In the past three decades, the number of Americans who are on disability has skyrocketed. The rise has come even as medical advances have allowed many more people to remain on the job, and new laws have banned workplace discrimination against the disabled. Every month, 14 million people now get a disability check from the government.
The federal government spends more money each year on cash payments for disabled former workers than it spends on food stamps and welfare combined. Yet people relying on disability payments are often overlooked in discussions of the social safety net. The vast majority of people on federal disability do not work.
Yet because they are not technically part of the labor force, they are not counted among the unemployed.
In other words, people on disability don’t show up in any of the places we usually look to see how the economy is doing. But the story of these programs — who goes on them, and why, and what happens after that — is, to a large extent, the story of the U.S. economy. It’s the story not only of an aging workforce, but also of a hidden, increasingly expensive safety net.
For the past six months, I’ve been reporting on the growth of federal disability programs. I’ve been trying to understand what disability means for American workers, and, more broadly, what it means for poor people in America nearly 20 years after we ended welfare as we knew it. Here’s what I found.
In Hale County, Alabama, nearly 1 in 4 working-age adults is on disability.
On the day government checks come in every month, banks stay open late, Main Street fills up with cars, and anybody looking to unload an old TV or armchair has a yard sale.
Sonny Ryan, a retired judge in town, didn’t hear disability cases in his courtroom. But the subject came up often. He described one exchange he had with a man who was on disability but looked healthy.
“Just out of curiosity, what is your disability?” the judge asked from the bench.
“I have high blood pressure,” the man said.
“So do I,” the judge said. “What else?”
“I have diabetes.”
“So do I.”
There’s no diagnosis called disability. You don’t go to the doctor and the doctor says, “We’ve run the tests and it looks like you have disability.” It’s squishy enough that you can end up with one person with high blood pressure who is labeled disabled and another who is not.
I talked to lots of people in Hale County who were on disability. Sometimes, the disability seemed unambiguous.
“I was in a 1990 Jeep Cherokee Laredo,” Dane Mitchell, a 23-year-old guy I met in a coffee shop, told me. “I flipped it both ways, flew 165 feet from the Jeep, going through 12 to 14,000 volts of electrical lines. Then I landed into a briar patch. I broke all five of my right toes, my right hip, seven of my vertebrae, shattering one, breaking a right rib, punctured my lung, and then I cracked my neck.”
Other stories seemed less clear. I sat with lots of women in Hale County who told me how their backs kept them up at night and made it hard for them to stand on the job. “I used to cry to try to work,” one woman told me. “It was so painful.”
People don’t seem to be faking this pain, but it gets confusing. I have back pain. My editor has a herniated disc, and he works harder than anyone I know. There must be millions of people with asthma and diabetes who go to work every day. Who gets to decide whether, say, back pain makes someone disabled?
As far as the federal government is concerned, you’re disabled if you have a medical condition that makes it impossible to work. In practice, it’s a judgment call made in doctors’ offices and courtrooms around the country. The health problems where there is most latitude for judgment — back pain, mental illness — are among the fastest growing causes of disability.
In Hale County, there was one guy whose name was mentioned in almost every story about becoming disabled: Dr. Perry Timberlake. I began to wonder if he was the reason so many people in Hale County are on disability. Maybe he was running some sort of disability scam, referring tons of people into the program.
After sitting in the waiting room of his clinic several mornings in a row, I met Dr. Timberlake. It turns out, there is nothing shifty about him. He is a doctor in a very poor place where pretty much every person who comes into his office tells him they are in pain.
“We talk about the pain and what it’s like,” he says. “I always ask them, ‘What grade did you finish?'”
What grade did you finish, of course, is not really a medical question. But Dr. Timberlake believes he needs this information in disability cases because people who have only a high school education aren’t going to be able to get a sit-down job.
Dr. Timberlake is making a judgment call that if you have a particular back problem and a college degree, you’re not disabled. Without the degree, you are.
Over and over again, I’d listen to someone’s story of how back pain meant they could no longer work, or how a shoulder injury had put them out of a job. Then I would ask: What about a job where you don’t have to lift things, or a job where you don’t have to use your shoulder, or a job where you can sit down? They would look at me as if I were asking, “How come you didn’t consider becoming an astronaut?”
One woman I met, Ethel Thomas, is on disability for back pain after working many years at the fish plant, and then as a nurse’s aide. When I asked her what job she would have in her dream world, she told me she would be the woman at the Social Security office who weeds through disability applications. I figured she said this because she thought she’d be good at weeding out the cheaters. But that wasn’t it. She said she wanted this job because it is the only job she’s seen where you get to sit all day.
At first, I found this hard to believe. But then I started looking around town. There’s the McDonald’s, the fish plant, the truck repair shop. I went down a list of job openings — Occupational Therapist, McDonald’s, McDonald’s, Truck Driver (heavy lifting), KFC, Registered Nurse, McDonald’s.
I actually think it might be possible that Ethel could not conceive of a job that would accommodate her pain.
There’s a story we hear all the time these days that doesn’t, on its face, seem to have anything to do with disability: Local Mill Shuts Down. Or, maybe: Factory To Close.
Four years ago, when I was working as a reporter in Seattle, I did that story. I stood with workers in a dead mill in Aberdeen, Washington and memorialized the era when you could graduate from high school and get a job at a mill and live a good life. That was the end of the story.
But after I got interested in disability, I followed up with some of the guys to see what happened to them after the mill closed. One of them, Scott Birdsall, went to lots of meetings where he learned about retraining programs and educational opportunities. At one meeting, he says, a staff member pulled him aside.
“Scotty, I’m gonna be honest with you,” the guy told him. “There’s nobody gonna hire you … We’re just hiding you guys.” The staff member’s advice to Scott was blunt: “Just suck all the benefits you can out of the system until everything is gone, and then you’re on your own.”
Scott, who was 56 years old at the time, says it was the most real thing anyone had said to him in a while.
There used to be a lot of jobs that you could do with just a high school degree, and that paid enough to be considered middle class. I knew, of course, that those have been disappearing for decades. What surprised me was what has been happening to many of the people who lost those jobs: They’ve been going on disability.
Somewhere around 30 years ago, the economy started changing in some fundamental ways. There are now millions of Americans who do not have the skills or education to make it in this country.
Politicians pay lip service to this problem during election cycles, but American leaders have not sat down and come up with a comprehensive plan.
In the meantime, federal disability programs became our extremely expensive default plan. The two big disability programs, including health care for disabled workers, cost some $260 billion a year.
People at the Social Security Administration, which runs the federal disability programs, say we cannot afford this. The reserves in the disability insurance program are on track to run out in 2016, Steve Goss, the chief actuary at Social Security, told me.
Goss is confident that Congress will act to keep disability payments flowing, probably by taking money from the Social Security retirement fund. Of course, the retirement fund itself is on track to run out of money by 2035.
Goss and his colleagues have worked out a temporary fix under which the retirement and disability funds will both run out of money by 2033. He says he hopes the country will have come up with a better plan by then.