Hadler N M
Ann Intern Med. 1982 May;96(5):665-9. doi: 10.7326/0003-4819-96-5-665.
Social Security Disability Insurance is a federally created and regulated insurance plan. The definition of disability as it relates to work capacity is exclusively the purview of government administrators. The primary physician's opinion has little, it any, impact on decision. Administering this insurance scheme requires the quantification of illness as it relates to work capacity (disability). What has evolved is a program that insures for the amount of "disease." The assumption is that with more disease, there is a greater likelihood of illness, even illness manifest as work incapacity. Leaving this underlying assumption tacit is responsible for the adversary climate that envelops the physician, the patient-claimant, and the administrators. It is also responsible for the paucity of clinical investigations into the critical issue of the amount and form of illness a diseased person will have.
社会保障残疾保险是一项由联邦政府设立和监管的保险计划。与工作能力相关的残疾定义完全属于政府管理人员的职权范围。主治医生的意见即便有影响，也微乎其微。管理这一保险计划需要对与工作能力（残疾）相关的疾病进行量化。由此演变出的是一个为“疾病量”提供保险的项目。其假设是，疾病越多，患病的可能性就越大，甚至表现为工作能力丧失的疾病也是如此。这种潜在假设不被明说，是导致笼罩着医生、患者索赔人和管理人员的对抗氛围的原因。这也导致了对患病者疾病的数量和形式这一关键问题缺乏临床研究。
