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From NPR News, this is ALL THINGS CONSIDERED. I'm Audie Cornish.
In the past three decades, the number of Americans who get a monthly disability check from the federal government has skyrocketed. It's now up to 14 million people. That's due in part to our aging workforce. But in many pockets of the country, there's much more to the story. Factories and mills have closed and the U.S. economy has left behind millions of workers who now find themselves unfit or unqualified for the jobs that remain.
For many, going on disability is the answer. In some counties, nearly one in four working-age adults are not working because they are disabled, one in four.
In this part of the program, we're going to take you to one of the those places, Hale County, Alabama. Our guide, Chana Joffe-Walt with our Planet Money Team.
CHANA JOFFE-WALT, BYLINE: The fact that one in four adults are disabled and Hale County shapes everything about daily life here. It's why the banks stay open late on the first and the third of the month when the disability checks come in. It's why it's hard to find a parking spot on Main Street that entire week.
Pam Dorer(ph) moved to Hale County 10 years ago. And when she arrived, she didn't know the disability numbers, so she spent her first year here so totally confused about the local economy.
PAM DORER: Well, I love yard sales and I'm such a crazy yard-saler, but I'd be on my bike the third weekend of the month or the fourth weekend of the month, and there'd be no yard sales. I'd be like really, what's going on? And then I'd notice the first of the month every place in town had a yard sale. So it just took me a while to understand why.
JOFFE-WALT: If you live in Hale County and you've got an old TV or armchair you're looking to sell, you put it out when you know the neighbors have money to spend.
People here have all sorts of theories about why the disability numbers are so high. A retired judge in town named Sonny Ryan mentioned one that I heard from a lot of people, cheaters.
SONNY RYAN: I remember I had one guy in court one day, and I mean he was robust-looking. And I said just out of curiosity, what is your disability? I have high blood pressure. I said, so do I. I said, what else? He says, I have diabetes. I said, so do I. What else?
JOFFE-WALT: There is no diagnosis called disability. You don't go to the doctor and the doctor says, well, we've run the tests and it looks like you have disability. It is, by definition, squishy. And in Hale County, one of the most common diagnoses is one of the squishiest - back pain.
ETHEL THOMAS: A car hit us from behind. And I felt it right then. I've got about five herniated disks in my back.
JOFFE-WALT: I sat with lots of women like Ethel Thomas who told me their backs kept them up at night, made it hard for them to lift children, care for the elderly.
Frances Jackson told me it became hard for her to stand at all.
FRANCES JACKSON: I used to cry to try to work. It was so painful because they didn't allow us to sit down. Our job was to stand.
JOFFE-WALT: For the most part, people didn't seem to be faking this pain. But it's confusing. I have back pain. My editor has a herniated disc and he works harder than anyone I know. So who gets to decide this? Who decides that one person's back pain is disabling and another person's is not?
Well, in Hale County, it basically seems like there is one guy, a man whose name was mentioned in almost every story people told me about becoming disabled, a doctor.
JACKSON: Dr. Perry Timberlake, he suggested I apply for my disability.
JOFFE-WALT: Who was that who recommended it?
UNIDENTIFIED WOMAN #1: Dr. Timberlake from here.
UNIDENTIFIED WOMAN #2: He saw Dr. Timberlake and Dr. Timberlake sent him right on to a heart doctor.
JOFFE-WALT: I became very curious about Dr. Timberlake and I began to wonder if he was the reason for the one-in-four number. Was he running some sort of disability scam, referring everyone he meets to the program?
Well, I met Dr. Timberlake and there is nothing shifty about this man. He's your classic bleeding heart, one of very few doctors in a very poor place where pretty much every person who comes into his office tells him they are in pain, usually back pain.
DR. PERRY TIMBERLAKE: Well, we talk about the pain and what it's like. Does it - moving your legs? And I always ask them what grade did you finish.
JOFFE-WALT: What grade did you finish is not a medical question. But Dr. Timberlake feels this is information he needs to know, because what the disability paperwork asks about is the patient's ability to function. And the way Dr. Timberlake sees it, with little education and poor job prospects, his patients can't function, so he fills out the paperwork for them.
TIMBERLAKE: Well, I mean on the exam, I say what I see and what turned out. And then I say they're completely disabled to do gainful work. Gainful where you earn money, now or in the future. Now, could they eventually get a sit-down job, is that possible? Yeah, but it's very, very unlikely.
JOFFE-WALT: Dr. Timberlake is basically saying one in four people in Hale County are disabled because they can't get a job, a fact that does not seem like it should be taken into account at all - you're disabled or you're not. But if you spend enough time in Hale County, you start to see his point.
The person who really drove this home for me was Ethel Thomas. I had been meeting person after person with back and shoulder pain, and I kept finding myself asking, well, what about a job where you don't have to lift people, or a job where you don't have to use your shoulder, or just simply: have you thought about other jobs that you could do.
People gave me such bewildered looks. It was as if I was asking, well, how come you didn't consider becoming an astronaut? So by the time I was sitting with Ethel Thomas - she's on disability for back pain - I tried to ask the question in a different way.
In your dream world, if you could have a different job that you could do with your back, what would that be?
You're shaking your head.
THOMAS: Mm-hmm. I just - I hadn't really thought about it.
JOFFE-WALT: Ethel and I talked for another long while about the town, her church. A good 45 minutes passed and I was getting ready to leave, and Ethel stopped me.
THOMAS: You asked me a while back what would be the perfect job.
THOMAS: I thought about it and I said that the perfect job would be like I would sit at a desk like the Social Security people and just weed out all the ones that come in and file for disability.
JOFFE-WALT: Wait. So what's your perfect job?
THOMAS: I can sit and weed out all the ones that don't need it.
JOFFE-WALT: At first I thought Ethel's dream job was to be the lady at Social Security because she thought she'd be good at weeding out the cheaters. But no. After a confusing back and forth, it turned out Ethel wanted this woman's job because she gets to sit. That's it. And I asked her, OK, but why that lady? Why not any other job where you get to sit? And Ethel said she could not think of a single other job where you get to sit all day.
She said she'd never seen one, which seemed impossible to me. There had to be an office or storefront in town where Ethel would have seen a job that is not physical. So I started sort of casually looking around town at jobs listings.
At the McDonald's, they're all standing. The fish plant, definitely no. Truck driver wanted, heavy lifting required. Registered nurse. I actually think it might be possible Ethel could not conceive of a job that would accommodate her pain.
It is that gap between the world I live in, where there are lots of jobs where you can work and have a sore back, and Ethel's world. That is a big part of why the disability programs have been growing so rapidly. That gap is growing and the disability programs are acting like a sponge, sapping up otherwise desperate people and disappearing them.
DAVID AUTOR: Well, that's a kind of an ugly secret of the American labor market.
JOFFE-WALT: David Autor, an economist at MIT, told me people on disability are not counted in the unemployment figures.
AUTOR: Part of the reason our unemployment rates have been low, until recently, is that a lot of people who would have trouble finding jobs are on a different program. They're on the disability insurance program and they don't show up in the labor force statistics.
JOFFE-WALT: So you're saying we all already knew it was bad, it's actually worse than we think.
AUTOR: It is. It's been worse than we thought for a long time. This has been going on, you know, pretty rapidly for now more than 20 years.
JOFFE-WALT: This has been happening for so long and so quietly, this shift from work to disability programs, that I've actually been reporting on it for years and I didn't even know it.
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UNIDENTIFIED REPORTER: A small town already struggling for financial troubles just found out a major employer is shutting down...
JOFFE-WALT: This is a familiar story, a small town or city loses its main industry. When the mill closed in Aberdeen in Washington state, I covered it. I stood in the dead mill with a bunch of laid-off workers, memorializing the end of an era. An era in America where you could graduate high school and get a job at a mill, live a good life.
GARY PETERSON: Them were the best jobs on the harbor here. When you have one of them jobs you had a great job.
JOFFE-WALT: For NPR News, I'm Chana Joffe-Walt.
And that was it. That was the end of the story. But, of course, there is a second half to that story. What happened next?
SCOTT BIRDSALL: I can hear you, but it's not real well.
JOFFE-WALT: Not well? OK, let me turn my volume up here.
I called Scott Birdsall(ph) who used to work at the mill. And he told me after the mill closed, the worker retraining agencies from the country came in, set up a bunch of meetings. And at one of these meetings at a place called Work Source, right in the middle of a pep talk about resumes and the value of education, one of the staff pulled him aside.
BIRDSALL: It was an older guy there that worked for Work Source. And he just looked at me and he goes, Scott, he goes, I'm going to be honest with you. There's nobody going to hire you. If there's no place for you around here where you're going to get a job, just draw your unemployment and just suck all the benefits you can out of the system until everything's gone and then you're on your own.
JOFFE-WALT: Scott says it was the most real thing anyone had said to him in a while. Scott had a heart attack after the mill closed. He did try school for a while. He was in his late 50s. He hated it, so he came up with a new plan.
BIRDSALL: I thought, well, you know, since I've had a bypass, maybe I can get a disability and then I won't have to worry about this stuff anymore.
JOFFE-WALT: Scott got on the disability program, and it wasn't just him. I talked to four other guys at this one mill who took the same path. All of them said if circumstances had been different, if the entire economy had not changed and the mill was still open, they'd be there. David Autor at The Economist says there is a problem with using the disability programs as a new form of social safety net.
AUTOR: Once people go in that direction, they're unlikely to come back.
JOFFE-WALT: Once a person gets on disability, there are really only two ways out. You get old enough that at 65, 66 years old you move on to a different government program, Social Security for seniors, or you die. Those are the two ways people exit disability. Almost no one gets better. The benefits don't get you rehabilitative services or supportive technology. They get you a check. And it's not a great income, about 13,000 a year.
But if your alternative is a minimum wage job that will pay you 15,000 a year, a job you may or not be able to get, may or may not be able to keep, that probably won't be full-time and very likely it will not include health insurance, disability may be a better option. Chana Joffe-Walt, NPR News.
CORNISH: Our weeklong series on disability continues tomorrow with a look inside the disability industrial complex.
UNIDENTIFIED ANNOUNCER: Disabled and can't work? Get the money you deserve. Call Al Jemma(ph) at 1-800-677-9030, Al Jemma gets results.
CORNISH: Lawyers who specialize in helping Americans get on disability, that's tomorrow on ALL THINGS CONSIDERED.
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CORNISH: You're listening to ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.