“Profiting from a child’s illiteracy,” Nicholas Kristof on the childhood SSI program (1/2)

It’s hard to write about anything this weekend beyond the awful events in Connecticut. Maybe the best we can do right now to honor yesterday’s victims is to reach out a helping hand to someone in our own lives who is suffering or grieving. Very best to everyone affected by the tragedy.

I did want to consider Nicholas Kristof’s New York Times column this week. His title, “Profiting from a child’s illiteracy,” presents the main thesis. Kristof visited rural Kentucky. What he saw there disturbed him:

This is what poverty sometimes looks like in America: parents here in Appalachian hill country pulling their children out of literacy classes. Moms and dads fear that if kids learn to read, they are less likely to qualify for a monthly check for having an intellectual disability.

Many people in hillside mobile homes here are poor and desperate, and a $698 monthly check per child from the Supplemental Security Income [SSI] program goes a long way — and those checks continue until the child turns 18.

“The kids get taken out of the program because the parents are going to lose the check,” said Billie Oaks, who runs a literacy program here in Breathitt County, a poor part of Kentucky. “It’s heartbreaking.”

This is painful for a liberal to admit, but conservatives have a point when they suggest that America’s safety net can sometimes entangle people in a soul-crushing dependency. Our poverty programs do rescue many people, but other times they backfire.

Kristof’s column was excoriated by many liberals, most recently in a nice piece by Kathy Ruffing and LaDonna Pavetti from the Center on Budget and Policy Priorities. (If you have extra geldt this holiday season, the indispensible nonprofit cbpp.org is always a good place to put it….)

Not everyone on the left was fair or civil. Matt Bruenig’s takedown was titled, “Nicholas Kristof is an irresponsible moron.” Although Bruenig presents valid criticism–see below, Kristof deserves a more respectful hearing. He has risked his life to report on many profound global health problems and violations of human rights. I admire him greatly for that.

More generally, it’s a big mistake to demonize journalists and scholars who write about cultural and behavioral issues intertwined with poverty. Daniel Patrick Moynihan, Oscar Lewis, Jason DeParle, Nicholas Lemann, William Julius Wilson, and others endured a mountain of unfair criticism for sometimes-flawed but useful good-faith efforts to discuss painful subjects. When journalists delve into sensitive waters–and maybe get a few things wrong or create misimpression–there’s a reaction to really slam them rather than to conduct a more positive conversation about the strengths and limitations of their work.

It’s important to see poverty’s human face, even if that close-up view reveals discomfiting things. The high rate of youth violence and non-marital births in low-income minority communities certainly commands discussion—as do the occasionally perverse incentives created by specific forms of public aid. Some parents wrongly gamed the system under the old AFDC program. I’m sure the same is sometimes true of SSI, too.

That said, Kristof presents an awfully incomplete and misleading view of disability policy. His impressionistic piece neglects a long line of policy research that specifically debunks sensationalist claims of widespread fraud. As Peter Edelman noted in response to Kristof’s piece, SSI employs a pretty tight screen of qualifying disabilities. Over the past decade, SSI has rejected about 54 percent of children claiming eligibility for mental health concerns. More than seventy percent of child applicants who presented with a primary impairment of ADHD were rejected, as well.

Kristof also fails to engage the complex implementation challenges of disability policy. These challenges are especially difficult in addressing conditions he superficially labels “fuzzy.” Many disabled children have quite genuine functional capacity impairments that don’t neatly correspond to medically determinable diagnoses such as Down syndrome, cystic fibrosis, or schizophrenia. The most controversial impairments arise in mental and behavioral health. Yet the same issues can arise in other areas such as cerebral palsy.

Then there’s this. Program eligibility is an all-or-nothing determination that doesn’t gracefully match the continuous and multi-dimensional nature of real-world disabilities. Try as one might to define disability as a discrete physical or mental health state independent of the broader economic and social environment, this isn’t always possible or coherent. A high school dropout in Jackson, Kentucky who damages his back is much less likely to find gainful employment than a similarly-injured college graduate living somewhere more prosperous.

Kristof’s essay left the impression that welfare dependence is a growing, chronic problem fed by ballooning SSI rolls. As he put things,

More than 1.2 million children across America — a full 8 percent of all low-income children — are now enrolled in S.S.I. as disabled, at an annual cost of more than $9 billion.

That is a burden on taxpayers, of course, but it can be even worse for children whose families have a huge stake in their failing in school. Those kids may never recover: a 2009 study found that nearly two-thirds of these children make the transition at age 18 into S.S.I. for the adult disabled.

I tracked down the 2009 study that Kristof had read. It’s by Jeffrey Hemmeter, Jacqueline Kauff, and David Wittenberg. I read the study rather differently. (My next post will show a nice graph with some historical trends.)

As Kristof reports, about two-thirds of youth on at age 17 are recertified at age 19 for the adult SSI program. Yet I read these numbers differently. Indeed the study’s other main finding is that “youth with behavioral disorders and mental disorders other than mental retardation are much less likely to receive SSI at age 19.” Moreover, the authors express concerns that these youth who do not transition into adult SSI do poorly.

It seems to me that the childhood SSI program runs a reasonably tight ship. Most children deemed eligible for childhood benefits have identified, serious, and chronic impairments that make them SSI-eligible when they are older. Youth with the fuzzier conditions that Kristof questions are precisely those most likely to leave the program at adulthood.

Of course, SSI could be operated better. A recent report by the Government Accountability Office found that the Social Security Administration (SSA) conducts many fewer continuing disability reviews (CDRs) than it did in the year 2000. GAO made a series of recommendations to do more reviews. Not unreasonably, SSA responded that it would be happy to do, as long as Congress agrees to allocate the required funds. Because Congress has not done so, there remains a significant backlog of such reviews, some of which might uncover cases of recipient fraud. But it’s a heavy political lift to hire bureaucrats or to expand SSA’s capacity to perform its assigned role. It has to be done.

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