Sunday, June 21, 2015

Disability Insurance and the Cost of Recovery

I’ve established myself as an advocate of getting people off of long-term disability.  Too many people with mental illness are discouraged from living at their most productive potential by a method of assistance that condemns them to living within a system that doles out subsistence while imprisoning them in a life where the guarantee of a monthly check prohibits the risk and reward of work.  There are many incentives to stay on assistance, and many stigmas and barriers to stepping out and being fully responsible for one’s present and future.  I also believe that if some organization is paying one’s bills, then that organization has every right to demand certain behavior of the payee.  Things like medication compliance, lifestyle practices, and the need to contribute in every way possible through volunteering, part-time work, etc. should be expected of the person being supported by someone else.  One is free to neglect treatment and engage in dangerous behavior.  One is also free to make no effort to pay a portion of one’s expenses.  This person, however, should not expect a public entity to support such irresponsibility and squandering of others' contributions, either through charity, insurance, or tax-based transfer programs.  The benefit of work on treatment outcomes is well established, and the legal structure exists to enable the challenged person to work with accommodations.  So to be very blunt, comply and try or expect no assistance.

This insistence must be tempered by the fact that some people are unable to work.  Just as society should provide opportunities for people to get off assistance, society has the obligation to take care of the most difficult cases.  In no way should people so sick they cannot function independently be left to suffer in a society that has resources to provide them with a comfortable and safe lifestyle.  But again, treatment compliance should be mandatory. 

The people with diagnoses who require assistance can place demands on the system  that supports them as well.  The biggest demands we can make are for compassion and understanding.  Society must not stray too far into the idea of individual responsibility that it maintains that every person is fully responsible for his own challenges.  Unexpected things happen, and few get well without help.  No one with a mental illness chooses to be sick.  Those who overcome the difficulty of living with mental illness and find success should be celebrated.  But so should every person who even tries, whether they fail or succeed.  For these people a safety net seems fair, just, and moral.

This compassion seems to be slipping from society.  Dignity and respect are afforded less and less to people who need help.  The left seems willing to sit with a system of “pay and go away.”  The right is so enamored with liberty and dictating morality that anyone who is different and needs a hand is viewed negatively.  In previous economic downturns assistance was given enthusiastically to those who lost and were trying to recover.  This did not happen in the last recession and it hasn’t happened since.  In fact, in many cases those who are less fortunate have been demonized and asked to suffer for mistakes and choices they made with a mind that did not function normally, or for actions that were taken in desperation.  Forgiveness and second chances are rare.

So the onus of recovery is on both sides.  Effort on the side of the challenged, and opportunity on the side of the advantaged.  Instead of mindlessly paying out benefits to those who can qualify, why not give incentives to doctors, treatment centers, and job training programs which move people off of disability and into self-sufficient society?  The person home and unable to work should not be blamed.  But their situation should rarely be accepted as permanent either.  All can contribute, and all can improve their own outcome and society’s.

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