The Americans with Disabilities Act (ADA) needs to be evaluated in the context of public programs that express disability policy. The older programs, which indemnify the income losses and health care costs associated with disability, are designed for persons who cannot work, as opposed to the ADA's objective of increasing employment. The tensions between the two approaches, the differences in the persons whom they serve, the conflicts between equity and efficiency goals, and some suggestions for future policies are the subjects of this article.
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References
1.
1. Gordon Allport, The Nature of Prejudice (Garden City, NY: Doubleday, 1954).
2.
See also World Health Organization, International Classification of Impairments, Disabilities and Handicaps (Geneva: World Health Organization, 1980). The World Health Organization model of disability differs from Nagi's in that it excludes the concept of functional limitations and includes “handicapped” to represent the disabling effects of social attitudes.
3.
3. William G. Johnson, “Disability, Income Support and Social Insurance,” in Disability Policies and Government Programs, ed. E. Berkowitz (New York: Praeger, 1979).
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4. The nonwelfare components of the DBS cover persons who are employed at the onset of disability. The emphasis on work for wages excludes from coverage persons who produce services for their own households. Since household production contributes a large part of the output of society, the losses due to disability among homemakers are also large. Proposals to extend SSDI coverage to homemakers have foundered because of the fears that disability could not be evaluated in the absence of a labor market test. William G. Johnson and William B. Burfield, “Disability Insurance Under Proposed Reforms,” in A Challenge to Social Security: The Changing Roles of Women and Men in American Society, ed. R. Burkhauser and K. Holden (New York: Academic Press, 1982).
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5. The medical rehabilitation model evolved from the efforts, pioneered by men such as Dr. Henry Kessler, to minimize the effects of injuries suffered by Americans who served in World War I. The model was also a concept included in the drafting of state workers' compensation laws, which were introduced in the years just before World War I as replacements for the tort liability approach.
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6. The civil rights model for public policy toward disability can be identified with the proposal, which was rejected, to include persons with disabilities as a protected group in the Civil Rights Act of 1970. The activities that led to the creation of section 504 of the Rehabilitation Act of 1973 and subsequent regulations are described in detail by Richard K. Scotch, From Good Will to Civil Rights: Transforming Federal Disability Policy (Philadelphia: Temple University Press, 1984).
7.
7. Harlan Hahn, “The Potential Impact of Disability Studies on Political Science (as Well as Vice-Versa),”Policy Studies Journal (Winter 1993).
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8. See sources cited in Marjorie L. Baldwin, “Can the ADAAchieve Its Employment Goals?” this issue of The Annals of the American Academy of Political and Social Science.
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9. Hahn, “Potential Impact of Disability Studies,” p. 741.
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10. Thus persons with epilepsy are included in the group against which prejudice is relatively severe, and persons with arthritis are included in a second group, representing persons with impairments that are subject to modest prejudice at most. The studies face a problem common to studies of discrimination against other minorities, namely, that of controlling for the effects of pre-market discrimination on education, skills, and work experience.
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11. D. Biklen, “The Culture of Policy: Disability Images and Their Analogues in Public Policy,”Policy Studies Journal (Mar. 1987).
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12. Except for mental illness, the incidence rates of the most prevalent disabling conditions—arthritis, cardiovascular disease, chronic back pain—are relatively flat until middle age and increase sharply with age after that time.
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13. Richard J. Butler, William G. Johnson, and Marjorie Baldwin, “Managing Work Disability: Why First Return to Work Is Not a Measure of Success,”Industrial and Labor Relations Review (Apr. 1995).
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14. The diversity is much greater than our simple between-group comparison suggests. See, for example, Jean F. McGuire, “Organizing from Diversity in the Name of Community: Lessons from the Disability Civil Rights Movement,”Policy Studies Journal (Spring 1994).
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15. G. S. Becker, The Economics of Discrimination (Chicago: University of Chicago Press, 1971). His famous work on discrimination cites the example of racially segregated firms as an alternative that would be efficient in certain circumstances but would not be acceptable as a social policy in the United States.
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16. The problems of maintaining employment after an initial return to work may or may not be influenced by discrimination. The one study of postreturn employment, by Butler, Johnson, and Baldwin, shows that chronic conditions gradually reduce and then eliminate employment for a large proportion of workers with disabling conditions, but it could not evaluate the effect of discrimination on the outcomes. See Butler, Johnson, and Baldwin, “Managing Work Disability.”
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17. The comparison also leads to a question about the differences between the remedies for age, ethnic, or gender discrimination and those available to persons with disabilities. This issue has not been addressed in the discussions of disability rights with which I am familiar except for the question of the doubly disadvantaged, namely, persons with disabilities who are also members of another minority group. A comparison of labor market discrimination against women with disabilities and discrimination against nondisabled women shows that gender-related discrimination is the same for disabled and nondisabled women and that disabled women face greater discrimination in employment and earnings. Marjorie Baldwin and William G. Johnson, “Labor Market Discrimination Against Women and Disabilities,”Industrial Relations (Oct. 1995).
