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Disability and Democracy

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Our long national nightmare is almost over: today, after seven hard weeks of bowlin' and shootin' and drinkin', the people of Pennsylvania will finally get to vote in our primary. It's been a critical time in this electoral cycle, a time during which American news media were able to dig hard and deep into the issues that underlie the moral and constitutional crisis to which the Bush Administration has brought us: did Barack Obama meet August Spies at a fundraiser in 1886 before founding the Muslim Brotherhood in 1928? And what about Cindy McCain - can she really be that perfect?

So I thought I'd write a little something about the candidates' policy positions on disability, because apparently (a) no one knows that the candidates have policy positions on disability and (b) policy positions on disability are not as important as flag pins. Granted, disability policy never swings an election. And why should it? Unless you yourself have a disability, or unless you know someone with a disability, or unless you're concerned about things like employment or health care, or unless you might get sick or injured someday, or unless you're planning on aging, disability policy is irrelevant to you.

Hillary's disability policies are pretty damn good, especially when it comes to health care, which I've always considered (not that I'm alone in this) the issue on which she's more solid than Obama. Why her campaign chose instead to emphasize her crossing of the Commander-in-Chief threshold with McCain, and the 3 am phone call from the wolves in the forest, is anybody's guess. My own is that they've thoroughly internalized the belief that Democrats are weak on national security, and that as a result, they decided to run against Obama's opposition to war in Iraq by talking dismissively of that speech he gave in 2002, fluffing McCain, and claiming that Hillary actually criticized the war before Obama did -- that is, if you start counting in 2005, if by "criticize" you mean "argue for a better war," and if you use "before" in the sense of "after." Thus we got Hillary as Iron Lady rather than Hillary as Health Care Provider and Disability Worker. Though it was probably crafted by Mark Penn, it sounds like a Democratic campaign devised by Maureen Dowd: at all costs, do not be the mommy party - associate the candidate with big hard military strength.

So over the past few months, I admit, I've had a hard time distinguishing between my own Hillaries: Hillary the capable policy wonk and Hillary the doubter of Obama's patriotism and and general electability. (I assure you that if you'd told me, two months ago, that she would seek the endorsement of the reclusive billionaire maniac behind the Arkansas Project, I'd have told you that you were smoking some of the crack that Governor Bill Clinton flew into the Mena airport with the help of the Contras and Queen Elizabeth.) But despite the shenanigans of these past few months, I still can recall that Hillary the capable policy wonk is a very capable policy wonk.

OK, so go to Hillary's web page, click on "Issues," choose "Providing Affordable and Accessible Health Care," then go over to the right sidebar - the one headed "Hillary's Plans," and go down to the subheading, "How Hillary's plan affects:" and then click on "Americans with Disabilities." You'll get a .pdf that reads, in part:

Employer-sponsored health care can present significant cost and coverage concerns for both employers and people with disabilities. Some insurance plans cap payments for durable medical equipment, which includes items such as wheelchairs, crutches, braces, and ventilators; in effect, making coverage for those items unavailable. The American Health Choices Plan prohibits insurance companies from denying coverage to limiting coverage for pre-existing conditions. In addition, insurers will be prohibited from charging significantly higher premiums based on medical conditions, age, gender, or occupation.

This is good stuff, though it painfully exposes the problem of relying on employer-sponsored health care in the first place - and doesn't mention the fact that the unemployment rate for people with disabilities is . . . well, exceptionally difficult to determine, but quite high. But then, there's another problem here, and throughout Clinton's website: because (as is so often the case), there's no separate heading for policies affecting people with disabilities, you have to look around under other issues - in this case, health care - to see if disability is mentioned.

OK, putting disability under health care makes sense, of course. But then in the "Issues" section under "Improving Our Schools," there's a subheading, "A Champion for Educators and Children," which contains the critical passage:

Among her many efforts to fully fund IDEA [the Individuals with Disabilities Education Act], Hillary cosponsored the IDEA Full-Funding Act of 2003 to finally fulfill the federal government's long-standing promise to provide for 40% of the average per pupil expenditure for each and every child with a disability. In 2005, she offered an amendment to provide $4 billion additional to IDEA. The amendment failed by a narrow margin.

This too is good stuff. IDEA is notoriously underfunded; the next time you hear a conservative whingeing about the injustice of "unfunded federal mandates," ask him (or her!) whether they'd vote for full funding for IDEA. That usually quiets 'em down pretty quickly. But you really have to hunt around for this material on the Hillary website: I mean, who would guess that her position on IDEA is filed under the subheading "A Champion for Educators and Children," but that the subheading "Giving Every Child a Chance" doesn't mention the subject?

Likewise, the wonderfully informative "Agenda to Expand Economic Opportunity for People with Disabilities is, for some reason, filed under "Supporting Parents and Caring for Children," even though it contains fine proposals like this one, which would seem to have relatively little to do with supporting parents or caring for children:

2. Re-establish the Clinton Administration Executive Order to Hire 100,000 Qualified Employees and Make the Federal Government a Model of Accessibility.
During the Bush administration, the federal government has failed to make jobs or information technologies fully accessible for people with disabilities. In her first month in office, Hillary Clinton will review all federal websites to ensure they are accessible. She will also re-establish Executive Order 13163 to hire 100,000 qualified employees with disabilities to federal employment over five years.

You get the idea. A Hillary Clinton Administration would be quite good on disability/ health and disability/ employment, and generally good for my kid - this one, not the college senior who turns 22 today (happy birthday, Nick! Now get back to work). I have no substantial complaints about Clinton's proposals, though of course I wish that her husband had issued that Executive Order to hire people with disabilities about seven and half years earlier than July 26, 2000. But someone should've told the campaign to reorganize that website so that Hillary's disability policies are clearer and more . . . accessible.

And I have to admit that I've been mightily vexed by this phenomenon in recent years. Not by Hillary Clinton herself, mind you - by the phenomenon of the avoidance of disability qua disability. It's as if we Americans have been talking about disability all our lives, as Molière's M. Jourdain has been speaking in prose, without realizing it. Remember that debate about SCHIP? You know, the one we lost on Bush's veto? What the hell was that about? It was about disability, folks - about children suffering catastrophic illnesses and traumatic injuries for which their parents couldn't (and their parents' dastardly, moustache-twirling health-insurance providers wouldn't) provide. Vets returning from Iraq with PTSD or TBI (post-traumatic stress disorder or traumatic brain injury) and being warehoused and/or underserved and/or neglected by VA hospitals? Uh, well, once again, here we're talking about disability. Why in the world do we frame these things as matters of "health" or "employment" or "veterans' benefits," when doing so prevents us from realizing that we're all touching different appendages of the 8000-pound elephant in the room? The subject is disability, people. It's about our common frailty and vulnerability. Get used to it.

Hillary's overall American Health Choices Plan (16-page .pdf) is about as good as a private-insurance-based plan can be. But if you're looking for disability policy, you'll look in vain. You'll read about "eliminating insurance discrimination" (page 5) and "creating a retiree health legacy initiative" for "major American employers with workforces that face unusually high health care costs due to a high ratio of retirees" (a group that includes "our major manufacturers," and, for Pennsylvanians like me, evokes "mine workers") that will "provide a tax credit for qualifying private and public retiree health plans to offset a significant portion of catastrophic expenditures that exceed a certain threshold" (page 8). (That passage is followed by a qualifier: "Such reinsurance would be time-limited to reflect the short-term demographic need of the aging baby boomers, and would be devised in a manner that does not add to our long-term fiscal challenges." Yes, well, good luck with that.) But the wonky point remains: if you're interested in public policies for people with disabilities, the Clinton campaign offers you a series of sane, sound proposals - many of which would benefit people with disabilities, but few of which speak of "disability."

Obama, by contrast, has a separate heading titled "Disabilities." This in itself is remarkable; but it turns out that this isn't just a matter of better web design. Whoever is advising Obama on disability policy is really, really smart. The nine-page .pdf, "Barack Obama's Plan to Empower Americans with Disabilities", says many of the same things Hillary does - about supporting full funding for IDEA, providing health coverage for the most vulnerable among us, and hiring 100,000 people with disabilities in the federal government (except that someone needs to tell the Obama camp that it's Executive Order 13163 Obama needs to reinstate, not 13173, which created an Interagency Task Force on the Economic Development of the Central San Joaquin Valley; reinstating 13173, whatever its merits, probably won't do much for disability policy in the United States). But the plan is, remarkably enough, at once broader and more specific than Clinton's.

It promises $10 billion in early intervention programs for children with special needs, via Early Head Start, Early Learning Challenge Grants, and IDEA Part C.

It proposes "a comprehensive study of students with disabilities and transition to work and higher education" - something that (a) has never been done and (b) is of great interest to teenagers with disabilities and their loved ones. "As president," we're told, "Barack Obama will initiate such a study and task his Secretary of Education with researching: the barriers that keep students with disabilities from seeking and completing higher education; the barriers that prevent students from making a direct transition to work; the extent to which students with disabilities are able to access loans and grants; reasons college students with disabilities drop out at a higher rate; and best practices from schools that have effectively recruited and graduated students with disabilities that can be implemented more widely." This is, as you might imagine, a (cough) special interest of mine. But that's not just because I have a 16-year-old with Down syndrome. In recent years I've had many fine students at Penn State - twenty-year-olds with dyslexia, or Asperger's Syndrome, or arthritis, or mild cerebral palsy - request "reasonable accommodation" from me on final exams. And I've been amazed and appalled at how many of my colleagues (here or elsewhere) seem to believe that they're under no obligation to provide reasonable accommodation for everyone. (Guess what? If you teach in the United States, you have that obligation! It's a real federal law!) So I'm thinking that "a comprehensive study of students with disabilities and transition to work and higher education" might not be a time-wasting exercise for disabliity-policy wonks. I'm thinking that it might actually make a world of difference for students with disabilities - in high school, in transition, and in college.

It pledges support for Tom Harkin's ADA Restoration Act, which would "overturn the Supreme Court decisions that limit the ADA's coverage and effectiveness." (This is huge for those of us who follow disability law. Don't get me started on University of Alabama v.. Garrett or Sutton v. United Air, because if you do, I'll break the 4000-word blog-post barrier, as I used to do at my windy old blog.)

It has a subsection devoted to flexible work plans, ranging from an expansion of the Family and Medical Leave Act to protection against "caregiver discrimination." "Workers with family obligations often are discriminated against in the workplace," it notes. "This is a growing problem, as evidenced by the skyrocketing number of discrimination suits being filed: there has been a 400 percent increase in the number of family responsibility discrimination lawsuits in the last decade." Again, though, this is of no interest to you unless you know someone with a disability, or know someone who might someday have a disability.

It promises to make the U.S. a signatory to the U.N. Convention on the Rights of Persons with Disabilities.

And it informs us that "Barack Obama is a cosponsor of the Genetic Information Nondiscrimination Act (GINA), which prohibits discrimination on the basis of genetic information by employers and health insurers. The Act also applies health information privacy regulations to the use and disclosure of genetic information."

The funny thing is that Hillary Clinton is among the bill's other cosponsors in the Senate, but you won't learn that from her website (why, I can't imagine). More importantly, if you have genes, or if someone you know and love has genes, you should be interested in genetic privacy. Because you never know when your employers might require you to submit to blood tests so that they can take a peek at whether you have any genetic susceptibility to debilitating conditions. Down that road lies the world of Gattaca, my friends, and that's why it passed the House last year by a vote of 420-3. Unfortunately, Tom Coburn (R- Outer Wingnuttia) has blocked it in the Senate, and since Coburn is apparently one of Obama's Friends From the Fringes, now would be a good time for Obama to ask his friend to do us all a great big favor.

Oh, and the rhetorical appeal to "my friends" reminds me! I'd almost forgotten all about that John McCain fellow. Apparently he's become the nominee of the Grand Old Party, on the grounds that he is not a barking lunatic who will promise to double Gitmo and build a tall fence to defend us against the Gay Immigrationist Mexislamofascist Menace. Yes, well, McCain's disability policy is much easier to summarize: (a): we need to cut costs; and, following from (a), (b): don't become disabled:

Controlling health care costs will take fundamental change -- nothing short of a complete reform of the culture of our health system and the way we pay for it will suffice. Reforms to federal policy and programs should focus on enhancing quality while controlling cost.

This means you, solider - and you too, person with autism, you, person with Alzheimer's, and the rest of you malingerers. Buck up! Your job is to control health care costs for the rest of us.

McCain 2008: Because People Who Talk About Health Care and Disabilities Are Just Taking Cheap Shots.

Cross-posted at Crooked Timber.


12 Comments

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Well, I certainly have no intention of aging, and even the prospect of having genes is disturbing to me. I do carry some risk of catastrophic hockey injury, however, so I appreciate your summary of the candidates' stands on disability issues. Thanks, Michael!

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Michael: Thanks for a terrific article. You made an excellent point about how disability issues too often become subsumed under other "headings" to the detriment of those wishing to advance the cause of disability rights.

I know you said you didn't want to get going on the ADA Restoration Act and all those Supreme Court decisions that have decimated the current ADA law (despite all the conservative hand-wringing in the recent years about "judicial activism," it's actually the conservative Justices on the Court that appear to be engaging in it), so I'll make this as brief as possible as well.

Here's a concise explanation of the problem of judicial interpretation of the ADA from the National Disability Rights Network:

Over the past 17 years, the courts have narrowed the definition of disability so much that people with conditions like epilepsy, diabetes, HIV, cancer, and hearing loss who manage their disabilities with medication, prosthetics, or hearing aids are viewed as "too functional" to have a disability. While these same people may be denied a job or fired because an employer mistakenly believes they cannot perform the job, they are denied the ADA’s protection from employment discrimination. This creates a Catch-22 in which employers say a person is "too disabled" to do the job but not "disabled enough" to be protected by the law.

"While great progress has been made since passage of the ADA, bad court decisions over the years have eroded many of its essential protections," said NDRN Executive Director Curt Decker. "We urge Congress to quickly pass this bill to restore the rights of all Americans to be free from unfair discrimination."

Further information on the ADA Restoration Act can be found at the following sites:
The ADA Restoration Act Blog
House Speaker Pelosi's Statement on the ADA Restoration Act
National Council on Disability Examines Untenable Aspects of Americans with Disabilities Act Decisions by Supreme Court

The proposed legislation has gotten scant attention the media, which is rightly far more interested in the truly substantial issues of the election, such as flag pins. And it's not just employment law where there's a problem. I know of at least one documented case of
an agency that used a question of disability to attempt to avoid making reasonable accommodations. Yet this agency had already documented the disability status of the participant, and apparently received additional federal funding as a result the services it provided to the participant on the basis of the person's disability! This sort of nonsensical action no doubt is at least partially a result of the confused set of judicial precedents that have left disability law in an untenable mess.

Both Clinton and Obama demonstrate a recognition and understanding of disability issues, which ought to be central to Democratic values (Obama even moreso, in my view, but then I'm a supporter). As of the year 2000, when the first ADA law was signed, 18% of the U.S. population had some sort of disability. The numbers are only increasing as the population ages and as veterans return from Iraq and Afganistan with seriously debilitating disabilities, particularly traumatic brain injury and PTSD. George Bush has responded to this crisis by proposing the elimination of Traumatic Brain Injury program funding in his 2008 budget and by appointing Justices to the Supreme Court who were known to be antagonistic towards disability rights.

Several new Supreme Court Justices may be appointed by our next President; that alone is sufficient justification for voting Democratic in 2008.

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Thanks, Wordie!

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Zounds, you're not kidding!

Seriously, thanks for a serious look at this. I am lucky, since the only disability exhibited by my children was an inability to find work at a hedge fund.

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Thank you.


Great Post!
I’m involved in advocating for both Mentally Ill and DD people here in Florida through the Federally Mandated P&A program (Protection and Advocacy for People with Disabilities).

Many Mentally Ill and DD people have a hard time getting on SSDI and it usually depends on who is in office at the time at the Federal level. Under Reagan you had to be flat on your back to qualify. Herbert Walker Bush and Clinton set more generous policy guidelines for the Department of Health.

We here in Florida have had mentally Ill people and some cases of DD and dual diagnosed people put in jail rather than provide them with psychiatric treatment facilities because it was cheaper. We fought them in court and won. They found enough money all of a sudden to provide the beds that were needed.

Many people with disabilities wind up homeless.


I’m a firm believer that the stigma associated with disability is the reason why it does not get a lot of public attention from our legislators. I’m involved in promoting more visibility for the disabled and their needs, and don’t think that things will get a lot better for the disabled unless there is more public awareness and concern.

The Paul Wellstone Mental Health and Addiction Equity Act, HR 1424, which was passed by a vote of 268 to 148, extends the parity in annual and lifetime dollar limits for mental healthcare provided by the Mental Health Parity Act of 1996 to include parity in cost-sharing requirements such as copays and deductibles and treatment limitations such as day and visit limits


The Mental Health Parity Act of 2007, S 558,that was passed by the Senate in September 2007 needs to be reconciled with the Senate bill. This is now in progress. But I fear that Bush might veto it. Here is where we can use some letter writing and lobbying..

BTW the NDRN (National Disability Rights Network) Conference is going to be held in New Orleans. It is geared more to the health care professional than the advocacy community, but is worth going to in any case

NARPA”s Annual Meeting (The National Association for Rights Protection and Advocacy) is being held in Austin Texas in October at the University of Texas Campus which I might attend.

It is all about networking

The only way to move forward on Disability issues is to network and lobby. The Reason it is not a hot topic with Hillary, Obama or McCain is that it is a loser as an issue. Tipper Gore found that out during her husband’s run for presidency.

The only way to change that is to de-stigmatize disability and get the general public enthusiastic about it as they are about racial discrimination, gay rights, gender issues and the rest of the progressive agenda

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Thanks, Andrew! --for all your work with people with disabilities, and for this kind comment. See, I knew we'd be friends someday.

Are you aware that there are some who are not happy with Obama's classification of 'Disability' as an ISSUE and are petitioning to get 'Disability' classified under the 'People' category? Apparently the Obama campaign is taking this seriously. I don't agree, because as a 'disabled' person, I see the things that affect me as ISSUES and don't want to be 'defined' as a 'disability' - I am much more than that. If anyone is interested I will send you more information about this, just let me know.

This appears to be a variation of the increasingly old and timeworn "disabled person/person with a disability" semantic debate. It can get rather silly. Do we say "person with xx or xy chromosomes" or "person with asian ethnicity?" Common sense tells you that we are talking about people. But as my wise ol' grand dad was fond of saying, "common sense ain't so common." The issues addressed are inherent to disability. They cannot be separated from the disabled experience. As such, I see no logical linguistic reason they not be framed as such.

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Thanks for asking, harsec. Oy, this makes my head hurt. I think PosterBrat has it right, and his comment is making me recall a half-hour I once wasted with people arguing that (a) "Down Syndrome person" was inappropriate and demeaning because it was not "people-first" terminology and (b) "person with Down Syndrome" was inappropriate and demeaning because it suggested that Down Syndrome was all these people had. Fortunately, we eventually agreed to shelve that discussion and declare unending war on the people who say "Down's Syndrome." And then justice was done!

Seriously, disability is (as I argue in the post) so completely invisible as a policy issue in this country that I can't imagine why anyone would want to subsume it under the completely nondescript "People" category. But you know, that's one thing I've learned about other people -- they have minds that work differently from mine. Dag nab it.

Michael,

I'd like to add that in December 2007, the National Alliance of Mental Illness posted a survey on their website, "Learn About the Candidates’ Views on Mental Healthcare." I think it's incredibly telling that of the three candidates who responded (Clinton, Obama, McCain), HRC responds the most fully and with what I see as the most genuine intention. Obama's responses seem to be rehearsed, pat, and listy. McCain only offers a cursory paragraph because it's his policy not to respond to surveys. Here is the info on the website:


December 28, 2007

NAMI sent a questionnaire on leading mental health issues to all the presidential candidates. Candidates are answering and we encourage you to view their positions on our new Explore the Candidates page.

NAMI will be posting additional responses and materials as they are received after this date, so please check our Explore the Candidates page regularly for updates. NAMI does not endorse specific candidates. Any materials posted are intended for educational purposes only.

http://www.nami.org/Template.cfm?Section=2008_Primaries_and_Elections&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=55411

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Hey wleec -- I agree, Hillary's responses to that questionnaire are terrific, and McCain's complete nonresponse is Teh Suck, as they say on blogs. But Obama's are fine too, and I don't find an answer like (to take one at random)

"I support the recruitment and training of mental health professionals to increase workforce diversity and serve rural areas. I am committed to tackling the root causes of disparities in certain health care populations, including disparity and rural populations, by addressing differences in access and health care quality and promoting prevention and public health. I will also challenge the medical system to eliminate inequities in health care by requiring hospitals and health plans to collect, analyze and report health care quality for disparity and rural populations and holding them accountable for any differences found; diversifying the workforce to ensure culturally effective care; and supporting and expanding the capacity of safety-net institutions, which provide a disproportionate amount of care for underserved populations with inadequate funding and technical resources.

to be "pat" or "listy." (I can't even imagine what would count as "rehearsed" for an answer to a questionnaire.) So I think my point remains -- the two Democrats are very good on disability policy, and McCain is godawful. If you still want reasons to find Obama inadequate, OK, that's your business.

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