Showing papers on "Disability insurance published in 1991"

Self-Screening in Targeted Public Transfer Programs

Abstract: The self-screening properties of initial eligibility determination, a mechanism often under the control of the administrators of targeted transfer programs, are derived and the use of this mechanism in the social security disability insurance system is explored empirically. An increase in the rigor of initial eligibility screening may discourage potential applicants because they are unaware of appeal prospects and because the eligibility decision delay is lengthened, as denied applicants are forced to appeal their claims. In the disability program, a 10 percent increase in the initial denial rate induces a 4 percent decrease in applications. Self-selection is nonperverse.

The quiet success of the national plan for the chronically mentally ill.

Abstract: In 1978 the President's Commission on Mental Health called for a national plan for the care of persons with chronic mental illness. The plan was completed and released in 1980, but was never adopted as the policy of the incoming Reagan Administration. Despite changes in attitudes in the 1980s toward the federal government's role in human services and an atmosphere of fiscal restraint, many of the plan's specific recommendations for changes in Supplemental Security Income, Social Security Disability Insurance, Medicaid, and Medicare have been implemented. In this paper, the implementation of these recommendations is analyzed. The authors discuss some of the strategies used by mental health advocacy groups to make gains in the 1980s. Recommendations for the 1990s are discussed.

An Intergenerational Policy Proposal for the 1990s

Abstract: This paper proposes a new policy initiative to assist family caregivers at a time when major demographic shifts in both the family and the workplace have taken place. Women especially are in the position of having to balance both work and family responsibilities without proper assistance. The initiative is based on an expansion of the Temporary Disability Insurance (TDI) model, to include care of family members of all ages by providing an adequate wage replacement. The shifting dependency ratio, resulting in a shrinking caregiver pool, is discussed as well as existing policies and their shortcomings. For example, no current policies provide paid leave. The evolution of TDI, including resistance to it, is examined. Finally, Massachusetts' abortive attempt at a comprehensive plan for employment-leave insurance is discussed in detail and policy recommendations are outlined.

Medicare costs prior to retirement for disabled-worker beneficiaries.

Abstract: This article is the last in a series of studies concerning Medicare program costs of Social Security Disability Insurance (DI) beneficiaries who were under age 62 at time of entitlement to disabled-worker benefits. The earlier work provided the statistical analysis and mathematical models needed to construct estimates of Medicare costs for those beneficiaries while in the DI program. In this article, estimated costs are presented for beneficiaries with various characteristics. Data are also presented that relate possible extensions of Medicare eligibility-elimination of the 2-year waiting period and full Medicare coverage for recovered beneficiaries-to estimated Medicare costs for DI beneficiaries through age 64 under current law. For the 1972 cohort of disabled-workers in this study, the per capita Medicare cost is estimated to be $20,129 at 1989 reimbursement levels. This cost is about 37 percent of the size of estimated cash benefits for the cohort while in the DI program. Elimination of the Medicare waiting period would result in an estimated cost increase of 29 percent. Extending Medicare eligibility through age 64 to all recovered beneficiaries would result in a cost increase of about 9 percent, assuming no Medicare “buy in” in effect.

Ethical Principles and American Public Policy on Disability

Abstract: Three ethical principles (e.g., autonomy, beneficence, and justice) that have influenced the shape of American public policy on disability are discussed, and the counterproductive imbalance between two of those ethical principles in disability policy (e.g., autonomy and beneficence) is explored. The fair opportunity rule of justice is defined and the effect of attitudes concerning the capability of persons with disabilities on the expression of the fair opportunity rule for persons with disabilities is discussed. The relationship between public perception of the capability of persons with disabilities to participate in community life and the expression of ethical principles in disability public policy is explored. The need for a capability-autonomy disability public policy perspective is presented, and recommendations, consistent with that perspective, directed at achieving the goals of current rehabilitation public policy are put forth. American thought that has shaped disability policy has been strongly influenced by three ethical principles that are greatly valued by the American public. These principles are: Beneficence- to do good for others, to take actions that promote the well-being of others (Beauchamp & Childress, 1983). Autonomy- respect for the individual's rights to freedom of tion ("as long as it does not interfere with similar freedoms of others ") and freedom of choice (Kitchener, 1984, p. 46). Justice- "treating persons fairly, which implies treating equal persons equally and nonequal persons differently if the inequality is relevant to the issue in question " (Welfel, 1987, p. 10). Justified distribution of the benefits and burdens of society (Beauchamp & Childress, 1983). It could be hypothesized that since Americans strongly value compassion, freedom, and fairness, they will find acceptable any public policy on disability that clearly reflects the ethical principles of beneficence, autonomy, and justice. Therefore, it is no surprise to find these principles manifested in the purposes of the programs authorized by the disability legislation. Programs such as Rehabilitation, Social Security Disability Insurance (SSDI), and Supplemental Security Insurance (SSI) are all directed at promoting the well-being of persons with disabilities (beneficence driven). They also represent attempts to provide a just allocation of resources to meet the needs of persons with disabilities Oustice driven). Finally, while rehabilitation does so more than SSI or SSDI, they all are to some degree directed at promoting the independence of persons with disabilities (autonomy driven). A Counterproductive imbalance Between the Principles of Beneficence and Autonomy in the Public Policy on Disability The current public policy on disability appears to be more beneficence than autonomy driven. This is most clearly evidenced by the great discrepancy between the level of public support provided for income maintenance and rehabilitation programs for persons with disabilities. Rogers (1987) has estimated that "public and private disability transfer payments (that is, cash payments made to compensate individuals for their disability) made to persons aged 18-64 reached $70.6 billion... in 1981 (p. 117)." On the other hand, less than 2 billion dollars was appropriated for the state-federal rehabilitation program for FY 1986 (National Council on the Handicapped, 1986). The imbalance between the two figures suggests that the American public may not believe that the full participation of persons with disabilities in American society is possible. The large difference in the funding for the two areas suggests that persons with disabilities are paternalistically perceived as a population of "deserving poor" with minimal capacity for self-support and independence (Erlanger & Roth, 1985; Hahn, 1982, Scotch, 1984). Consequently, most public money available for meeting the needs of persons with disabilities is directed toward beneficence driven income maintenance transfer payment programs rather than toward autonomy oriented habilitation/ rehabilitation programs. …

Social Insurance and Social Security: A Comment on Professor Atkinson's Lecture

Abstract: Professor Atkinson has provided us with a very stimulating survey of some central issues in social insurance. The exposition is very clear, and the knowledge that he displays both of theory, history and economic and social institutions is extremely impressive. The lecture has variously been announced as 'The future of social insurance" and simply "Social insurance". In the end it has turned out to be as much about the past as about the future. I am myself very sympathetic to the view that in order to make good choices for the future we must understand the past. This implies a belief not only in the importance of economic and social history as a basis for the economics of today, but also in the intellectual history of thinking about economic problems, in particular about the problems of social insurance. This belief is also very much reflected in Professor Atkinson's lecture. In Norway issues of social insurance have become very prominent in political debate in recent years. The pensions part of the social insurance system will be coming under pressure with the aging of the population that will become particularly significant a decade into the next century. And both politicians and the general public are worried about the growth of payments under the disability insurance system. Throughout the seventies and eighties the number of disabled persons has grown much faster than the population, and the growth rate is high even when one adjusts it for the aging of the population. The empirical evidence indicates among other things that the incidence of disability varies positively with the regional incidence of unemployment, and there is some worry that doctors, who play a key role in declaring people qualified for disability insurance, have a tendency to stretch the purely medical criteria to allow for the absence of alternative employment in the region where people happen to live. If this practice becomes even more common than it is today, it will clearly become untenable. Within the context of our theory we might well take this kind of phenomenon as another piece of evidence in favour of our theories of asymmetric information and moral hazard, but it also raises some wider questions of what the social security system is for, and how social insurance in a narrow technical sense fits into the wider framework of economic and social policy. I very much agree with Atkinson's emphasis on the employment relationship as a key to the understanding of the demand for social insurance. Preindustrial society had risks of its own, related e.g. to the connection between the natural en-