Professional Documents
Culture Documents
The Inadequacies of Health Care Policy for Disabled Persons in the U.S.
With the evolution of many health care policies in the United States throughout
the 20th and 21st centuries, we have witnessed the uprising of many injustices within the
health care system itself. In 2005, we observed that about 45 million people or 18% of
the nonelderly population in this country was without health insurance, and the number
has continued to grow every year (Kraft and Furlong 227). Of those Americans that are
uninsured, it is estimated that over 400,000 of them are disabled individuals (Center).
While the government has set up some provisions for disabled citizens, the procedural
policies and requirement standards to attain them are inadequate and inefficient. As a
student with a developmental spinal disability whose mother is also disabled as the
result of a car accident, I have personally encountered the injustices of the health care
system for both children and adults. With regard to the federal government’s attempts
to provide disabled citizens with health care, I have seen that the greatest flaws in this
system are the result of inadequate policy design, inefficient policy problem analysis,
and the failure to meet the evaluative criteria of public policy proposals.
According to Michael Kraft and Scott Furlong, in Public Policy: Politics, Analysis,
and Alternatives, policy design refers to “the careful consideration, during the policy
formulation stage, of the role of the government agents and the target population –
those who receive benefits or who the objects of government regulation are” (Kraft and
Furlong 137). In other words, the focus of policy design should be directed by the need
amendment to the Social Security Act of 1935, to help senior citizens age 65 or older
meet basic health care needs (Kraft and Furlong 230). In 1972, Medicare was
expanded to include people who have “significant” disabilities. With this change,
lawmakers created a waiting period which mandates that people with disabilities must
first receive Social Security Disability Insurance (SSDI) cash benefits for 24 months,
an individual must be “unable to engage in any "substantial gainful activity" due to any
result in death or which has lasted or can be expected to last for a continuous period of
not less than 12 months. In addition to being unable to perform his or her previous work,
the person cannot, considering age, education, and work experience, engage in any
other kind of SGA that exists in the national economy” (Social). In my experiences, I
have observed these standards to be so stringent and unreasonable to the point where
my own mother, age 41, who has an immobilizing nervous condition, cannot sit or stand
for long periods of time, cannot lift more than 30 pounds, and is certainly unable to
maintain a job in the workplace was repeatedly denied benefits for four years before
finally qualifying for SSDI. This discrimination is even more observable on a broader
scale: 64% of applicants in 2005 were flat out denied admission into the program
(Social). Is it really likely that only 36% of SSDI applicants were actually disabled? In
fact, the system actually has a variety of technicalities and standards which are merely
meant to limit the beneficiaries of SSDI services. The policy design of this system is not
Typically, SSDI has a period of approval determination from the Social Security
received, and then another 24 month waiting period to get Medicare coverage
little ability to provide for themselves, may have to wait years to attain medical
coverage? To further exemplify the flaws of the system’s policy design, I, as a child did
in fact qualify for SSDI, however, when I reached age 18, I had to re-qualify and start
the entire approval process over again because of the absurd appeal process, further
delaying my access to medical care for many years. In fact, the condition of my spinal
disability can only worsen over time. There is no chance that it could have improved or
could have miraculously gone away from age 17 to 18, but SSDI’s unreasonable
program.
that 400,000 Americans with disabilities are uninsured and many more are underinsured
at a time in their lives when the need for health coverage is most dire. In fact, various
studies show that death rates among SSDI recipients are highest during the two year
efficient one when it is, in effect, responsible for the deaths of its target citizens. The
policy design of disability health care in the United States allows disabled persons
access to medical care; however, it shows its obvious faults. Again, the goal of a policy
program is not successful in doing this, then there needs to be some problem analysis
and evaluation.
In Public Policy: Politics, Analysis, and Alternatives, Michael Kraft and Scott
Furlong present the concept of problem analysis. “Problem analysis involves trying to
answer the basic questions about the nature of a problem, its extent or magnitude, how
it came about, its major causes, and why it is important to deal with as a matter of public
policy” (Kraft and Furlong 123). To conduct problem analysis on a public policy, there
needs to be some kind of defining indicator or quantitative measure which details the
extent of the problem at hand. With respect to disability health care policy, some of the
problems at hand are complex and are at times immeasurable by some quantitative
value; however the primary issue is indeed a measurable one. As stated previously,
As the cost of medical care continues to grow, the uninsured, especially the
disabled, are subject to being sicker more frequently, will receive inadequate medical
attention for emergencies, and are 25% more likely to die than citizens with health
insurance (Kraft and Furlong 227). In addition, it is known that four percent of persons
on SSDI die during the waiting period for Medicare. These are obvious quantitative
figures that can be useful in establishing problem analysis; however there are many
other qualitative problems to be analyzed. One such issue includes SSDI’s narrow
response time allocation for the disabled individuals enrolled. For example, if there is
paperwork that a disabled person must fill out within a certain time period (i.e. usually
seven days), and they are unable to submit that paperwork by the deadline, they are
subject to being expelled from SSDI. Doesn’t it seem hypocritical to make a disabled
potentially helpless person for not submitting some paperwork within an unreasonable
narrow time gap? Also, as mentioned previously, the reevaluation cutoff at age 18 for a
child receiving services is another problem to be analyzed. The sum of all these issues
explains the extent of problems to be analyzed as well as how they came about as a
direct effect of the policies established. In problem analysis, we also have to try and
forecast the extenuating effects of a problem if left unresolved and how they will affect
the policy target population over time (Kraft and Furlong 129). As the baby boomers
reach the age of increased likelihood of disability, the need for medical care will only
grow. However, from evidence presented, it is clear that the future of disability health
care policy, unchanged, will only lend itself to leaving more and more disabled persons
without medical care. The next step is to look at the evaluative criteria to see how
policy or government action” (Kraft and Furlong 148). With regard to health care policy
for disabled persons, it seems that the attempts to meet the evaluative criteria are
abysmal. These policy evaluations depend greatly on the problem analysis results, and
since those results are hardly reflective of the true problems to be addressed, the
evaluation results are skewed and result in only minor changes, if any, to the system.
While the focus of most national attention seems to be reducing the overall percentage
of persons without health coverage, reducing the percentage of uninsured disabled
The selected criteria for evaluating public policy proposals are based on:
technical feasibility, and social acceptability of the policy. To address the evaluating
criteria in disability health care policy, we need to first shed light on its effectiveness
before examining other flaws in the process. The need for effectiveness criterion is
evident in the complaints about all flawed government programs including SSDI. In this
sense, effectiveness refers to reaching the starting goals and objectives of the policy at
hand (Kraft and Furlong 151). Since hundreds of thousands of disabled citizens remain
without health care despite the establishment of a federal program to alleviate this, the
lawmakers should consider both problem analysis of quantitative data and ethical
analysis of feedback from disabled citizens (Kraft and Furlong 173). The efficiency of
disability health care policy must truly be questioned as well. When a policy design
mandates that disabled persons have to wait years and years to receive Medicare
benefits, this is clearly the farthest thing from efficiency. Additionally, this policy is not
even fiscally responsible because of the determination and redetermination costs and/or
the cost of human life. Similarly, equality in health care policy is an area to be
addressed. When a policy program makes efforts to ensure that 64% of disabled
applicants are denied access to federal assistance for medical care, there needs to be
some recognition to the fact that this is outright discrimination and blasphemy. This
nation’s founding fathers established the United States on the basis of liberty, or the
condition of being free from governmental restriction or control. However, what is more
impious than a federal policy which imposes so many restrictions, limitations, and
unreasonable burdens on its beneficiaries in hopes that they will breach the qualification
standard and be expelled from the program? Political, administrative, and technical
feasibility are by no means limited by financial restrictions. With $1.9 trillion of the
federal budget in 2005 and an expected $3.6 trillion in 2014 going to subsidized health
care, it should be feasible to accommodate the needs of every disabled person in the
monitoring of policy spending are ways to insure that no disabled person be without
medical care. Finally, social acceptability of disability health care policy is dependent on
three factors: whether the decisions being made reflect the intent of the policy design,
whether the policy is consistent and fair throughout the system, and whether or not the
programs are lacking funding. Just from review of the other evaluative criteria
mentioned here, it is clear that none of these factors are met with success, and
therefore do not meet the standards of social acceptability. The failure of disability
health care policy (i.e. SSDI) to successfully meet the evaluative criteria for a public
With health care policy receiving a great deal of attention in the 2008 election
year, there should be a greater focus of attention on reforming disability health care
policy. Indeed some of the presidential candidates thus far have expressed interest and
concern over this matter, however the great extent of the current policy flaws are still
the unrighteousness of the system, and the discrimination against individuals who
should qualify for benefits, but are repeatedly turned down. As such, it is evident to me
that the greatest flaws in this system are the result of inadequate policy design,
inefficient policy problem analysis, and the failure to meet the evaluative criteria of
public policy proposals. As we approach the future of health care in this country, we can
only hope that reform will help to reduce the number of disabled persons without
medical coverage, and that steady changes to policy will mandate effectiveness,
Center for Medicare Advocacy Inc. “Sen. Bingaman’s Bill to end 24 month waiting
http://www.medicareadvocacy.org/Reform_BilltoEnd24moWaitingPeriod.htm
Kraft, Michael E., and Scott R. Furlong. Public Policy: Politics, Analysis, and
http://www.disabilitybenefits101.org/ca/programs/income_support/ss_disability/ss
di/program.htm
legalresources/healthcare/healthinsurance/social-security.jsp