Disability: The New Welfare

From, of all places, National Public Radio, a most insightful piece on the explosion of disability in recent years.

They are not the first to notice this rapid rise, but they provide a lot of insight into how it has happened.

Essentially, it is too easy to get on disability, even on the basis of vague or ill-defined medical problems. When one looks at the vastly increased numbers in recent years, it’s hard to avoid the conclusion that most of these people could work. But why do that, when you can draw a regular check?

In the 1990s, led by the state of Wisconsin, “welfare” (technically, AFDC) was reformed, and women on the program required to work. Welfare had long been stereotyped (with considerable justification) as a program that discouraged work and supported idleness. Thus highly effective work requirements were put into effect.

But while “welfare” had a bad reputation, few people had any desire to get tough on people who were “disabled.” It’s not your fault, after all, if you have a medical condition. Of course, there are medical conditions and there are “medical conditions.” There has been a marked shift over time in the composition of the “medical conditions” that allow people to be on disability. Conditions that can produce a hard diagnosis (heart disease, cancer, respiratory disease) have either remained constant or declined as a proportion of those on disability, while back pain and mental illness have radically increased. But the American people have not become less healthy over the past (say) 30 years.

Ironically, the growth of disability has vitiated another piece of Federal legislation: the Americans With Disabilities Act. That Act was based on the assumption that people with disabilities can work, especially if employers are required to make an “accommodation” for their disability. But the trend, unfortunately, has not been to get disabled people into the workforce, but to take them out of the workforce with government assistance.

This, like the growth of AFDC in the 60s, 70s and 80s, is another example of how good intentions can get out of hand and produce highly negative results. The graphs below tell the story.

Women Pressured to Abort Down Syndrome Babies

From Christianity Today:

Women whose babies are prenatally diagnosed with Down syndrome report that “their obstetricians had failed to provide enough up-to-date printed material” and “felt rushed or pressured into making a decision about continuing the pregnancy.” The study of mothers whose children have Down syndrome was published in the American Journal of Obstetrics and Gynecology.

One woman quoted in the study said that in 1999, when her child was diagnosed with Down syndrome, the doctor “showed a really pitiful video first of people with Down syndrome who were very low tone and lethargic-looking and then proceeded to tell us that our child would never be able to read, write, or count change.”

In response, senators Sam Brownback and Ted Kennedy are sponsoring legislation that would require doctors to provide current medical information about any diagnosed disability after a prenatal test, along with treatment options, the expected development of the child, and information about local support communities.

“A lot of the testing is done for disease processes that we really can’t do anything about,” says Stephen Nelson, staff neonatologist and director of the Neonatal Transport Service at MeritCare Children’s Hospital in Fargo, North Dakota. “Our ability to diagnose diseases prenatally exceeds our ability to treat.”

Prenatal testing is a way of learning valuable information about a baby, but just as important is what parents will do with that information, says John Kilner, president of the Center for Bioethics and Human Dignity at Trinity International University in Deerfield, Illinois. “It is usually used to find out if there is something there you don’t want so you can abort.”

Kilner said that when he and his wife had trouble conceiving their second child, doctors offered prenatal tests. “It was just offered to us as obvious in the normal course of things,” Kilner said. “It was only in response to our questions that we discovered there was any risk at all. And then when we realized that we would only be getting information that would lead us to abort, it was like, wait a minute.”

Still, “there’s a lot of unspoken pressure to abort once you’ve had the testing done,” says Nelson. Throughout the medical literature, “parents are blamed if they have a baby with Down syndrome.” Parents who decide to give birth to a Down syndrome child “say that they feel like outcasts, they feel blameworthy.”

The Brownback/Kennedy bill could help alleviate cultural pressure to abort. “The effect of this sort of ‘weeding out’ is creating new eugenics, a form of systematic, disability-based discrimination,” said Brownback. “We don’t want a world where parents feel driven to justify their children’s existence. We need to link parents with these programs so that they are equipped with all the information they need to hopefully make a life-affirming choice.”

For many parents, having a child with a disability can be difficult but profoundly enriching. “Scripture doesn’t lie. These children really are gifts,” says Nelson, whose son has a genetic disability. “Our other children have a much greater appreciation for people with differences as a result of their brother, Taylor. It’s been a really remarkable experience for our family. He’s truly been a gift to our family.”

This is exceedingly ironic in a society which has an Americans With Disabilities Act.

Not only is it illegal to discriminate against people with disabilities, one is required to make special accommodations for them!

Unless they haven’t been born yet.