Doc Ernie's Blog

Conundrum - co·nun·drum  -  from Merriam-Webster's Dictionary; first known use in 1645.

This past July I was offered a job!  A paying, full-time position as medical director of an everyday care + urgent care facility.  Though this involved mostly on-site supervision of PA's and NP's, it also included medical care provided by myself on-site, as well as remote supervision through the use of telephone-texting-email consultations.  It was an honor and a huge lift to my spirits to be wanted again as a physician - to be sought out for such a position.  Those were some of the details of the position, yet there were concerns too.

It would involve commuting to the Seattle Capital Hill area 4 days per week minimum, in addition to several days per month of off-site remote availability.  This was to be for 49 weeks/year with a pay scale that would exceed my current disability pay by $800 per month.  Still, I must confess, I was interested.  Yet before I proceeded any further I thought it best to seek consultation from my attorney and two insurance agents whom could review my SSD and personal disability policy.  I had already known that if I were to earn more than $750 per month I would lose my Medicare and SSD payments, but once the legal language of my personal disability policy was deciphered, the conundrum was apparent.

Yes indeed, I would lose my SSD and Medicare, yet the real risk came in the ramifications this would make to my own disability policy.  Once a job was taken for 90 days or more, if it later became apparent I could not physically do the work, I would need to wait 6 months before my own policy would resume any monthly payments to me.  In the meantime, I would need to reapply for SSD and Medicare.  Simply stated, there is no way our family could exist without income for more than perhaps 2 months, if even that long.  Beyond these risks, once a job was accepted, if even for a short time my disability policy monthly payments would be calculated no longer upon what my salary was as an Emergency Physician at Virginia Mason; but instead would be based upon the medical director salary of the potential new position (significantly less pay than as an ER physician).  So that even after a 6 month wait for payments to resume, once they did, they would be at several thousand dollars less than we currently receive.  Such was the intricate and difficult problem.  Accept a position which would net me $800 more per month than I currently receive; but at the risk of truly losing our home and many other things we now enjoy if the job proved to be too physically demanding for one with a spinal cord injury.

I was advised to turn down the offer by all those reviewing the options.  And that is what I did.  Certainly I am deeply grateful for SSD, Medicare and my own disability policy; without them I am uncertain what life would look like.  It would be hugely different from what it is today.

So here are my thoughts on the way SSD, Medicare and disability policies in general are set-up.  They are not work-friendly.  In their current form, they do not encourage one to obtain a job - the risks, as in my case, are too great.  Here is my proposal.  Most people who have a spinal cord injury cannot physically work a full-time job; perhaps a few, but most cannot work full-time.  Even for me as much as I am able to walk and bicycle and maintain physical conditioning, it is very challenging and exhausting to be on my feet more than a few hours a day.  Part-time work might be possible, yet that is not enough to obtain job benefits such as medical insurance; but it is enough to cause me to lose SSD and Medicare.  And if you are disabled, you must have some medical insurance coverage, or you risk living on the street.  So to limit me to $750 per month, or others I know to even $100 per month before each of us loses our SSD and Medicare, is just not right.  It makes no sense. 

What does make sense to me is cost sharing or means-testing.  Simply put, if I make more than $750 per month, don't eliminate my SSD and Medicare entirely, just have me pay a bit more for my Medicare coverage and at the same time lower my monthly SSD payout.  I would gladly do this!  It is doubtful and risky that I could ever work a full-time job again as I have pointed out, yet a part-time position or intermittent consultant work seems quite possible.  Not ever likely enough to qualify me for vital benefits, such as medical insurance, but enough to help our family's budget.  In this scenario, as my monthly income goes up, the amount I pay for my Medicare goes up too and the amount of SSD I receive goes down.  If at some point I find I can work enough to obtain benefits, then at that time take my Medicare away; and eventually too if my earnings are enough my SSD would go away.  Similarly with my own disability policy, rather than an all or nothing approach to monthly payments, it seems appropriate to have a sliding scale.  The more I earn per month, the less the disability payout to me.  Create some incentive to work, by having the net monthly income (job income + disability income) be beyond what the disability income alone would amount to.  As one is hopefully able to adjust to longer work hours and more days of work, your own disability policy begins to support you less and less. 

I think that is fair, and I also think such a system would encourage many disabled people to actually find a paying job.  A job that would give them a purpose, an identity, a sense of worth and value to society.  Yet right now, we are all faced with the hard reality of financial ruin and loss of medical insurance if we work, and for most the upper limit of what you can earn is ridiculously low.  As a consequence we have many sharp intelligent people who are paralyzed by the current systems and policies; forced to live a life of simple means.  If one cares to otherwise carve out a new identity and purpose there is always volunteer work to be done.  Not that there is anything wrong with that, it is just that it would be nice to earn a little money at times!

Thanks for reading.