Goldman H H, Gattozzi A A
Department of Psychiatry, University of Maryland School of Medicine, Baltimore 21201.
Hosp Community Psychiatry. 1988 May;39(5):505-9. doi: 10.1176/ps.39.5.505.
A key objective of the Reagan administration when it took office in 1981 was to decrease domestic spending. Intending to offer the new administration "a little bit of a present," employees in the General Accounting Office, an arm of Congress, identified ineligible Social Security Disability Insurance (SSDI) beneficiaries as a possible source of billions of dollars of savings annually. Subsequently the administration's Office of Management and Budget instructed the Social Security Administration to begin, on an accelerated schedule, eligibility reviews authorized by the Social Security Amendments of 1980. One-fourth of the 130,500 beneficiaries dropped from the rolls during the first full year of the reviews were mentally impaired, although the mentally impaired constituted only one-ninth of SSDI beneficiaries. The reaction by mental health advocacy groups, Congress, and the courts turned "a little bit of a present" into a major problem for the administration, and the various components of government that had consorted on a misguided policy began to make amends. The experience offers useful insights for future policymaking.
1981年里根政府上任时的一个关键目标是削减国内开支。为了给新政府“送一份小礼物”，作为国会下属机构的总审计局的员工们认定，不符合资格的社会保障残疾保险（SSDI）受益人可能是每年节省数十亿美元的一个来源。随后，政府管理和预算办公室指示社会保障管理局加快进行1980年《社会保障修正案》授权的资格审查。在审查的第一个完整年度中，从名单上被剔除的13.05万名受益人中有四分之一存在精神障碍，尽管精神障碍者仅占SSDI受益人的九分之一。心理健康倡导团体、国会和法院的反应将“一份小礼物”变成了政府面临的一个重大问题，而参与了一项错误政策的政府各部门开始做出补救。这一经历为未来的政策制定提供了有益的见解。
