Chapter 2 brings us an excellent example of Keller’s tendency to make broad generalizations that may — or may not — be justified, based on a couple of anecdotes. For instance, on p. 41, the book tells us that Mayor Dolan and his wife Alison used to work at the East Boston Neighborhood Health Center, where they evidently saw thousands of people “abuse[] the free services.”
They wonder why some of the “disabled” clients they saw, able-bodied but purportedly suffering from bipolar disorder and collecting thousands in benefits, can’t help ease the tax burden by taking on at least part-time work. “They should encourage people to work instead of just giving them money,” suggests Alison.
Interesting issue — should able-bodied but mentally ill people have to work, and if so, how much? And who should make those assessments? I’ll leave that one for people better versed in such things than I. But what is quite unfair, IMHO, is Keller’s very next couple of sentences.
She’s echoing a complaint that’s been pouring out of working-class Massachusetts for decades. In 1987, …
and Keller goes on to recount a 20-year-old story of “welfare-approval mills” where crooked doctors would take bribes in exchange for certifying able-bodied people as unable to work and therefore eligible for welfare under then-current regulations.
Let’s back up a step. The “complaint” that Alison was “echoing” had to do with people who could physically work, but whose mental condition might have made it difficult. Now, that’s a complicated issue on which, it seems to me, reasonable people might disagree, and as to which informed medical opinion would be useful. But the 1987 “welfare-approval mill” story has nothing to do with that — it’s a straightforward story of criminal activity by both doctor and would-be welfare recipient, and would not be condoned by the most ardent opponent of “welfare reform.”
And it gets worse. Right after the welfare fraud story, without so much as a paragraph break, we are told that the secret of John Silber’s success in the 1990 Democratic primary was his “questioning” of “generous state welfare policies.” Maybe yes, maybe no (I honestly don’t remember), but in any event, Silber wasn’t talking about reforming the state’s “policy” of tolerating fraudulent doctors, since obviously there never was any such policy. Silber’s primary win, and subsequent loss to Bill Weld, which inaugurated the GOP’s 16-year hold on the Corner Office, is an interesting story — which has nothing to do with “welfare-approval mills.”
Am I overdoing it on this point? I don’t think so, because I think this passage illustrates a clever device that runs through Keller’s book. He picks a particularly outrageous anecdote — in this case the welfare-approval mills — and uses it to paint a much broader and more complex issue — welfare reform — in over-simplified, black and white, highly emotional terms. Welfare reform is not about crooked doctors, and talking about crooked doctors only makes it harder to talk about difficult issues in a serious way.
There’s other stuff worth mentioning briefly in the chapter. Mayor Dolan apparently has had difficult experiences with Melrose’s public employee unions, and reports that they are unwilling to share in cost reduction. It’s a fair complaint — the new law that lets municipalities join the Group Insurance Commission’s health care plan is a good step, but it is neutered by the requirement that 70% of the local unions must sign on. Keller also mentions union opposition to the consolidation of local pension systems into the state system, though he apparently missed Deval Patrick’s position on that during the campaign — he claims that Patrick “laid low on the subject,” while in fact Patrick called pension reform that would consolidate local underperforming pension systems into the state system “a terrific idea” during the campaign and recently signed his bill doing just that.
In general, though, this is one of the less exciting chapters in the book. But just wait for chapter 3, which Keller calls “A Pizza a Week,” but which reads more like “The Canonization of St. Barbara.” Anderson, that is. Stay tuned …
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I had a friend who was on SSI due to mental disorders. She was quite able-bodied and, to a casual observer, entirely able to work, yet mostly she just lived off the (meager) government benefit. She would occasionally get a part time job, which gave her a bit of extra money which might enable her to, for example, get an apartment for a while (rather than live with a parent), but she’d never be able to hold it for long. And that’s just the problem: although she could work, her brain chemistry had effects that most employers, understandably, couldn’t handle for very long. For example, she could not be depended on to show up at scheduled times. Her level of competence was very inconsistent. These were not things she had much control over – she got a different roll on the brain chemistry front than most of us, and no medication was able to overcome this to make her employable.
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I suspect Keller would’ve missed something like this. Unless he actually tried to employ the people he thought were abusing the system.
I dated a woman in college who was mentally ill. She was brilliant, but couldn’t get through her classes because she never showed up, never tried. She was clinically depressed, and at times very manic. She flunked out of college a couple of times.
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She started taking medication and was doing OK, was able to hold down a couple of jobs as a medical transcriptionist. But she couldn’t hold them down for long because most companies who hire such people say “if you’re more than 5 minutes late a couple of times, you’re fired”. When she wasn’t holding down a job, she wasn’t able to afford her medication, and stopped taking it, or took it in reduced doses. I paid for a couple of refills out of my pocket, but the bill would be around $300 or so.
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She moved back home, got on some different medication, completed her undergrad degree, went to a medical school in Europe, graduated, and is now successfully practicing medicine in the US. The key was finding the right combination of both medicine and environment that allowed her to thrive.
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Should people with mental disorders work? Absolutely. But until others stop insisting that such people should toe the same line that they do, this will not be possible. It would be a very difficult situation to allow some people flexibility in their jobs due to a mental illness, while not allowing such flexibility to those who are not mentally ill.
i will just add to your excellent post that there are physical disabilities as well that are not apparent to other people, but that interfere with doing work on a typical schedule.
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also, i think raj alluded to this elsewhere, but having the capacity to do a certain amount of a certain type of work does not mean that there is an employer at all interested in hiring you. further, when deciding whether a person should have access to benefits, the courts don’t care whether there is a job available to you, they only care whether there is a job description that you could reasonably inhabit.
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for many disabled people, there is NO safety net in the country. unless you are brain dead, even getting social security requires hiring a lawyer and going through about a 2 year process. these legal processes are especially harrowing to someone in physical pain and who has lost their job due to disability. many give up because the stress is just too great. and forget disability insurance through your former employer. those companies are there to make money, not pay you the benefit to which you are entitled. good luck not losing 30% of your benefit to a lawyer before possibly having the court order the insurance company to honor it’s contract. our system is despicable. keller doesn’t know shit.
The question relates to the matters below the flip. I’m not going to read Keller’s book, but can you tell us whether Keller presents any evidence as to (i) the extent of his purported welfare fraud, or (ii) comparisons with other states? As far as I can tell, your report suggests that his reportage is merely anecdotal
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As a further addendum to the question below the flip Interesting issue — should able-bodied but mentally ill people have to work… one wonders whether mentally ill people try to seek employment, but are unable to find it. There is a difference.
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On the observation, above the flip. So the Dem mayor was excluded from the Dem convention because he supported a Repubican, and the Dem convention’s rules said that a Dem who supported a Republican would not be seated as a delegate to the convention. What is his complaint? The rules said that. If he didn’t like it, he should try to change the rules. His complaint was stupid.
(i) No.
(ii) No.
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And therein lies much of the problem.
It’d be a pretty dull book with stats and tables instead of anecdotes.
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But, anecdotes aside, it’s kinda weird that Massachusetts has the highest percentage of all the states, of its resident SSI recipients disabled because of mental illness: 47.3% of all Mass SSI recipients are disable because of mental illness.
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Now, is that because of the “welfare mills”, or is it the enlightenment of the state in recognizing disability? Maybe the very liberal high supplemental benefits (nearly $900 per month plus medical coverage) have something to do with it.
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Hey! Maybe the high rate of mental illness explains the state’s liberal tendency! Just saying…
I look at that stat and I’m just glad there aren’t more people that are physically disabled. Certainly, in my life as an attorney I’ve run into people with both physical and mental disability. A lot of the physically disabled people that I’ve run into got that way from job related injury (car accident on the job, construction accident…) and they’re usually pretty sad cases. However, I don’t think its unfair to thank compliance with OSHA requierments by MA businesses as a reason why the physical disability percentage is closer to fifty percent.
Many states do not cover mental illness unless physiologically based; others may cover it will a $100,000 lifetime limit. In Massachusetts we have a Mental Health Parity Law, which requires mental health to be treated like physical health, with no sub-limit.
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If I lived in Kansas, and had a family member who neeeded health care, and has exhausted whatever benefit I may have ahd there , I’d FIND a way to come to Mass., regardless of housing costs.
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There are BIG differences in how mental illness is covered by insurace from state to state, and what institutions and hospitals are available. It’s like people with cancer coming to Dana Farber – they just want the better standard of care.
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This is one reason why I urge progressives to be wary of a single payer national system – 49 states aren’t going to adopt our standards. Far moe likely we would lose coverage that we’ve chosen to make available. The same thing happend with Special Education – Mass. alone adopted a standard of ‘best available’ over ‘reasonable and customary’ schooling, assuming that all other states would follow suit. After 10 years, when not a single other state had adopted the higher standard, we repealed ours.
That actually hadn’t occurred to me. You work in the insurance industry I take it?
Wanna buy a homeowners?
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Seriously, I spent 5 years designing self-insured health plans, and doing that made it essential to know what other states offered, as businesses starting here or relocating here could use those coverages as a frame of reference. Did you know if you self insure, you don’t have to abide by ANY Mass. mandated coverage? And that HMO’s – because they are not legally insurance oompanies – don’t have to either? So every time the Legislature passes a law mandating another benefit, it fall on the shoulders of a Guardian or John Alden, while the other companies escape it. Whic is why we have so many fewer carriers in the state now then when I was licensed in 1987.
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I’d accept that explanation, IF, the Mass disability rate were low. But it’s not. As a percent of the population, it’s in the upper quartile of the states where disability exceeds 4% of the population.
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Summary: The State disability rate is high, and among those disabled, Massachusetts has the highest of the states (tied with Minnesota) of mentally disable persons.
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Why is that? If your OSHA hypothesis were true, the overall rate would be lower.
That 16 years of Republican governors drove people crazy đŸ˜‰ – particularly that most recent one.
I didn’t know anyone could make U-turns that quickly!
…and you are precisely correct in your conclusion.
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Have you figured out who the intended audience for this book is? To whom is it being advertised?
Angry, white middle-aged men?
That isn’t a large audience. And I doubt very seriously that many people in Oklahoma (where the corn is–what?) are all that interested in the minutiae of politics in MA.
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Then again, maybe, the people in OK don’t read, regardless.
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Maybe I’ll look for the book at the Mobile Bookfair’s dollar table when we get back to the US at the end of Sept. Then again, probably not.
I’m going to revise that statement. I’ll probably buy the thing (although $25 is a little steep for a book of such…ahem…quality).
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Like it or not, Keller is what passes as expert opinion on all matters political in this state. Its interesting to see where that opinion comes from.
…a “gig”–which Keller now has with WBZ, and he used to have with WVLXI–with expertise. He has a gig.
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There’s a difference between gig and expertise. Actually the only thing that a succesful gig person has is a Rollodex.
that book signings are a little odd. It’s like getting an autograph at a baseball game, except for adults. And often very nerdy adults at that. There’s always at least one person in the crowd that’s just a little too into the author, know what I’ saying? So, I guess toward that end, I’d like to go to a Keller signing, just to crowd watch for that one guy whose really into Jon Keller.
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My brother-in-law fixing jet engines at Tinker AFB thanks you, my in-laws and their eleven siblings and descendents thank you, my uncle in law who spent his career at the State Dept. thanks you, my cousin in law teaching at the OU graduate program in Psychiatry acknowledged to be the best in the nation thanks you, …
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THIS is why the book will sell well – because the snotty attitude of Massachusetts is despised in the rest of the nation.
…I was raised in OH. Have you ever looked at the OH newspapers? Obviously not.
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I could continue with the newspapers from the other American centers, but then I’d get a silly reference from you about me “eurocentric.”
I don’t get it. Didn’t Bill Clinton, a Democrat, largely get rid of the welfare system as we know it, in the mid 1990s?
but Clinton, though himself a “boomer” (and therefore with two strikes against him), is not from Massachusetts. So he is capable of doing something right.
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< /snark >
but since welfare as we know it hardly exists anymore, why is Keller still complaining about it? Unless…he actually wrote his book in 1988, while Mike Dukakis was running for president, and couldn’t get it published until now?
that Rob Dolan endorsed “boomer liberal” Deval Patrick’s Municipal Partnership Act, which includes a corporate tax increase/loophole closure. This was the beginning of an attempt to end over-reliance on property taxes, as Keller half-assedly acknowledges. In fact, Patrick gave his budget address in Melrose, presumably with Dolan’s blessing.