Banksy, Nola Girl with Umbrella

"The avoidance of taxes is the only intellectual pursuit which still carries some reward."

-John Maynard Keynes-

Last year, I spent a lot of time helping people prove they were disabled in order to collect about $950 a month in disability benefits. While my office did not take on cases without merit, there were certainly some disabled clients who walked a fine line between sometimes being able to work part-time at minimum wage jobs and being disabled profoundly enough to collect benefits.

Hidden Unemployment

Source: The Lovely Addict

In March, This American Life aired a piece called "Trends with Benefits" about the increasing cost of Social Security disability claims. Right now, 14 million people collect Social Security Disability Insurance or Supplemental Security Income.* Many economists argue that rising disability claims result from two trends: an aging workforce, and a changing economy. Because the rise in the number of claims is tied to the slowing of the economy, people have labeled the group of borderline disabled Americans who collect Social Security benefits the "Hidden Unemployed". 

What happens to vulnerable people in America? 
During the course of my work, I discovered two things: 

1. Part of the process of making a disability claim involves proving that one can no longer do the kind of work they have been trained to do. 
2. Most of our clients were unable to afford current housing and living costs, even with disability benefits.

The first fact means that the application process is easier for people who have only performed unskilled work. This group is also more vulnerable to work injuries and the effects of outsourcing. The second is just plain depressing, since disabled people often require assistive care and expensive accessible housing units. In 2009, the National Coalition for the Homeless reported that 13% of homeless people are physically disabled, and 26% suffer from chronic mental illnesses. Clearly, many disabled people are clinging to a hole-ridden safety net.

*SSDI is a conventional insurance program funded by payroll contributions. SSI on the other hand, is a social safety net program for people who have not worked enough to pay into the system. It is funded by general tax revenues.

The Life & Death of the American Social Security System

Source: Modern American Poetry, The Great Depression

During the social and economic upheavals of the Great Depression, American politicians finally recognized an opportunity to create an organized program which would provide ongoing substantive care for the elderly and disabled. The resulting creation of the Social Security Administration meant that the US government could reduce national poverty through a future-oriented insurance program. However, the system was not without its flaws; changing demographics, rising inflation, and lower tax revenues now threaten to deplete the trust fund that supports Social Security by 2033.

Source: The Simpsons

How to Help Old & Disabled People

If we don't change our current tax structure, Social Security is doomed to fail within the next century. Social service workers see themselves torn between reinforcing a system which barely works at all and pushing for larger reforms. However, the backlash to Mitt Romney's comment about the "47% of voters who are dependent on the government" shows that many people are learning to acknowledge the problems with our tax and safety net systems and attribute the cause to social and economic issues, not the failure of the disabled and working poor to take "personal responsibility".

"Laughter is the best medicine for when you cannot afford health insurance."

-Probably an American-

Have you seen this video?
Some key statistics regarding pre-Obamacare healthcare:

• Only about 28% of Americans get their insurance through government-funded programs.
• The US spends about 18% of its GDP on healthcare costs. Australia pays 9%.
• A month of the drug Lipitor in the US costs $124. In New Zealand it costs $7.
• America has higher rates of obesity, but less alcohol and tobacco use than most developed countries. 
• Tort reform (i.e., state laws passed to guard against frivolous malpractice lawsuits), have led to a .1% drop in health costs. Defensive medicine only accounts for 2% of our total health spending.

Healthcare is a unique part of the economy, and research suggests that it is a fairly inelastic market. Healthcare companies won't change enough because of competition; there's just not enough incentive to do so. Therefore, Obamacare will probably not lower healthcare costs to nearly the level of countries that provide socialized medical services.

Source: Invendo-Medical, Colonoscope

Up Yours
In an article focused on the price of American colonoscopies, Elisabeth Rosenthal of The New York Times examined the difference between American health companies and comparable but cheaper varieties of care in other countries. Competition actually played a role in raising the cost of a procedure in her case study. Rosenthal found:

"The high price paid for colonoscopies mostly results...from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees."

Rosenthal's example shows that healthcare is a capitalistic industry, and generally has no real drive to provide better or cheaper care. Business executives only need to ensure that every part of the system is profitable by constructing ways to maintain high profit levels for the companies, doctors, and administrative personnel who provide services. The threat to UPMC's tax exempt status demonstrates that even supposed charitable institutions are not immune from corporate influences.

In the future, everyone will die from typhoid and blood poisoning. Like Oregon Trail. 

Source: The Oregon Trail

True story: in 1911, the whiskey maker Jack Daniel died from blood poisoning he contracted after kicking a safe. Research shows that unless a new generation of antibiotics is developed in the next few decades, it's possible we'll all be felled by similarly preventable bacterial infections and diseases. The problem is that there is no market incentive for pharmaceutical industries to produce new antibiotics. Indeed, The Washington Post reported in 2012 that pharmaceutical companies are shutting down antibiotic labs. The reasons? Technical troubles, excessive regulation, and lack of profitability.

Life in not a race. It's a marathon.
Antibiotics, which cure diseases quickly and permanently, are less profitable than maintenance drugs like insulin, so companies aren't investing in new ones. Meanwhile, deadly superbugs are popping up in hospitals worldwide. As The Post reported, "it's a case of evolution outrunning capitalism."

In an article for Jacobin, Leigh Phillips argues that cases like this are proof that it is actually essential to socialize some parts of the medical industry; without political support for research, there will simply not be an incentive to develop new antibiotics...and many of us will eventually die from quaint diseases like cholera and dysentery.

Social Welfare and Health Policies
Social service workers have long been confined by immediate client needs to advocating on behalf of individual patients. By creating an opportunity for everyone to buy affordable health insurance, Obamacare allows us to broaden our efforts to include other policy reforms.

Although Obamacare has many faults, it represents a step in the direction of creating transparency within the health care industry, lowering prices for some patients, and preventing medical bankruptcies caused by paying for uninsured procedures. However, policy makers have to take a comprehensive approach to disentangling the messy dynamics of a profit-driven healthcare system. As the "superbug" articles demonstrate, complacency is dangerous.