NORTIN M. HADLER, M.D.
Social Security Disability Insurance is a federally created and regulated insurance plan. The definition of disability as it relates to work capacity is exclusively the purview of government administrators. The primary physician's opinion has little, if any, impact on decision. Administering this insurance scheme requires the quantification of illness as it relates to work capacity (disability). What has evolved is a program that insures for the amount of "disease." The assumption is that with more disease, there is a greater likelihood of illness, even illness manifest as work incapacity. Leaving this underlying assumption tacit is responsible for the adversary climate that envelops the physician, the patient-claimant, and the administrators. It is also responsible for the paucity of clinical investigations into the critical issue of the amount and form of illness a diseased person will have.
HADLER NM. Medical Ramifications of the Federal Regulation of the Social Security Disability Insurance Program: Social Security and Medicine. Ann Intern Med. ;96:665–669. doi: 10.7326/0003-4819-96-5-665
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Published: Ann Intern Med. 1982;96(5):665-669.
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