In a recent hearing of the House Oversight Committee, Representative Duckworth sat face-to-face with Braulio Castillo, whose status as a disabled veteran earned his company preferential treatment from the government—contracts worth up to $500 million.1 What qualified Mr. Castillo as a “disabled” vet? He’d injured his foot in the 1980s playing football at the U.S. Military Academy prep school before later going on to play college football. His exchange with Congresswoman Duckworth made headlines across the country.
“Mr. Castillo, how are you?” she began. “Thank you—thank you for being here today.”
“I am not well, but you’re welcome,” Castillo replied.
“All right, so, your foot hurt, your left foot?”
“Yes, ma’am.”
“It hurts. Yeah, my feet hurt too,” Representative Duckworth said. “In fact, the balls of my feet burn continuously, and I feel like there is a nail being hammered into my right heel right now, so I can understand pain and suffering and how service [connected injuries] can actually cause long-term, unremitting, unyielding, unstoppable pain. So I’m sorry that twisting your ankle in high school has now come back to hurt you in such a painful way, if also opportune for you to gain this status for your business as you were trying to compete for contracts. I also understand why, you know, something can take years to manifest [itself] from when you hurt [it]. In fact, I have a dear, dear friend who sprayed Agent Orange out of his Huey in Vietnam, who, it took forty years, forty years, for the leukemia to actually manifest itself, and he died six months later, so I can see how military service, while at the time you seem very healthy, could forty years later result in devastating injury. Can you tell me if you hurt your left foot again during your football career, subsequently to twisting it in high school?”
Castillo pretended not to understand the question.
“You played football in college, correct?” Representative Duckworth asked.
“Yes, ma’am.”
“As a quarterback?”
“Yes, ma’am. I did.”
“Did you hurt, did you injure that same foot again subsequently in the years since you twisted it in prep school?”
“Not to my recollection, ma’am.”
Castillo proceeded to try to explain that despite playing football in college, he’d suffered pain from the original ankle injury for years.
“Do you feel the 30-percent rating that you have for the scars and the pain in your foot is accurate to the sacrifices that you’ve made for this nation?” Representative Duckworth asked. “That the VA decision is accurate in your case?”
“Yes ma’am, I do,” he replied.
“You know, my right arm was essentially blown off and reattached,” she said. “I spent a year in limb salvage with over a dozen surgeries over that time period, and in fact, we thought we would lose my arm, and I’m still in danger of possibly losing my arm. I can’t feel it; I can’t feel my three fingers. My disability rating for that arm is 20 percent.”
Representative Duckworth then read from a letter Castillo had prepared. “My family and I have made considerable sacrifices for our country,” he had written. “My service-connected disability status should serve as a testimony to that end. I can’t play with my kids because I can’t walk without pain. I take twice-daily pain medication so I can work a normal day’s work. These are crosses—these are crosses—that I bear due to my service to our great country, and I would do it again to protect this great country.”
“I’m so glad that you would be willing to play football in prep school again to protect this great country,” Representative Duckworth concluded. “Shame on you, Mr. Castillo. Shame on you.”2
That exchange illustrates the two ways people can approach disability. On one side was a citizen who viewed her severe injuries as a challenge to overcome but not an end to a productive and complete life. On the other side was a man who viewed the smallest physical difficulty as a qualification for taxpayer support.
In a time of increasing medical capability and an economy based less and less on physical labor, you might expect citizens to face the everyday pains with a fraction of Tammy Duckworth’s courage and determination. Unfortunately, an increasing number of Americans are trapped in the disability prison, viewing physical challenges (serious or trivial) as a reason or an excuse to end their productive lives.
National Public Radio recently aired an alarming series of reports, Unfit for Work, documenting the rise of disability in America. The journalist Chana Joffe-Walt visited Hale County, Alabama, where one in four residents receives a disability payment from the Social Security Administration each month. She spoke with many of Hale County’s “disabled” residents and found some who did seem to have serious physical impairments. More commonly, though, they had the standard “back pain,” or other manageable health problems like high blood pressure or diabetes. Labeling them as “disabled,” it seemed, stretched the meaning of the word. Yet as Joffe-Walt reported, “Over and over again, I’d listen to someone’s story of how back pain meant they could no longer work, or how a shoulder injury had put them out of a job. Then I would ask: What about a job where you don’t have to lift things, or a job where you don’t have to use your shoulder, or a job where you can sit down? They would look at me as if I were asking, ‘How come you didn’t consider becoming an astronaut?’”3
Millions of Americans are now receiving disability payments from the federal government—fourteen million, to be precise. For comparison, that’s more than the population of the thirteen smallest states put together; only four states in the country have more than fourteen million people. Cash payments to these “disabled” Americans now cost taxpayers more than food stamps and welfare combined.4
The overwhelming majority of disability recipients do not work. An analysis of federal survey data by the Washington Examiner found that only 13 percent have worked for pay since they started receiving benefits.5 And once they enroll in the program, they’re unlikely ever to return to independence.
“People who leave the workforce and go on disability qualify for Medicare,” Joffe-Walt reports. “They also get disability payments from the government of about $13,000 a year. This isn’t great. But if your alternative is a minimum wage job that will pay you at most $15,000 a year, and probably does not include health insurance, disability may be a better option.”
Welfare reform had the unanticipated consequence of giving states the incentive to move people from welfare (where the states pay part of the cost) to disability (where the federal government picks up the cost). Clever entrepreneurs have even established companies to help states move people from their welfare rolls to the federal government’s disability rolls.
Most disability recipients aren’t as corrupt as Tammy Duckworth’s sparring partner. Many are just trying to survive in a bad economy.
In Joffe-Walt’s conversations with “disabled” Hale County residents, one name came up over and over again: Perry Timberlake, a local physician. When she visited his office, she discovered that though he wasn’t exactly running a disability scam, he was basing his subjective decisions about which patients qualify as “disabled” on some questionable criteria.
“We talk about the pain and what it’s like,” he told her. “I always ask them, ‘What grade did you finish?’” Of course, this question has nothing to do with whether a patient has a debilitating health problem. But the doctor told Joffe-Walt that he considers the information crucial in evaluating the patient’s ability work in rural Hale County. “Dr. Timberlake,” she says, “is making a judgment call that if you have a particular back problem and a college degree, you’re not disabled. Without the degree, you are.”6
The doctor’s comments are striking for two reasons. First, they confirm the worst stereotypes of some disability recipients—on the dole even though they aren’t truly disabled. But second, while the doctor shouldn’t be using the program to hand out welfare, he has a point. It has become difficult to find work in many places if
you don’t have a high school education. Disability handouts for the non-disabled are not the solution to this problem, however. They only obscure it.
The disability program isn’t just trapping these Americans in permanent poverty; it’s also trapping a new generation with the same educational disadvantage. Families have learned that if their children are diagnosed with mental difficulties that affect their performance in school, they can collect disability for their kids as well. For a poor family, that seven hundred dollars per month per child may be its main source of income. Many families’ incomes, therefore, are perversely tied to their children’s falling behind in school.
The problem isn’t small. Thanks to these incentives, the incidence of children with disabilities has increased by 700 percent in the last thirty years.7 Crippling a child’s ability to live a full life for the sake of a seven-hundred-dollar monthly check is child abuse of almost Dickensian proportions.
Eight former Social Security commissioners objected to the Unfit for Work series. They argued that most of the increase in disability payments was due to demographic changes, an aging population, and the greater involvement of women in the workforce.
The commissioners’ response was a classic example of the bureaucratic mindset. They did not explain why, after two generations of progress in treating veterans with disabilities, there has been no corresponding progress for civilians. And they ignored the incentives for individuals, state governments, and businesses to abuse the federal disability programs.
The Examiner’s recent analysis of federal survey data further undermines the commissioners’ objections. As the Examiner summarized in its findings, “Recipients of federal disability checks often admit that they are capable of working but cannot or will not find a job, that those closest to them tell them they should be working, and that working to get off the disability rolls is not among their goals. More baffling, most have never received significant medical treatment and [have] not seen a doctor about their condition in the last year, even though medical problems are the official reason they don’t work.” The data showed that returning to work is not a goal for over 70 percent of people on Social Security Disability Insurance. At the time the survey was taken, 96 percent had not looked for work in the previous four weeks. Only 25 percent saw themselves working in the next five years.8
This corrosive system of dependency contradicts the foundational American principle that we are endowed by our Creator with the unalienable right to the pursuit of happiness. It is obscene that the government erected to secure that right encourages mothers to sabotage their children’s education.
The corruption of federal disability programs is a tragedy for all involved, especially those who are cheated out of the dignity and fulfillment of a productive life. The government of the United States should not be in the business of narrowing its citizens’ horizons. This corruption is also a financial disaster. Bestowing a lifetime of subsidies on someone because of a one-time diagnosis of disability makes no sense.
The remedy is not to “get tough” with disability cheats. Tighter regulation, more aggressive reviews, and longer waiting periods will not solve the problems that are baked into the system. We must change our focus from what limits people to what empowers them.
With the amazing breakthroughs in health and in lifelong learning, we have the opportunity to change the obsolete concept of disability into the new concept of capability. We have to rethink the system.
A system of lifelong learning—built on innovations like Khan Academy, Kaplan, and Udacity—should allow every American to learn what he needs to have a decent job. If you can’t keep your warehouse job because of a back injury, there are hundreds of other trades or careers you can learn instead. Our policy should reflect and reinforce these opportunities. Dr. Timberlake’s automatic disability certifications should become a thing of the past, since anyone who doesn’t have an extremely serious health problem should be able learn the skills he needs to get a job he can do.
Breakthroughs in health should make many forms of disability obsolete, too. If you require kidney dialysis, there’s a good chance you qualify for disability payments; your medical condition really does make it difficult to work. But if the work of pioneers like Dr. Anthony Atala succeeds in regenerating kidneys, that disability will go away.
Helping people with serious challenges get to and from work may be one of the first areas in which we deploy self-driving cars. We already build advanced systems to help seriously disabled veterans. This technology should soon be available to all Americans.
We could turn fourteen million people from passive recipients of government aid into self-sufficient, income-earning citizens, people who exercise the American birthright of the pursuit of happiness.
CHAPTER THIRTEEN
BREAKOUT CHAMPIONS
Americans have a reason for hope. We have the opportunity to enter a new era in which we live longer, healthier, more independent lives; in which easily affordable lifelong learning gives us unprecedented security and flexibility in our careers; in which prosperity and opportunity expand as never before.
But it will take a lot of work to make it happen.
The pioneers of the future have already achieved many breakthroughs, but there are large areas of American life in which the prison guards of the past are blocking breakout.
We need a popular movement to overwhelm the prison guards. Moving our laws and government away from the litigation-focused, bureaucratic model of the past will require breakout champions—the citizens, elected officials, candidates, and government staff who push for the changes we need to achieve breakout.
How Breakout Champions Think about Government and Public Policy
Our society, in this era of big government, is centered on bureaucracy, regulation, and law. This mindset makes breakthroughs difficult and a general breakout almost impossible.
To become breakout champions, citizens and elected officials need to think about society and government in a completely new way. There are eight key principles that distinguish pioneers of the future and the breakouts they bring about.
One: Look beyond Government
Leaders in this new breakout world, in which new technologies empower ordinary citizens, realize that there are many things that can be solved by free people banding together in creative ways. Bureaucratic government should be the last resort. When looking for solutions or measuring resources, start with society, not the bureaucracy. When organizing solutions, start first with voluntary, decentralized organizations, and go to bureaucracies and government only as a last resort.
Two: Focus on Outcomes, Not Input
Because a breakout requires dramatically smaller bureaucracies and fewer centralized regulations, our systems should focus much more on outcomes than inputs. For example, how many children have learned to read is a more important question than how much is being spent on the reading program. In a decentralized society, customers are important, and customers care about outputs, not inputs. The result is constant pressure for better quality and lower cost. Since a decentralized system is open to many solutions, the ideas that work can bubble up while the ideas that fail can shrivel up. Big bureaucracies do the opposite: they escape accountability and simply demand more resources, so failure becomes an excuse to build an even bigger system with even more expensive failures.
Three: Continually Work on Improvements
Breakouts emerge from pioneers working independently or in small groups on breakthroughs. They constantly drive for improvements. The bureaucratic system of cumbersome, slow, and rigid central planning guarantees that the institutions that would be improved by the breakthroughs will not adopt them. And as bureaucracies become less competent, they defend themselves by excluding, opposing, or even destroying what the pioneers are offering. The answer is not to try to build the perfect breakthrough replacement. The answer is to design systems capable of continuous improvement and open to constant internal challenges and adaptations—syst
ems, that is to say, that are the opposite of the bureaucracies we have inherited from the recent past.
Four: Look for Solutions in Unusual Areas
Most so-called experts are people who know more and more about narrower and narrower topics. In an age of breakout, however, new developments in one area can be applied to problems in another area. Winston Churchill, while First Lord of the Admiralty, invented the tank after realizing that the combination of the internal combustion engine and treads could be a solution to the problems of trench warfare. No one in the army had thought of this. The question of using smartphones and apps in medicine or education or public safety is a more recent example. Dramatic change occurs when people working in one specialty are alert to what they can learn from advances in other fields.
Five: Imitation Is Almost Always Cheaper than Invention
People in positions of responsibility in both the private and public sectors should spend at least one day a month exploring the new breakthroughs in fields other than their own, asking themselves if those advances could work for them. It will almost always be less expensive in time and money to import solutions than to invent them yourself.
Six: Remember to Look for Opportunities as well as Solutions to Problems
Breakthroughs often create opportunities that have nothing to do with problems they were intended to solve. For example, the smartphone opens up opportunities in education, medicine, public safety, commerce, and work. The fax was not just a better way to send a letter. The internet is not just a better way to send a fax. Each of these advances created opportunities that no one had thought of until the technology actually existed. We may achieve more progress out of opportunities-focused analysis of new breakthroughs than if we devoted the same amount of time narrowly searching for solutions to currently understood problems. We need to do both, but we usually spend far more time and energy on problems we already understand than on new opportunities.
Breakout: Pioneers of the Future, Prison Guards of the Past, and the Epic Battle That Will Decide America's Fate Page 22
