Last weekend I loaded the wife and kids into the car and made the long trip to the sprawling metropolis of Fort Covington, NY to spend Easter with family. While the kids watched Despicable Me (again) I listened to one of my favorite podcasts, This American Life. I highly recommend you take a listen to this episode which was dedicated to the disability system in the US. If you are not into podcasts then you can read about the topic here.
This episode focused on Hale County Alabama where 1 in 4 adults are on disability. However, this problem is not isolated to one county in one state. States like West Virginia, Arkansas, Alabama and Kentucky all have over an 8% disability rate for 16-64 year olds.
The US pays disability benefits to over 14 million people each month and these numbers continue to grow. Not surprising the fastest growing sector of disability is from musculoskeletal disorders (33.8%, up from 8.3% in 1961). I am sure like me, many other physical therapists have seen firsthand how messed up the system is.
What was most interesting to me about the episode was the impact that politics, social ideals and economics had on the disability system. For instance, the unemployment rate makes headlines all the time, but you never hear about the disability rate. So it is a political advantage to move unemployed workers to disability (poof, the unemployment rate goes down). Also, states have to pick up the bill for welfare but the federal government pays for disability. As a result, states will hire consultants to contact people on welfare and attempt to get them qualified for disability.
The episode further expands on this misalignment of incentives. Once on disability you are “punished” (disability benefits taken away) if you get better and/or get a job. As a result, very few people ever get off disability once approved. This got me thinking about the neuromatrix and pain. Imagine a patient with low back pain whose only source of income is a disability check and they have no job prospects. Getting better poses a huge threat and staying disabled and in pain may be the safer option. Maybe we need a questionnaire which measures the fear of getting better?