The American Association for Disability Policy Reform
— rehabilitation first —
Discrimination Against the Poor
Ernie injured his back when he lost control of his car and crashed in a small-town auto race. Having worked as a carpenter, going from one job to another, he had no insurance and far too little money for health care. The nearest charity clinic was swamped with patients and couldn't help. As a result, when Ernie went to apply for disability benefits, he had almost no medical records. His treatment by the Social Security Administration was typical: If you've got no medical records, you've got no medical (or psychological) problems. They turned him down.
For the Social Security Administration, Ernie's treatment was ROUTINE. It happens every day, in thousands of cases. And Congress hasn't a clue.
Here are some of the reasons the disability program discriminates against the poor:
- The poor are commonly less educated. This places them at a disadvantage by not being able to explain the nature of their impairments as well as others can. Some have a particularly hard time with written communication (Social Security's forms).
- Many of the poor cannot afford to maintain a phone number for contact, causing them to have difficulty looking out for their interests while applying for benefits. The homeless cannot maintain a reliable mailing address, causing them to miss form requests and notices. They are at risk of being denied benefits with "whereabouts unknown" given as the reason.
- The poor rarely can afford health care, commonly have little or no access to health care, and sometimes can't get to a source of health care even when it's available. Since the Social Security Administration assumes that medical records provide the best source of information about an applicant's ability to work, the poor are placed at a great disadvantage. Decision-makers normally assume that those without medical records don't have medical problems. In the list of conditions which are assumed to render a person unable to earn anything (called "the listings" [20 C.F.R. 404(P)(1)]), we find the following remarkable piece of text which states the Social Security Administration's attitude that a person whose condition meets the requirements of a listing will have medical records showing that the requirements are satisfied:
We will usually need a longitudinal clinical record to assess the severity and expected duration of your impairment(s). If you have a listing-level impairment, you probably will have received medically prescribed treatment. ... The record will provide us with information on your functional status over an extended period of time and show whether your ability to function is improving, worsening, or unchanging. ... If you do not receive treatment, you cannot show an impairment that meets the criteria of most of these listings. ... In rare instances where there is no or insufficient longitudinal evidence, we may purchase a consultative examination(s) to help us establish the severity and duration of your impairment.
Unfortunately, except in extreme cases, the examinations the Social Security Administration purchases are of little or no value in determining whether or not an applicant is or has been disabled (details). Thus, those without past medical care are denied one of the most important routes to obtaining disability benefits, by having medical records which show that their conditions meet the requirements of a disability listing.
The listings include many requirements for medical tests and treatments which the poor cannot afford. Among these are computerized axial tomography (CAT scans), magnetic resonance imaging (MRI scans), bone density tests, blood tests repeated over an extended period of time, genetic testing, echocardiograms, nuclear stress tests, Holter monitoring, cardiac catheterization, angiography, electroencephalography (EEG tests), ambulatory EEG testing, endoscopy (esophagoscopy and gastroscopy), biopsies, paracentesis, examinations by certain specialists, angioplasty, blood transfusions, organ or stem cell transplantation, renal dialysis, chemotherapy and hospitalization. The Social Security Administration almost never will purchase any of these and some of the poor are not even able to get to the nearest charity clinic, even when a clinic is available.
The assumption that the disabled have medical records showing disability greatly favors those who have (or recently have had) the money or medical insurance needed to get medical care. Those who have been able to afford multiple visits to doctors to complain about their problems are able to develop a record of complaints, prescriptions and, at times, surgery. Having no reliable method for evaluating subjective complaints (of pain, fatigue, anxiety, etc.), Social Security decision makers often are forced to equate records of complaints, prescriptions and surgery with disability. Because the poor, are not able to accumulate a history of complaints, prescriptions and surgery, they are assumed to have been in good health and are placed at a great disadvantage.
- The poor do not have the same access to disability representatives as do those with money. As a result, some of those who most need assistance in applying for disability benefits cannot get the help they need.
For all these reasons, the poor are at a large disadvantage in applying for disability benefits. Some of the most disabled of our society and most in need of help are the least likely to be granted disability benefits. We find the lack of sensitivity to the plight of the poor on the part of Congress and the Social Security Administration to be very unfortunate. Reform is badly needed.
Last updated on 10/11/12.