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Copying over a post from the ssc subreddit because I found it interesting. (Hope this is allowed.)
In the mid 2010s there was a crisis around social security disability. Things were so dire that estimates placed the DI reserves to run out by 2016.
And yet as we know, this didn't happen. Part of it was thanks to the Bipartisan Budget Act of 2015, which temporarily reallocated payroll tax revenues from the OAS fund to the DI trust fund but that was temporary and ran out in 2022. And as far as I can tell (and as far as my double checks with the chatbots can find), it wasn't extended.
And now with the upcoming social security crisis the DI reserves are the only part to not be facing any expected issues.
Another piece of the disability crisis, 14 million people were on disability in 2013 and the number was expected to keep rising and rising. And yet it didn't happen, the trend reversed and as of 2024, only around 7 million are on disability It was halved! Substantial drop! We're back to levels from two decades ago.
Why? How did things change so radically so fast?
Covid. I don't know how much of an impact Covid had, but it was disproportionately impacting the disabled both directly and indirectly (by using up hospital resources) and that likely lead to some deaths but it doesn't seem to be that much, we were already trending downwards before the pandemic. [Edit: See edit below, it's quite possible that Covid had a greater impact than I thought]
The social security admin changed up their policies a bit and got more pressure on appeal judges to make denials. This had an impact, but the changes to denial rates don't seem to be that drastic to explain a 50% drop. And since then that small trend downwards has actually reversed too, the overall final award rate of 2024 applications seems to be higher than the mid 2010s average.
I don't think those are the main reasons why it changed.
What do I propose was the main reason? The economy got stronger and the disabled got older.
You can see for yourself how disability applications correspond pretty heavily with the unemployment rate.
Unemployment has a selection bias, it mostly impacts the older, sicker and less educated. Those are people who in a good economy with low unemployment might be able to get jobs, but in a weaker economy they are too old and disabled to find something compared to their healthier younger peers.
You can see a huge surge in disability applications around the time of the great recession. These people were largely in their late 50s and early 60s, too young for early retirement but too old in the recession environment to compete well.
An NPR article from the time reveals this in an example of [in 2009] 56 year old Scott Birdsall and what an employee at a retraining center told him after a local mill closed down and the aging workers were left finding other jobs
A 56 year old in 2009 is what age in 2024? 71. They are past retirement age, and would have transitioned off of disability and onto normal retirement pay.
This is what I think solved a significant portion of the disability crisis. Overall disability in the late aughts and early 2010s was being used as a makeshift early retirement program for uneducated middle aged and senior workers who didn't yet quality for their benefits, but were functionally unemployable already in the post recession economy.
And while I came up with this idea for myself, during research I stumbled onto an analysis that suggests the same thing. Their analysis ended at 2019, where there was still roughly 9.8 million on the rolls, and found that about half the explanation is the business cycle/aging and half is ALJ retraining. The trend from 2019-2024 is likely explained in a similar way, and given the increased final award rates we've tended back towards, this is likely explained even more heavily by the aging explanation.
There are some factors that help support this explanation more. SSDI in general tends to go to older, poorer, more rural and sicker (at least given death rates are 2-6x higher than peers) individuals.
While this does not explain why the 2010s surge itself happened since those factors are relatively stable, it does explain why the surge was so temporary.
This also leads to an interesting question, what happens in the next period of high unemployment? How do we plan to address mass AI based layoffs if they occur?
Many people may be able to find a new job, but many won't and we will likely be facing a new disability crisis if it is forced to served as a early retirement program again.
Edit:
Thinking about it, one weirdness here is Covid unemployment which didn't seem to increase disability rates and in fact the trend downwards continued despite that. But we did see a huge surge in early retirement with about 2.6 million excess retirees. So maybe something changed in how early retirement works since? Or maybe Covid era unemployment mostly impacted younger healthier people or the jobs market for furloughed workers wasn't as bad. Or heck, maybe it's just coincidence that the downward trend was already happening and Covid really did have a major impact on the total number of beneficiaries.
My guess would be in the recovery, Covid unemployment surged higher but recovered really fast so we probably just didn't see as many Scott Birdsall situations.
Back to my thoughts, I'm extremely skeptical that the disability numbers could halve over such a relatively short period without some sort of accounting trickery. I could definitely see Covid having an impact, especially since the vast majority are older people. But the drop in numbers is just too great for me to take them at face value.
We've seen it before with disability, social security, etc, but often times the medicalized benefits system will just shuffle large amounts of people from one category to another once political pressure comes to bear on a label like "disability."
This also reminds me of the old post by Alone on how SSI is basically medicalizing political problems - can't seem to find it but if anyone knows what I'm talking about and has the link that would be great.
Just to get the convo started... wow. I'm reading this NPR article on disability and this is a direct quote:
Ok great, so disability is basically just handouts for people who didn't have the intelligence or wherewhithal to complete college. Got it.
On the one hand I don't think it's necessarily a bad idea to help low IQ folks or those who made poor life choices to some degree - but lets at least make it clear. Hiding it behind this medical idea that they are unable to work is wrong.
I wouldn't put too much stock in that article. The treating physician has very little say in whether a claimant qualifies for disability. Disability isn't a medical condition, it's a legal status based on ability to work, and ability to work can't always be determined by a medical diagnosis (and when it can, that's what the listings are for). The determination of disability is made by and adjudicator in consultation with a doctor employed by the state. This doctor does not actually examine the patient but reviews medical records to find evidence of limitation. He offers an opinion of what the claimant is capable of based on the records, but the legal determination is ultimately up to the adjudicator.
I would also note that it's incredibly uncommon for any treating physician to offer an opinion about a claimant's ability to work, or even to actively participate in the process. Protocol calls for the adjudicator to attempt to call the physician who treats the condition they're claiming disability for, and the only times a doctor was ever willing to speak to me were in cases where the patient was in such bad shape that their disability was almost a given regardless, with the exception of one where a woman had an unusual condition but no money for regular treatment and an ER doctor actually got on the line to explain it to me. Other than that, they aren't even willing to fill out the forms we send them, and take a month to even send the medical records. Occasionally they'll mention in the chart that the patient told them they were applying for disability, but that's usually as far as it goes.
What we looked for wasn't whether the doctor commented on disability specifically, but on their ability to work. Even this was rare, though. There were occasional instances of orders not to lift above so many pounds or walk too far or whatever, but the determination was made based more on clinical signs than on opinions. Even when a physician made a clear statement that the claimant couldn't continue to do their job, our doctors would note the opinion, say they gave it "appropriate" weight, and make their own assessment based on objective markers. If the objective markers weren't there, our doctor wasn't going to recommend disability based on the treating physician's say so.
As far as education goes, that's not something our doctor would touch, or even look at. If you're under 50 and capable of doing sedentary work, you aren't getting disability regardless of your education level. "Education" is kind of a misnomer anyway; whether or not you can do a job doesn't depend on your education level but whether you've done the job in the past 20 years, and the level of Specific Vocational Preparation required as defined by the Dictionary of Occupational Titles. At this point it gets complicated, and beyond age 50 we start looking at transferable skills and the ability to adjust to other work. So you can have a law degree from Harvard but if you're over 50 and did manual labor your whole career it doesn't matter. If you're a high school graduate and only have done office jobs your entire career it doesn't matter. If you're under age 50 and are capable of doing unskilled sedentary work, you aren't getting disability except in unusual circumstances.
Yes from the physician perspective we want the least amount of responsibility here possible and try and be as vague as we can, send to other people when possible, and limit our level of commentary.
Unless specifically specialized in this you don't really get paid for it but accept a bunch of liability.
Classic example is potentially violent emotional support animals.
Keep us the fuck out of it.
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Dr. Timberlake is correct. If your condition disables you to perform the sorts of work that anyone in your vicinity would be willing to pay you money to do, you're factually disabled.
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It's also partly the federal government time limiting most benefit programs supplied by federal grants and making SSDI the best option for permanent support. That sets a single national standard for benefits and keeps users from flocking to the most generous state just for the benefits (not great for the generous state's population in the long run.
How do they take cost-of-living differences into account?
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I think people gloss over the part where I'm worried about mass AI layoffs because it's just a single sentence but I think it's a great place to start for this conversation. Disability is interesting in that it's not a binary question of yes or no but rather depends on your relative ability compared to the people around you and the society you're in.
Imagine a person who is so unbelievably dumb that they can only do work carrying buckets of water from the river because they were taught it as a kid when their brain was slightly more pliable and anything else, including any variation of bucket carrying just does not work out properly. This person obviously does not exist, but if they did then they would just not function anymore in today's society with plumbing and pipes. We don't really have any jobs that are "go get buckets of water from the river for us to drink, shower with and do laundry" anymore. Plumbing turned them from abled (to do the one job) to disabled.
Obviously again this person does not exist in real life and people are more adaptable, even the dumb ones. But in the context of dumb old people with aging bodies and injuries? They might have been able to do the job they've been doing for the past few decades, but transferring them over to something else will be difficult. And in the context of a bad economy with high unemployment? They might not be able to find anything. They're not entirely equal to the water idiot, but they're not that far off either.
In that same way, it's not just the idiot middle aged men anymore that we should be thinking about. A generalist AI in the 2030s might make all of us puny humans disabled by comparison. Technology historically has freed up labor to go to do other jobs, some that didn't even exist until the labor was around to do it. But this future AI might beat us at everything. You may go from your job subsistence farming to the car factory in the past. Now you may go from your current job taken by AI to a new job that also gets taken by AI.
Maybe we'll maintain some comparative advantage and still be worth having most people work despite the absolute supremacy, but this might be an issue coming up. What happens when no one can work anymore because the robots are simply better in every single way? Some would put up that as a utopic paradise, like that silly meme of fully automated luxury communism, others worry about an automated dystopia.
But either way, a major change may be coming. And perhaps all humanity will be disabled. And even if the generalist AI doesn't come for a while, remember the great recession was only 10% unemployment.
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Didn’t complete college and can’t do manual labor. Unless the good doctor is rubber-stamping disability for healthy young farm boys?
What work are they able to do?
There's an entire list of unskilled sedentary jobs as they appear in the Dictionary of Occupational Titles that "exist in significant numbers in the national economy". As long as someone is able to do one of these jobs, they aren't disabled (assuming they're under 50 and thus can be expected to adjust to new work). Most of these are obscure specialized jobs that involve some kind of industrial assembly that con be done entirely sitting down. An example:
The relevant symbols below are that the strength is listed as sedentary, defined as:
And the Specific Vocational Preparation is 2, meaning that for the specific job, the typical worker would be able to achieve an average level of proficiency in less than 1 month. There are a ton of jobs like this you've never heard of, though whether or not they are actually realistic options for the claimant is irrelevant. From what I recall, the law specifically states that it doesn't matter whether such a job is actually available or whether they'd actually be able to get the job if it were available. A lot of people think this is ridiculous, but it underscores the point that disability is for people who physically can't work at any job they are qualified to do, not for people who physically can't work available jobs that they have a chance of actually getting. Saying "but there aren't any jobs as a label pinker" is basically saying that the reason you don't have a job is because you can't find one, not because you can't do one.
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What about babysitting? Or cleaning people's houses?
I'm also of the opinion that most of these issues are psychosomatic, so I will admit I'm a bit biased here. Not that psychosomatic disorders don't need care and compassion, but I'm skeptical that they actually cannot ever work again.
The exact jobs I've seen arguments about on here that are too low-skill and 'anyone can do them' to charge high wages so the cost of childcare is scandalous compared to the labour done.
You can't have it both ways: either that kind of labour is a job and is paid accordingly (not sky high but enough), or it's paid peanuts because "my sixteen year old niece will mind my two kids after school" and thus isn't going to support an adult (let alone one with a family).
And yeah, even for babysitting/childminding, you do need to be able to lift and bend and carry, and it's a job where you can put out your back over time.
Suggesting that disabled coal miners go into childcare might be on par with that Ben Shapiro bit about selling houses.
Well now we need to encourage more men into the industry as it's pretty much female-dominated, do you have something against equality or what? 😁
I’m ready for the Pacifier sequel where Vin Diesel takes on his toughest parenting challenge yet: the opioid epidemic.
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What could possibly go wrong?
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Ahh yes. Cleaning - such a gentle load on a person's back.
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How did you form that opinion, and how confident are you in it?
It's a bit personal, but I am quite confident in it. Read this article on Sarno if you're curious to start going down the chronic pain rabbit hole.
Which of his falsifiable claims hasn't been disproven?
Most of the claims of the mechanisms are likely not spot on I'll admit, but the 'psychological' effect is absolutely real. Make of that what you will.
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My wife also had a chronic health issue for a few years before she stumbled on Sarno and it went away in 2 months by doing (basically) nothing.
Mentioned this to other friends as well and those that "tried it" had similar success stories (tiny sample but still).
So I think this is vastly underestimated. I tried starting a conversation years ago on a comment post on Scott's blog but nothing came of it iirc.
Yeah the typical rationalist mind is allergic to this sort of thing. It's a shame.
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Totally willing to believe most people claiming ‘chronic pain’ are faking it for either 1) a medical marijuana scrip or 2) a disability diagnosis. That doesn’t mean they’re in good health/can take jobs with any arbitrary physical demands.
At the end of the day, blue collar laborers in their fifties are not going to be able to do much if they lose their jobs. Fake disabilities reflect the underlying reality that these people cant adjust to a new set of physical demands.
I think the point is not that they fake it but that they meme themselves into being retarded. The pain is real, the cause is not. Or something like this is the saying.
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@hydroacetylene
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(I legitimately don’t remember who’s a parent or not, don’t get offended) uhh, have you ever watched a toddler? There’s some picking kids up(that may not want to be) involved, and running after them and the like. And cleaning houses is similar- lots of bending over, moving things out of the way. Neither one is conducive to poor-health based physical unfitness, although they don’t need a power lifter.
How dare you??? I have 11 youngins you whippersnapper!!!
Nah, don't have kids yet. I am largely unsympathetic to people with chronic health issues as I've said elsewhere. I'll tag you.
Look, I do a sedentary office job as administrative support. The heaviest things I carry are a bunch of files. I use my hands and arms for typing.
And I had a upper spinal disc problem (yes it showed up on x-ray so no I wasn't imagining or pretending) that meant I had terrible pain that started in my neck, gradually went down my arm, and ended up at the knuckles every single day and night for a prolonged period of time. It genuinely felt like my arm was on fire and I couldn't sleep because of the pain. My doctor didn't put me on painkillers (no idea why, unless it was 'don't want to facilitate addiction') so I was dosing myself up with over-the-counter analgesics (I sincerely believe I may have borked my liver the amounts I was taking for relief, plus I managed through other means to source tablets containing codeine which did permit me to sleep by reducing the pain to a dull roar) and I genuinely feared I wouldn't be able to work, because the pain made it impossible to use my hands.
Fortunately, the trapped nerve or whatever eventually untrapped itself or died or something so the pain stopped.
And that was just for a damn "sit at a desk and type emails etc." job. Imagine if I was doing anything even a bit more labour-intensive requiring dexterity or strength.
So just wait until you get old enough, or over-exert yourself enough, to run into a chronic health issue then come back with the same opinion.
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Sure. If they can do those things, then they’re less disabled. How do you get from there to “handouts for people who didn’t have the intelligence or wherewithal”?
Imagine a more extreme case where a guy loses his legs and, thus, his lifelong job at the widget-stomping factory. If he gets disability, it’s not because he couldn’t make it in college.
Now say a doctor asks him, “hey, do you have any skills that could get you a different job? One that doesn’t require jumping up and down?” Here a college degree would be a mitigating factor for his existing, factual disability. The handout was never for failing college. It was for not having legs.
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Cashier. Delivery driver. Maybe a waiter, probably the guy in the aisle at Home Depot.
These are not ‘good jobs’ but they do pay better than disability.
I figured those were ruled out by the “back problem.”
I agree that, if they are doable, someone might well prefer them to scraping by on disability.
What I don’t get is where “IQ and wherewithal” come into it. Either the guy is able to do jobs or he’s disabled. A college degree adds some set of jobs, so it can take him out of the disabled category, but not put him in.
Cashiers and DoorDash drivers don’t do much heavy lifting, at least. Waiters it varies. The guy in the aisle at Home Depot doesn’t need to lift stuff but needs to be on his feet all day.
Plus if you genuinely have a bad back, standing on your feet all day can put strain on it which causes pain.
If anyone has ever put their back out by lifting something too heavy or the wrong way, you soon find out how every little action somehow involves the muscles of the lower back so that even trying to get out of bed is a production.
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More importantly, they provide actual economic value and give the employee the dignity and a forcing function to get out of bed, have a routine, socialize, et cetera. Work is good for us. Most people on disability, from what I've seen, end up mostly rotting away via endless entertainment.
What have you seen, and how confident are you that it is representative of the broader phenomena it purportedly represents?
I'm not that confident! I also believe from my own personal experiences with chronic pain though, that taking disability is not a good way out for the majority.
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Let me argue for the other side: Disability assistance is providing money to those with the inability to financially support themselves. Stephen Hawking did not require disability assistance, despite being significantly disabled, because his intellect provided him the ability to provide for himself. It makes perfect sense to account for intellectual ability if making the holistic judgment on whether someone's net ability makes them employable. Just consider them to be suffering from a mild intellectual disability on top of their physical one.
But, I largely agree that it reaches a degree of ridiculousness. Where does it end? If someone can't hold down a job due being totally lazy and refusing to arrive on time, I guess they're temporally disabled and we owe them our money.
But wait, let me change the above scenario: the person in question has severe fetal alcohol syndrome. Do they deserve disability now? How about a severe head injury yielding the same result? How about they have absolutely no diagnosable issue but just have 1/10,000,000 shit genes for intellect and conscientiousness?
A tangent.
I keep gravitating back towards my own null hypothesis - public welfare is a bad idea through and through, and no matter how many epicycles its proponents attach in attempts to sanewash it, it will never be a better system than not having public welfare. I know this means that I effectively espouse the need to pay out the ass for private insurance, and that there will be a very large parts of the population near the bottom end of the socioeconomic spectrum that will look very disagreeable even to my middle class sensibilities. A low-wage class, a serf class, a dehumanized mass of barely viable specimens, or outright unviable ones kept alive by their barely viable associates, or unviable ones in the process of honest-to-god starving on the streets. But what will the world look like with another few centuries of public welfare and, I assume, no eugenics? The same low-viable population, only grown unchecked by economic pressure thanks to welfare always bailing them out at significant cost to the productive elements of society.
I keep being told that this is baseless, that the unproductive poor will be elevated by education, or that they will naturally stop breeding, or that each subsequent generation is a blank slate and those non-viable traits will not persist over long timeframes. Or, of course, that AI will fix everything for everyone anyways. Or that there's no point in worrying because the planet is doomed and we may at least die in solidarity and upholding basic standards of living and human dignity for everyone on the way.
But I don't see it. I just don't. What I see is ever-growing burdens placed on those who create value, to the benefit of an ever-growing proportion of those who do not. I'd call it injustice if that made sense to anyone nowadays, when "justice" means that those who don't work are sustained by those who do, forever, no strings attached. Until society as a whole produces nothing but parasites and their sustenance - and then either collapses or finally puts a stop to these dynamics, much later and more grievously than had it been done earlier.
"Do you want to see people dying in the streets?", one might ask me. No I don't. Of course not. But it strikes me as quite possibly the lesser evil, in the long run.
I actually warmed up to welfare over the years, though I strongly disagree with it's unconditional dispensation. In my ideal model any healthy male would need to enroll into boot-camp or equivalent conditions to get a pay-check. The conditions could be relaxed depending on one's health, but essentially, you'd have to break some sweat before you get anything. UBI and other unconditional schemes, or even the "pure formality" conditional ones, are the ultimate evil.
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Yes. Of course, Ayn Rand expressed the same thing in Atlas Shrugged, and all it got her is infamy and some really terrible movies.
The idea that there should be some sort of social insurance for construction workers who lose their legs doesn't seem too unreasonable, even if I might oppose it. When that extends to disability payments for the congenitally lazy or "who made poor life choices to some degree"... well, shit. I don't want to work either, and I didn't get the benefit of those poor life choices the other people made, so why the hell should I be paying for them? Thing is, there seems to be a slippery slope from the reasonable to the unreasonable, and no one with any power is interested in building a fence across it.
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I think I agree Theres a bit of a moral hazard in too much welfare, especially uncoupled from the need to push people to do what they can, and to avoid bad behavior. If someone is generally capable of working, I don’t think they should starve. That’s insane. But if the person is clearly making bad, antisocial decisions, cutting off the gibs would force them to behave. Or for that matter force them to make their kids behave, attend school and do their homework. They should contribute as they are able, and they should be making sure their kids get a decent education. And staying out of crime, drugs, and so on. If you’re doing those kinds of things, im perfectly willing to pay to keep them from starving. If they’re sitting home on gibs, doing drugs, not making sure their kids are getting educated and not getting into trouble, they don’t get the gibs. It should be a hand up to hopefully being self sufficient, not a hand out to keep them comfortable doing nothing.
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I'm not sure why this would be the null hypothesis. Coercively funded public welfare has been around since time immemorial, the consequences of abolishing it have been politically unacceptable even in poorer and harsher times, and members of the manual labour class who can no longer work hard enough to hold down a job due to old age have almost always been seen as the most deserving cases.
Poor relief through the Church in medieval Europe was not voluntary charity - it was institutionalised welfare funded by State-endorsed coercion. In England the system largely operated through the monasteries and there was a combination of real secular coercion (tithes were a compulsory levy which could ultimately be collected by force, and impropriation of rectories by monasteries basically meant that tithes beyond what was needed for the support of the parish priest were diverted to monastic "charity") and spiritual coercion (in a society where people actually believe in a religion which incorporates justification by works, "you will go to hell if you do not leave a reasonable percentage of your net worth to the local monastery" is coercive). In the middle of the 16th century the dissolution of the monasteries and the Reformation mean that this system stops working, and the resulting increase in visible destitution is as politically destabilising as the present-day street-shitting crisis in San Francisco. Eventually England gets a comprehensive system of tax-funded secular poor relief in 1601. The Malthusian turn in the 19th century doesn't change the principle - the workhouses were harsh but they weren't cheap. And "don't put the infirm elderly in the workhouse" was the first demand of left-populists and one of the top five demands of right-populists for most of the next century.
What did change, probably for the worse, was the shift from a poor relief system where who gets what was ultimately at the discretion of local elites who could rely on their own knowledge to distinguish between deserving and undeserving poor to a bureaucratised system. And that change was made by the workhouse-mongers who thought that the local elites were too soft - something that is still an issue in the UK in the present day, where governments of all stripes keep trying to centralise eligibility assessment for disability benefits because patients' own NHS GPs (in the late 20th century, the archetypal local elite) are too soft, particularly in high-unemployment post-industrial areas like the Welsh valleys.
Not the. Just mine.
Fair points on your part. I won't argue against your historical analysis. That said, I still don't think situational barely-subsistence welfare at the discretion of local elites in pre-modern societies corresponds very exactly to universal high-standard-of-living welfare administered by nationally uniform buerocracies in terms of long-term demographic dysgenics.
Disability is not exactly a high standard of living.
Compared to pre-modern people who received any sort of public welfare?
While fair, the actual homeless receive a higher standard of living than the average person in 1800 by some measures(they probably eat a better diet, for example); ‘premodern charity cases’ are a dumb comparison.
Disability cases have a standard of living that’s pretty low by North American standards. There’s probably some room to cut it, but asking them to live like homeless tramps from the Middle Ages isn’t something our society is prepared to do- of anyone.
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SSDI abusers are generally past prime reproductive age, so the impact on long-term demographic dysgenics is nearly zero.
The decision to treat never-married single mothers as deserving poor was, in the UK at least, both conceptually and temporally separate from the decision to bureaucratise poor relief. I agree with you that it hasn't produced good outcomes.
Under the Old Poor Law, the deserving poor were generally understood to be:
Wounded or disabled veterans were increasingly considered deserving poor over the course of the 18th century, although they were not legally treated as such by the Poor Law system so if they didn't qualify for the Royal Hospitals at Chelsea (for the Army) or Greenwich (for the Navy) then they often ended up on the streets or in the workhouse.
True. Which is why I prefaced this entire tangent as such; an excuse to ride my hobby horse of the more general public welfare topic.
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On the other hand, he might have spent more time on his professorial duties (not to mention whatever he considered "leisure"), had his condition not been such a financial burden to his household.
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Yeah I agree, it's extremely hard to draw the line. In generally I think this is why charity from churches and generally voluntary sources is the way to go.
If you force people to pay charity via taxes, it will never be clear enough that the criteria are satisfying what the giver actually wants. It just becomes a total mess. Not that voluntary donations can't be gamed and have their own problems, but it's a whole nother level of bad when it becomes forced.
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