Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

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

David Mokotoff, MD
Physician
March 29, 2013
Share
Tweet
Share

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.

Prev

A frequent witness to the power of faith

March 29, 2013 Kevin 4
…
Next

Clinical pearls that you don't learn during medical training

March 29, 2013 Kevin 6
…

Tagged as: Psychiatry

Post navigation

< Previous Post
A frequent witness to the power of faith
Next Post >
Clinical pearls that you don't learn during medical training

ADVERTISEMENT

More by David Mokotoff, MD

  • How tunnel vision can lead to bad medicine

    David Mokotoff, MD
  • Why doctors don’t like to retire

    David Mokotoff, MD
  • The unscientific lure of antibiotics

    David Mokotoff, MD

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 180 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

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

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...