1、原文二THESOCIALSECURITYREFORMOFAMERICANJOBSLOSTDURINGTHERECENTRECESSIONCAUSEDADELUGEOFAPPLICATIONSTOTHESOCIALSECURITYDISABILITYINSURANCEPROGRAMMORETHAN6MILLIONEACHYEARIN2009AND2010ANDTHREWINTORELIEFTHEFACTTHATTHESSDIPROGRAMISSTRUCTURALLYUNSOUNDTHECURRENTAPPLICATIONSSURGEWILLACCELERATETHEEXHAUSTIONOFSSD
2、ISTRUSTFUNDANDWILLFORCECONGRESSTOHAVETOCHOOSEAMONGTWOUNPALATABLEOPTIONSINCREASESSDIPAYROLLTAXESORREDUCEBENEFITALLOWANCERATESBUTTHATISNOTENOUGHIFTHEPARTICULARLYVULNERABLEPOPULATIONTHESSDIISDESIGNEDTOSERVEISTOBEPROTECTED,WHILEPRESERVINGINCENTIVESTOWORK,THEPROGRAMHASTOBERADICALLYRESTRUCTUREDWHYGETAJOBE
3、VENINNORMALECONOMICTIMES,THOSEWITHMARGINALLYPHYSICALORMENTALIMPAIRMENTSAPPLYINTHEHOPEOFACQUIRINGDISABLEDSTATUSUNDERSSDIAMONGTHOSEALREADYRECEIVINGSSDIBENEFITS,THEINCENTIVETORETURNTOTHEWORKFORCEISVERYPOORREVEALINGONESABILITYTOWORK,ESPECIALLYIFITSINALOWPAIDOCCUPATION,COULDCAUSEPERMANENTLOSSOFSSDIBENEFI
4、TSSTRONGWORKDISINCENTIVESUNDERSSDIRESULTFROMITSELIGIBILITYSTANDARDTHATGUIDESBENEFITAWARDSANINABILITYTOENGAGEINSUBSTANTIALGAINFULACTIVITYFOR12MONTHSORMOREPROFESSORSDAVIDAUTOROFMASSACHUSETTSINSTITUTEOFTECHNOLOGYANDMARKDUGGANOFTHEUNIVERSITYOFMARYLANDRECENTLYPROPOSEDREFORMINGSSDITOSOLVEITSTWINPROBLEMSOF
5、IMPENDINGFISCALSHORTFALLSANDPOOREMPLOYMENTINCENTIVESTHEYPROPOSEANEW“FRONTEND“UNIVERSALPROGRAMOFPRIVATEDISABILITYINSURANCEPDIPAIDFOROUTOFANEWPAYROLLTAXTOBESHAREDBYEMPLOYERSANDEMPLOYEESPDIWOULDPROVIDEEMPLOYMENTSUPPORTSTODISABLEDWORKERSWITHAVIEWOFKEEPINGTHEMONTHEJOBITWOULDALSOPROVIDENEWSUBSIDIESTOEMPLO
6、YERSTORETAINDISABLEDWORKERSONTHEJOBUNDERTHEIRREFORM,APPLICATIONSTOSSDIBYTHOSEWITHDISABILITIESBUTWHOCOULDCONTINUEWORKINGWITHASSISTIVETECHNOLOGIESWOULDBESTATUTORILYDELAYEDBY22MONTHS,DURINGWHICHTIMETHEYWOULDCONTINUETORECEIVEPDISEMPLOYMENTSUPPORTSAPPLICATIONSFORSSDIBENEFITSBYWORKERSWITHSERIOUSDISABILITI
7、ESWHOOBVIOUSLYCANNOTCONTINUETOWORKWOULDBEPERMITTEDASBEFOREINDEED,INALLLIKELIHOOD,THESERIOUSLYDISABLEDWOULDBEGINRECEIVINGBENEFITSQUICKLYTHROUGHSSDISCOMPASSIONATEALLOWANCESPROGRAMFOROTHERS,CURRENTSSDIWOULDBECOMETHE“BACKEND“OFATHREEPARTSYSTEMOFDISABILITYINSURANCEAUTORANDDUGGANESTIMATETHEANNUALCOSTOFIMP
8、LEMENTINGPDIAT150AND250PERYEARPERWORKERTHEYEXPECTPDITOREDUCETHENUMBEROFSSDIAPPLICATIONSTHEMOREVOLATILEJOBMARKETPROCESSFORTHEDISABLEDBECAUSEOFTHEIRLOWERPRODUCTIVITY,THEYTENDTOBELAIDOFFFIRSTANDHIREDLASTOVERTHECOURSEOFBUSINESSCYCLESIMPLIESVOLATILITYINAPPLICATIONSTOSSDIPOTENTIALLYFILTERINGOUTFRIVOLOUSAP
9、PLICATIONSUNDERAPDIPROGRAMWOULDREDUCEVOLATILITYOFSSDIAPPLICATIONSDURINGRECESSIONSANDREDUCETHEPROGRAMSDENIALRATEINADDITION,ASMALLERCASELOADWOULDREDUCEWAITINGTIMESFORADJUDICATINGLEGITIMATECLAIMSANDREDUCETHEPROGRAMSOVERALLCOSTSINDEED,AUTORANDDUGGANSUGGESTTHATASUBSTANTIALAMOUNTOFTHECOSTOFIMPLEMENTINGPDI
10、WOULDBERECOVEREDTHROUGHSSDICOSTSAVINGSCOSTSINTIMEANDMONEYNEVERTHELESS,WORKERSANDDISABILITYADVOCATESAREUNLIKELYTOSUPPORTTHEAUTORDUGGANPROPOSALITINVOLVES,THEYWOULDARGUE,LARGERUPFRONTCOSTSANDMUCHLONGERDELAYSINQUALIFYINGFORSSDIBENEFITSAPARTFROMDISCOURAGINGFRIVOLOUSAPPLICATIONS,MANDATORYDELAYSMAYALSODISC
11、OURAGEDESERVINGCANDIDATESFROMAPPLYING,ANDDECISIONSABOUTINITIALEMPLOYMENTSUPPORTSWOULDBEMADEBYPRIVATE,PROFITDRIVENINSURANCEFIRMS,POTENTIALLY,RESULTINGINUNFAIRBENEFITDENIALSINADDITION,ALTHOUGHTHEAUTHORSESTIMATETHECOSTOFPDITOBESMALLRELATIVETOANNUALSSDIPAYROLLTAXESFORALIFETIMEMEDIANWAGEEARNER,THEYDONOTI
12、NCLUDETHETAXPAYERCOSTOFEMPLOYERINCENTIVESTORETAINDISABLEDWORKERSTHOSESUBSIDIESMAYWORKDURINGNORMALECONOMICTIMES,BUTNOTDURINGRECESSIONSWHENTHECOMPENSATIONOFDISABLEDWORKERSNETOFTHESUBSIDIESCONSIDERABLYEXCEEDSTHEIRPRODUCTIVITYFLOODOFAPPLICANTSONTHEOTHERHAND,PDIMIGHTATTRACTSOMANYNEWAPPLICANTSINCLUDINGFRO
13、MAMONGTHOSECURRENTLYEMPLOYEDTHATSIZABLECOSTSAVINGSTOSSDIMAYNEVERMATERIALIZEINTHATCASE,PDIWOULDJUSTBECOMEANOTHERNEWPAYGOFINANCEDENTITLEMENTPROGRAMOFEMPLOYMENTSUPPORTSWITHOUTANYCOMMENSURATEGAINSINEMPLOYMENTORPRODUCTIVITYIF,INDEED,THISAPPROACHCOULDSAVESSDICOSTSBYASMUCHASTHEPDIPROPONENTSCONTEND,ANAPPLIC
14、ATIONDELAYWITHEMPLOYMENTSUPPORTSFORAPPROPRIATECANDIDATESCONDITIONALONLABORFORCEATTACHMENTANDDEMONSTRATIONTHATEMPLOYMENTSUPPORTSAREESSENTIALCOULDBEINTEGRATEDINTOTHECURRENTSSDIPROGRAMITSELFANEMPLOYMENTCONDITIONEDDISABILITY“FRONTEND“THISWAY,ANYCOSTSAVINGSWOULDACCRUEIMMEDIATELYANDDIRECTLYTOSSDITHEAVAILA
15、BLEPOLICYOPTIONSAREINCREASEPAYROLLTAXESTOPAYFORSSDISUNFUNDEDCOSTSCREATEANEWPDIENTITLEMENTWITHCONTINUATIONOFTHECURRENTPOORLYSTRUCTUREDSSDIPROGRAMORREFORMSSDIDIRECTLYTOIMPROVEWORKINCENTIVESANDPOTENTIALLYMAKETHEPROGRAMFINANCIALLYMORESECUREINTRODUCINGAMANDATORYAPPLICATIONDELAYWITHEMPLOYMENTSUPPORTSWHERE
16、APPROPRIATEWITHINSSDIWOULDAVOIDMANYOFTHEAUTORDUGGANPROPOSALSSHORTCOMINGSANDHELPTOINCREASEINDEPENDENCEANDSELFSUFFICIENCYAMONGMANYOFTOMORROWSPERSONSWITHDISABILITIESTODAYSNARROWRULINGINVIRGINIAONTHECONSTITUTIONALITYOFAPROVISIONOFTHEAFFORDABLECAREACTISJUSTONEOFMANYRECENTRULINGSONSIMILARCASESTHATHAVECOME
17、DOWNINRECENTMONTHSSINCETHELAWPASSED,OPPONENTSOFREFORMHAVEFILEDMORETHAN20DIFFERENTLEGALCHALLENGESJUDGESHAVEALREADYGRANTEDTHEADMINISTRATIONSMOTIONTODISMISS12OFTHESECASESANDINTWOCASES,FEDERALJUDGESLOOKEDATTHEMERITSOFTHEOPPONENTSARGUMENTS,DETERMINEDTHATTHEAFFORDABLECAREACTISCONSTITUTIONALANDUPHELDTHELAW
18、WEDISAGREEWITHTHERULINGISSUEDTODAYINVIRGINIAANDTHEDEPARTMENTOFJUSTICEISCONSIDERINGITSAPPEALOPTIONSWEAREPLEASEDTHATJUDGEHUDSONAGREESTHATIMPLEMENTATIONOFTHELAWWILLCONTINUEUNINTERRUPTEDINTHENINEMONTHSSINCETHEHEALTHREFORMLAWWASPASSED,WEVEMADETREMENDOUSPROGRESSTOSTRENGTHENOURHEALTHCARESYSTEM,INCLUDINGLOW
19、ERINGCOSTSANDIMPLEMENTINGANEWPATIENTSBILLOFRIGHTSTOENDSOMEOFTHEWORSTINSURANCECOMPANYABUSESTHATWORKCONTINUESANDWERECONFIDENTTHATWHENITSALLSAIDANDDONE,THECOURTSWILLFINDTHEAFFORDABLECAREACTCONSTITUTIONALHISTORYANDTHEFACTSAREONOURSIDESIMILARLEGALCHALLENGESTOMAJORNEWLAWSINCLUDINGTHESOCIALSECURITYACT,THEC
20、IVILRIGHTSACT,ANDTHEVOTINGRIGHTSACTWEREALLFILEDANDALLFAILEDCONTRARYTOWHATOPPONENTSARGUETHENEWLAWFALLSWELLWITHINCONGRESSSPOWERTOREGULATEECONOMICACTIVITYUNDERTHECOMMERCECLAUSE,THENECESSARYANDPROPERCLAUSE,ANDTHEGENERALWELFARECLAUSEOPPONENTSOFREFORMCLAIMTHATTHEINDIVIDUALRESPONSIBILITYREQUIREMENTTHEREQUI
21、REMENTTHATALLAMERICANSCARRYAMINIMUMLEVELINSURANCEBY2014EXCEEDSCONGRESSPOWERTOREGULATEINTERSTATECOMMERCEBECAUSEITPENALIZESECONOMIC“INACTIVITY“MAKENOMISTAKEINDIVIDUALSWHOCHOOSETOGOWITHOUTHEALTHINSURANCEAREACTIVELYENGAGEDINECONOMICDECISIONMAKINGTHEDECISIONTOPAYFORHEALTHCAREOUTOFPOCKETORTOSEEKUNCOMPENSA
22、TEDCAREEVERYYEARMILLIONSOFTHOSEWHOHAVECHOSENTOGOWITHOUTHEALTHINSURANCEACTIVELYSEEKMEDICALCARE,WHICHISEVIDENTINTHEBILLIONSOFDOLLARSSPENTONUNCOMPENSATEDCAREEVERYYEARTHEAFFORDABLECAREACTCAMEINTOBEINGPRECISELYBECAUSEOFTHEINTERCONNECTEDNESSOFOURHEALTHCARECOSTSPEOPLEWHOMAKEANECONOMICDECISIONTOFOREGOHEALTH
23、INSURANCEDONOTOPTOUTOFTHEHEALTHCAREMARKET,BUTINSTEADSHIFTTHEIRCOSTSTOOTHERSWHENTHEYBECOMEILLORAREINVOLVEDINANACCIDENTANDCANNOTPAYTHOSECOSTS43BILLIONIN2008ALONEAREBORNEBYDOCTORS,HOSPITALS,INSUREDINDIVIDUALS,TAXPAYERSANDSMALLBUSINESSESTHROUGHOUTTHENATIONTHISCOSTSHIFTADDEDONAVERAGE1,000TOFAMILYPREMIUMS
24、IN2009ANDROUGHLY410TOANINDIVIDUALPREMIUMTHISCONCEPTISCLEARLYSEENINOTHERAREASOFCOMMERCEFOREXAMPLE,INMOSTSTATES,DRIVERSAREREQUIREDTOCARRYAMINIMUMLEVELOFAUTOINSURANCEACCIDENTSHAPPENANDWHENTHEYDO,THEYNEEDTOBEPAIDFORQUICKLYANDRESPONSIBLYREQUIRINGDRIVERSTOCARRYAUTOINSURANCEACCOMPLISHESTHISGOALSIMILARLY,TH
25、EAFFORDABLECAREACT,THROUGHTHEINDIVIDUALRESPONSIBILITYREQUIREMENT,WILLREQUIREEVERYONETOCARRYSOMEFORMOFHEALTHINSURANCESINCEEVERYONEATSOMEPOINTINTIMEPARTICIPATESINTHEHEALTHCARESYSTEM,ANDINCURCOSTSTHATMUSTBEPAIDFORITSNOSURPRISETHEN,THATPRESIDENTREAGANSSOLICITORGENERALCHARLESFRIEDRECENTLYWROTE,“THEHEALTH
26、CARELAWSENEMIESHAVENOALLYINTHECONSTITUTION“TWOFEDERALJUDGESTHATRECENTLYRULEDONTHECHALLENGETOTHECONSTITUTIONALITYOFTHEREFORMLAWINMICHIGANANDVIRGINIAAGREEDTHESELAWSUITSWEREDISMISSED,WITHTHEFEDERALJUDGEINVIRGINIACONCLUDING“HOWANDWHENTOPAYFORHEALTHCAREAREACTIVITIESINTHEAGGREGATESUBSTANTIALLYAFFECTSTHEIN
27、TERSTATEHEALTHCAREMARKET“TWOFEDERALJUDGESHAVEAGREEDWITHTHISARGUMENTINANEARLIERRULINGINTHEWESTERNDISTRICTOFVIRGINIA,AFEDERALJUDGEWROTE“IHOLDTHATTHEREISARATIONALBASISFORCONGRESSTOCONCLUDETHATINDIVIDUALSDECISIONSABOUTHOWANDWHENTOPAYFORHEALTHCAREAREACTIVITIESTHATINTHEAGGREGATESUBSTANTIALLYAFFECTTHEINTER
28、STATEHEALTHCAREMARKETNEARLYEVERYONEWILLREQUIREHEALTHCARESERVICESATSOMEPOINTINTHEIRLIFETIMES,ANDITISNOTALWAYSPOSSIBLETOPREDICTWHENONEWILLBEAFFLICTEDBYILLNESSORINJURYANDREQUIRECAREFARFROMINACTIVITY,BYCHOOSINGTOFORGOINSURANCE,PLAINTIFFSAREMAKINGANECONOMICDECISIONTOTRYTOPAYFORHEALTHCARESERVICESLATER,OUT
29、OFPOCKET,RATHERTHANNOW,THROUGHTHEPURCHASEOFINSURANCEASCONGRESSFOUND,THETOTALINCIDENCEOFTHESEECONOMICDECISIONSHASASUBSTANTIALIMPACTONTHENATIONALMARKETFORHEALTHCAREBYCOLLECTIVELYSHIFTINGBILLIONSOFDOLLARSONTOOTHERMARKETPARTICIPANTSANDDRIVINGUPTHEPRICESOFINSURANCEPOLICIES“THEAFFORDABLECAREACTALSOBANSINS
30、URANCECOMPANIESFROMDISCRIMINATINGAGAINSTPEOPLEWITHPREEXISTINGCONDITIONSHOWEVER,UNLESSEVERYAMERICANISREQUIREDTOHAVEINSURANCE,ITWOULDBECOSTPROHIBITIVETOCOVERPEOPLEWITHPREEXISTINGCONDITIONSHERESWHYIFINSURANCECOMPANIESCANNOLONGERDENYCOVERAGETOANYONEWHOAPPLIESFORINSURANCEESPECIALLYTHOSEWHOHAVEHEALTHPROBL
31、EMSANDAREPOTENTIALLYMOREEXPENSIVETOCOVERTHENTHEREISNOTHINGSTOPPINGSOMEONEFROMWAITINGUNTILTHEYRESICKORINJUREDTOAPPLYFORCOVERAGESINCEINSURANCECOMPANIESCANTSAYNOTHATWOULDLEADTODOUBLEDIGITPREMIUMSINCREASESUPTO20FOREVERYONEWITHINSURANCE,ANDWOULDSIGNIFICANTLYINCREASETHECOSTHEALTHCARESPENDINGNATIONWIDEWEDO
32、NTLETPEOPLEWAITUNTILAFTERTHEYVEBEENINACARACCIDENTTOAPPLYFORAUTOINSURANCEANDGETREIMBURSED,ANDWEDONTWANTTODOTHATWITHHEALTHCAREIFWEREGOINGTOOUTLAWDISCRIMINATIONBASEDONPREEXISTINGCONDITIONS,THEONLYWAYTOKEEPPEOPLEFROMGAMINGTHESYSTEMANDRAISINGCOSTSONEVERYONEELSEISTOENSURETHATEVERYONETAKESRESPONSIBILITYFOR
33、THEIROWNHEALTHINSURANCETHEREHAVEBEENMANYRULINGSONCOURTCASESREGARDINGHEALTHREFORMANDWEKNOWTHEREWILLBEMANYMOREINTHEEND,THEAFFORDABLECAREACTWILLPREVAILANDTHEAMERICANPEOPLEWILLENJOYTHEBENEFITSOFREFORMBACKGROUNDTHEPLAINTIFF,SHAWNAPDOMBERT,BRINGSTHISACTIONPURSUANTTOTITLEXVIOFTHESOCIALSECURITYACTSEEKINGREV
34、IEWOFTHEDECISIONOFTHECOMMISSIONEROFSOCIALSECURITY,DENYINGTHEPLAINTIFFSAPPLICATIONFORSUPPLEMENTALSECURITYINCOMESPECIFICALLY,THEPLAINTIFFALLEGESTHATTHECOMMISSIONERSDECISIONISNOTSUPPORTEDBYSUBSTANTIALEVIDENCEINTHERECORDTHESSACOMMISSIONERCONTENDSTHATTHEREISSUBSTANTIALEVIDENCEINTHERECORDTOSUPPORTHISDECIS
35、IONTODENYTHEPLAINTIFFSSIBENEFITSBOTHPARTIESHAVENOWMOVEDFORJUDGMENTIN2008,THEPLAINTIFFFILEDANAPPLICATIONFORDISABILITYINSURANCEBENEFITSANDSSIALLEGINGDISABILITYDUETOBACKPAIN,ARTHRITIS,DEPRESSION,ANXIETY,HIGHBLOODPRESSUREANDAFOOTDEFORMITYTHEADMINISTRATIVELAWJUDGEFOUNDTHATTHEPLAINTIFFDIDNOTHAVEANIMPAIRME
36、NTLISTEDINTHEREGULATIONSANDTHAT,ALTHOUGHSHEDIDNOTHAVEPASTRELEVANTWORKEXPERIENCE,PLAINTIFFHASTHERESIDUALFUNCTIONALCAPACITYTOPERFORMSEDENTARYWORKFURTHER,PLAINTIFFISA46YEAROLDWOMANWITHAHIGHSCHOOLEDUCATIONWHOHASWORKEDASASHORTORDERCOOK,ANASSISTANTTOADISABLEDVETERAN,ANASSISTANTTOADISABLEDWOMAN,ACASHIER,AH
37、OUSEKEEPERANDASEAMSTRESSRULINGTHECOURTFINDSTHATTHEREISSUBSTANTIALMEDICALEVIDENCEINTHERECORDFORTHEALJTOCONCLUDETHATTHEPLAINTIFFWASNOTDISABLEDWITHINTHEMEANINGOFTHESOCIALSECURITYACT,ANDTHATTHEPLAINTIFFCOULDPERFORMSEDENTARYWORKSEDENTARYWORKISDEFINEDASWORKTHATINVOLVESSITTING,WITHOCCASIONALSTANDINGORWALKI
38、NG,LIFTINGNOMORETHAN10POUNDSATATIME,ANDOCCASIONALLYLIFTINGORCARRYINGARTICLESLIKEDOCKETFILES,LEDGERSTHEALJPROPERLYWEIGHEDTHEVARIOUSMEDICALOPINIONSTHECOURTFINDSTHATTHEALJPROPERLYDETERMINEDTHATTHEPLAINTIFFSSUBJECTIVECOMPLAINTSWERENOTCREDIBLEASTHEYWERENOTSUPPORTEDBYTHERECORDAMONGTHEEVIDENCE,THEMARCH2009
39、REPORTFROMTHEPLAINTIFFSTREATINGPHYSICIANSSTATEDTHATSHEWASABLETOSTANDANDSITFORANHOURATATIMEANDLIFT10POUNDSTHEPLAINTIFFREPORTEDTHATSHEWASABLETOTAKECAREOFHEREIGHTYEAROLDSON,DOLIMITEDCLEANINGANDSHOPPING,DRIVEANDTAKEPUBLICTRANSPORTATIONTHEPLAINTIFFSCOMPLAINTISTHEREFOREDISMISSED译文美国社会保障的改革最近山洪暴发般的经济衰退造成了大
40、量应用与社会保障伤残保险的程序每年超过6万，在2009年至2010年松了一口气事实程序结构的合理性,SSDI是站不住脚的。当前应用程序潮将促进用尽SSDI的信托基金，并将强制国会在两个难吃选项中进行选择SSDI工资税的增加或减少福利津贴。但这是不足够的。如果要同时保留奖励工作，SSDI为了服务，特别是弱势群体的程序已经被彻底调整了。为什么就业甚至在经济比平时有轻微的身体或精神障碍中也适用，希望能获得SSDI下的禁用的状态。已接收SSDI好处的，回到工作中激励是很差。透露工作的能力，尤其如果是在一份低报酬的工作时，才可能导致SSDI好处永久丢失。根据SSDI的强有力的工作抑制，因其资格标准指南受
41、益奖项不能从事实质效益可观活动,12个月或者更多。麻省理工学院的教授DAVIDAUTOR和马里兰大学的教授DUGGAN最近提出改革两个问题,旨在解决其SSDI迫近的财政不足以及可怜的就业的奖励。他们提出了一个新“前端“通用程序的私人残疾保险PDI，由雇主和雇员共同支付的一种新的工资税。PDI将为残疾工人服务，以期保持他们对这项工作的工人提供就业支持。它还会保留对这项工作的残疾的人士的雇主，提供新的补贴。根据他们的改革，谁能继续与辅助技术的SSDI应用程序会法定延迟22个月，在这段时间他们将继续接收PDI的就业支持，。严重残疾工人SSDI福利申请的人显然不能继续工作他们将获准和以前一样。事实上，
42、在所有的可能性中，严重残疾人士会为他人开始接收快速通过SSDI的体恤津贴计划的好处。当前SSDI将成为残疾保险的三个部分系统“后端“。AUTOR和DUGGAN实施年度费用估算PDI每年每人在150美元到250美元之间。他们期望PDI减少SSDI应用程序的数量。更加不稳定的就业市场过程以帮助残疾人士因为其较低的生产力往往是下岗的第一原因，在商业周期雇用的过程中意味着经济周期在SSDI应用程序中的波动，潜在的过滤轻薄的应用PDI计划将会下SSDI减少波动的应用,在经济衰退期间降低程式的否定率。此外,一个较小的病人需要等待的时间就会减少合法要求和减少为审判程序的总成本。事实上，AUTOR和DUGGA
43、N建议将通过节省成本的SSDI收回大量实施PDI的成本。成本在于时间和金钱，然而工人和残疾的倡导者不支持AUTORDUGGAN的提案。它涉及到，他们会争辩，较大的前期成本和更长的时间延误符合SSDI的好处。除了劝阻轻薄的应用、强制性的延时可能也不值得利用、决定候选人对初聘支持都由私人利益,潜在的保险公司,导致不公平的利益否定。此外,虽然作者估计PDI的成本相对小的年度SSDI工资税一辈子中值WAGEEARNER,它不包括纳税人鼓励雇主成本保留残废的工人。二可能会工作在正常的经济时代,但不是在经济衰退期间残疾工人赔偿时网络的补贴大大超过他们的工作效率。另一方面,PDI可能吸引这么多新聘人包括在目
44、前所采用的积蓄,相当大的成本SSDI可能永远都无法物质化。在这种情况下,PDI只会成为另一个新的PAYGO就业授权活动资金支持没有任何相称在工作或收益生产力。如果,事实上,这种方法可以挽救SSDI成本高达PDI的支持者认为,一个应用程序的延时和适当的候选人就业支持附件和劳动力方面有就业示威活动,支持是必要的就会被整合到当前的SSDI程序本身一个EMPLOYMENTCONDITIONED残疾“前端。”这种方式,任何代价直接向SSDI增加储蓄资金直接向SSDI。可用的政策选择是1、增加工资税来支付SSDI的无资金支持成本。2、创建一个新的PDI权利的进行结构SSDI差程序。目前3、或者改革SSDI
45、直接改善工作的激励和潜在经济使程序更安全。此外，介绍一个强制性的应用和适当的SSDI就业支持,会避免AUTORDUGGAN方案的许多缺点并帮助提高独立众多、自给自足的残障者。今天的狭窄的裁决在维吉尼亚州的合宪性上付得起的牙医的规定行为只是其中之一，在许多最近裁决的类似病例中，由于反对该法律通过改革的反对者已正式提出20多个不同的法律挑战。法官已经授予了政府的运动来解雇12项的病例。在两起事故中,联邦法官看着是非的对手的参数,确定他们付得起的牙医行为是信奉的宪法和法律。我们不同在弗吉尼亚州今日发出的裁决，律政司正在考虑其上诉选项。我们感到高兴的是得到哈德逊法官的同意，并执行法律将继续不间断执行该
46、法律。在过去了九个月后通过了卫生改革的法律，因为我们已经作出加强我们包括降低成本和执行结束一些最大的保险公司滥用的新病人的权利法案的卫生保健系统的巨大进步。继续这项工作，我们有信心确定它在所有工作完成之后，法院一定会找到价格合理的服务法宪制。历史和事实是在我们这一边，所有领域和所有失败的主要新的法律，包括社会保障法、公民权利和选举权利法都存档失败了。相反，出乎反对这项新法律落在国会的力量来调节经济活动根据商务条款,必要、合理条款,且公共福利条款。改革的反对者声称个人责任要求要求所有的美国人进行2014年的最低级别保险超过大会的权力，规定州际商务，因为它惩罚经济的“活动“不要犯错误那些选择去而没
47、有医疗保险的积极从事经济决策决定支付卫生保健服务现金或寻求UNCOMPENSATED照顾。每年有数百万的那些选择去而没有医疗保险的积极寻求医疗,这是明显的,在数十亿美元花在UNCOMPENSATED护理,每年都有。他们付得起的牙医的行为形成了遥远的正是因为我们的医疗费用。那些让经济决定放弃健康保险不脱离养生保健市场,而是改变他们的成本转嫁给别人,当他们生病或参与一场车祸中丧生并且不能付钱。这些成本总共430亿美元,2008年生的独生子女,由医生、医院、保险个人、纳税人和小型公司在全国各个地方。这COSTSHIFT平均每个家庭增加1000美元保险费在2009年,大致个人410美元保险费。这一概念
48、能清楚地看到其他地区的贸易。例如大多数州的驱动程序需要进行的汽车保险的最低水平。发生意外，当他们做他们需要快速和负责任的态度而支付的。需要进行汽车保险的驱动程序来实现这一目标。同样，经济服务通过个人责任的规定将要求每个人都进行某种形式的医疗保险，因为一些时间点上的每个人都参与健康医疗和必须支付的费用。然后，毫不奇怪，里根总统专员查尔斯最近写道“保健法律的敌人没有盟友在宪法里”。最近裁定，密歇根州和弗吉尼亚州改革法律的合宪性挑战的两位联邦法官同意。这些诉讼被驳回，联邦法官在弗吉尼亚结题“如何及何时支付医疗卫生保健的ACTIVITIESINAGGREGATESUBSTANTIALLY影响S州际卫生
49、保健市场。”两名联邦法官已同意此参数。在西弗吉尼亚州区一个较早的裁决，一名联邦法官写道“我认为有一个理性基础国会得出这样的结论个人的决定对如何以及何时进行支付卫生保健服务对冲基金的活动可以极大地影响着养生保健市场号州际公路几乎每个人都需要健康医护服务,在他们一生中的某些时刻,不可能对预测何时你将困苦人所受的疾病或伤害,需要照顾远离的不活动。”通过选择放弃保险、原告正在做一项经济决策来支付卫生保健服务后,从口袋里,而不是现在,通过购买保险。当国会找到,这些经济决策总检出率呈上都有显著影响全国市场为健康通过集体转移数十亿美元用于其他市场参与者的价格也推高了保险政策。价格合理的服务法还禁止保险公司对预先存在条件的人的歧视。然而，如果每个美国人都需要有保险，它将成本高昂，覆盖已存在的条件的人。这里的原因有如果保险公司可以不再拒绝覆盖面，适用于保险的人特别是那些有健康问题的，可能更昂贵，然后包括没有停止来自等到他们生病或受伤的报道由于保险公司不能说没有申请的人，这会导致保费增加两位数，达到20。对每个人都明显增加费用卫生保健费用清单。我们不让人们等到他们一直在一场车祸中汽车保险申请并获得报销,我们不想这么做医疗保健。如果我们打算拍摄非法歧视基于既往症,只有这样才能阻止人们的游戏系统,提高成本对别人是为了保证每个人都把对于
