, and that the comments it generated were both interesting and revealing. You sound like you’d be a fierce advocate for your patients, and that you get frustrated dealing with roadblocks in the system which are of neither your nor your patients’ making.

      It’s been an interesting post to follow. Thank you.

    • Payne Hertz

      You made a false dichotomy between the “truly disabled” and people with severely disabling conditions like CFS, low back pain and MS who are allegedly faking it. Your apology rings hollow when you then assert that one has only to see what you see to know that this is true. “I’m sorry, but…” There’s always a “but.” Sounds to me like you’re still making the same ill-informed claim.

      If I could follow inside your head and see with your eyes I would not be convinced, not when the “evidence” you present of people allegedly faking is that they appear healthy.

      If you actually took the time to talk to these people and understand what they’ve been through, rather than judging them based on their appearance and publicly demonizing them, you might learn just how bad some of their disabilities really are.

    • Dusgusted

      And if you followed all the patients with “real” illness that get blown off by arrogant doctors like you who say their illness are less damaging than they are, you would be angry too. Generalization damages everyone. Even your patients.

    • Koivy

      It seems like this doctor must be trained in every specialty in medicine…as well as being a psychic, as he seems to be able to tell whether or not a patient is “truly” disabled simply by appearances. Clearly, only *his* assessment of disability is legitimate, but not his colleague’s. If only his colleagues (that includes primary care physicians, rheumatologists, pain physicians, immunologists, other cardiologists, etc) could understand that MS, fibro, CFS, and chronic pain are not really disabilities!!!

    • querywoman

      Does following you for a week consist of watching you interact with mostly cardiac patients? That’s not a realistic picture of the medical and disability systems.

  • guestinpayne

    I don’t know where to start but in brief it is very hard to get adequate care for back. for example trying to get in to get a block, especially any sort of specialty procedure can take a month or more. It does not matter how bad it is or if you cannot bear weight at all. this may be the difference between working and not. there are solvable problems but even with insurance it can become insolvable without adequate access

    • http://twitter.com/wellmike15 Michael McNeil

      Let’s trade “Disabilities” then. I’ll take your “severe back” and you can have my genetic condition that’s untreatable.

  • Fay

    My child is disabled, adding thousands of extra dollars in bills to my annual budget. And yet, I don’t receive SSI. I am prodded and pushed by those near to me and those who share my child’s disability, and yet I feel that this is my small way of standing against a corrupt system that has our country spiraling downward.
    Yes, some who receive SSI and SSDI are truly disabled, but many are not, and are stealing from people like me, who are working hard to forge it on our own. If you are disabled, I’m sorry for you, and glad that you receive compensation. If you are not, stop arguing, you’ve never felt the pinch of medical costs, knowing that you’re paying the government to support your lazy neighbor.

  • M.K. Caloundra

    Very interesting and pertinent article (op-ed), thanks for sharing it!

  • M.K. Caloundra

    CBPP is a left-leaning Soros-funded welfare lobby group. They have been advocating for greater tax expenditures on social welfare programs since their inception in 1981. They are no more impartial players in this matter than any given right-leaning Koch Brothers funded lobby group would be.

  • http://somebodyhealme.dianalee.net/ Diana Lee

    SSI stands for Supplemental Security Income. This was misstated in the article.

    I’d like to remind readers and this physician that many disabling conditions are invisible to the naked eye. I hate being 35 and having to tell people I’m disabled. I look normal. It’s humiliating, and reinforcing mistaken impressions the way this article seems to isn’t helpful. There’s no doubt there is a legitimate issue when we see the number of people on disability rise with the rates of unemployment, but we must be careful to separate real concerns from unfair judgments and stigmatization.

  • http://www.facebook.com/people/Charlie-Smith/1248201997 Charlie Smith

    You don’t see why persons with CFS can’t work, yet you have persons with “heart disease” who clearly can’t? Guess you conveniently chose to block out that some of the most severly affected patients with CFS actually have have cardiac output in the organ failure range. To me, that sounds like “heart disease”. Do an impedance cardiogram on these patients and compare with your own values.

  • laurie

    It really angers me to see capable people taking benefits. My son has schizophrenia and receives benefits. I see clearly he can not focus on anything more than 10-15 minutes so benefits are there for him thank God. But my friend told me of her friend who just got benefits for her “bad headaches”. I asked won’t she have headaches whether she’s working or at home? She answered that with less stress from the workplace she probably won’t have so many headaches. This person also goes to rock concerts and smokes marijuana. Not too helpful for headaches right? As long as my son gets his benefits I can stay reasonably sane, but if he were ever denied I’d go through the roof hearing of these abuse stories. They are rampant-so many of them have cash jobs on the side-I hear about them! I’d be ashamed to tell my friends, but apparantly their friends are accepting and supportive of this! In the case of the woman described above she’s just sitting around her little cabin enjoying her stress free life and not worrying about cash jobs right now. She has parents who give her cash when she needs it bad. Read a recent article about doctors in certain areas that are particularly sympathetic about putting people on disability in hard economic times and work goes around and people seek these doctors out to become eligible.

  • Veeda Fuchs

    I have Meniere’s disease and I have had it most of my life. It affects the balance, hearing and causes a person to go deaf slowly. There are dizzy spells and vertigo. I have had the symptoms over most of my life. I was diagnosed at age 58. There were periods of remission. At this late age of 64 I have had vertigo and hearing impairment. Sometimes I could not hear what people we saying or listen to music. The telephone was impossible to use. I am retired now. I just started social security and am waiting for Medicare to begin next year. My two pensions do not pay enough to have health care. But when I was having hearing loss issues last year, I knew then I could never work in an office like I did for 25 years. Without my being able to hear, I cannot do my job.

    Sometimes we look OK as people see us, but sometimes there are disabilities that cannot be seen by looking at someone. Have some compassion. I am not afraid of the disease as I tell other Meniere’s sufferers. But they complain sometimes, family and friends just do not understand.

    Plus, I have never been told by any Ear doctor to seek disability. There are some who get it. I was not fully in the bad symptoms that it stopped me from working. And I was able to hold out to get my social security. Others have issues sooner.

  • http://www.facebook.com/mdoino1 Mari Doino

    Dr. Mokotoff!

    I am on SS Disability with Medicare/Medicaid! I have several spinal chord injuries! I look pretty good, my Neurosurgeon said “If I hadn’t have looked at your imaging I wouldn’t thought there was a thing wrong with you”. I wouldn’t be in this situation if not for a series of misdiagnosis, and Incompetent Doctors! I am tired of being discriminated against by Doctors like yourself! Fortunately my heart is fine, and except for my spine I am as healthy as a horse. I refused to succumb, I do yoga and exercise, so I am not obese, like many back patients, who are into much pain to move at all! This is thanks to Incompetent Doctors who don’t recognize symptoms of nerve damage! My life has been ruined by incompetent and sanctimonious doctors like Yourself! I have had to leave jobs, because I could not get basic accommodations! Oh and with my constant pain and my leg giving out, I worked 2 jobs for years and attended College. I might have been able to continue if I had gotten competent medical care, and a diagnosis.

    There is another factor involved also, jobs have gotten so repetitive. The human body can only take so much! also without Health Insurance and Medical care, a minor injury can become disabling!

    Shut it Doctor! I would like to consider you for a demonstration on Chronic Pain! I can simulate some of the symptoms with a car battery and some alligator clips! Unfortunately I can’t factor in duration, and the not knowing when it will end! I am tired of snarky articles like yours! You obviously cannot comprehend all of the factors involved!
    you probably only practice Cardiology, because that is where the money is!

  • Tom Eleson

    The examples you use of fraud “And unlike private disability rewards, no one from the government will be snooping around the SSDI beneficiary’s home to see evidence of fraud, like washing their car, playing golf, fixing a roof, hauling hay, etc.” are only in context when you consider the way the work is performed and whether it can be continued. All you are doing along with most of the commenters here is justifying your derision. That’s fine: It fits.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      There was a time when they used to have someone go check up on everyone, but from what I have heard that isn’t the case so much anymore because of the number of people on it. There’s too many now for them to do that the way they once used to.

      • Tom Eleson

        I believe you are thinking of insurance companies. They do that, sneak around looking for evidence to deny a claim because they believe anyone that files a claim is committing fraud. This doctor would be a good ally for them. Perhaps you would be too!

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          Interesting thought that makes sense. I am not sure where the person that told me that got the information. Because I have always known that there were those that were checked up on because of the issue of false claims which as you say would be fraud. As I said makes sense to me. Thanks.

  • Tom Eleson

    David Mokotoff,

    Your generalizations are astounding and while you appear to be passionate about your cardiac patients I don’t believe you.

  • http://www.facebook.com/sujana.pulivarti Sujana Pulivarti

    for those of you who need a crash course in neurology-the brain is the most important structure in the body. unipolar depression according to the world health organization, is the number one disease burden in the world. most of it has to do with lack of monetary funds to access professionals who can help them. i went to get screened to see if i am qualified for ssi and it turns out i am qualified for medicare and medicaid. i refuse to go on ssi–to me it means the end of life. i will continue to fight everyday. as for medicaid, i need desperately because my medicates cost 1,000 dollars a month plus i have receive maintence ECT every 6 months. i feel like i have been robbed somehow and i must have done something to deserve this awful disorder. as much as i advocate for mental illness as medical condition; i will never fully accept that fact. Deep down inside; I will always, always think that I am a lazy, worthless person. i am ashamed and when i hear doctors and people with normal functioning lives who call us lazy, stupid, and just plain whiners; I truly feel like an empty shell. -sujana pulivarti, jd, m.s.e.

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