I've actually got a professional opinion on the American Social Security disability system.
The worst part, for me, is knowing how varied the judges are in their opinions at the hearing level. You get judges pushing 90% approval rates, and you get judges around 10% approval rates. I'm not expecting the variance to only happen after three decimal places, but is some kind of system in the system too much to ask? I know of several judges who will, for example, turn down an 18 year old and award benefits to a 49 year old with lesser impairments because the judge is biased to believe that older people are disabled but youngsters are not. I used to know where to find a judge who awards benefits to every claimant who is smart enough to answer "Yes" to, "Are you a god-fearing man/woman?" I honestly don't see much racism or sexism in decisions, but some of the trends you do see are just weird. Heck, just look at how approval numbers vary so much by state.
State agencies doing the initial and reconsideration determinations are basically programmed to have somebody hit disability by the numbers or have their boss crawl up their butt with a microscope. There's a suspicion that only favorable decisions get audited.
I see the claimants who may not be disabled by the rules, but I understand why they believe they can't work. I see the group who really aren't disabled, but it's simply pitiful knowing they're just healthy enough to work and be completely miserable with no quality of life doing it. I see the blue-collar crowd who worked until their bodies fell apart. I see the people who did something stupid and will pay the price for the rest of their lives. I see the people who will pay the price the rest of their lives for somebody else doing something stupid. And I see the moron junkies who just can't figure out why their heart goes into fibrillation every time they snort cocaine as well as the drunks who think DTs are a seizure disorder. I see the people who would cheerfully crawl a mile over ground glass for their day in court, and I see the ones who skip their hearings because they're drunk. I see people who can't manage benefits because they internalize what the TV says, people who can't manage their own benefits because they'll spend it all on crack, and innocent people who have the person responsible for their benefits stealing the money for their own drug habit. Rest assured, whatever group you think of when you think of disabled people exists, and it exists in significant numbers. When you get into an argument with somebody and have a stereotype thrown in your face, rest assured that group really exists in significant numbers too.
I am also struck by how many people aren't receiving benefits because they don't know they should at least apply. Not just disability, either. Food stamps, community/teaching hospital services, never mind the people who think they need to be found disabled before they get a simple handicapped parking placard. If you think the solution to people not taking advantage of existing programs is more programs for them to not take advantage of, you're not paying attention. We really need to educate people better on what's out there before doing anything else.
I must admit, I see so many people struck by the flying fickle finger of fate, and I see so many kids who just never had a real shot at life, that when you show me somebody with a substance abuse problem, they don't really tend to have first shot at my sympathy. This also applies to the people with COPD who won't stop smoking. Personally, I'd like to see the rules written so a positive drug test was a disqualifier. Being pro-active and paying for the tests is a waste of money, IMO. If substance abuse is a problem, it will get them in the hospital and it will get them noticed. Just have Medicaid and Medicare refuse to pay for any treatment if substance abuse is one of the listed diagnoses. Then have them refuse payment for SSI/SSDI benefits based on that. Incidentally, you'd be amazed how many people are on disability due to hospitals pushing it to cover bills generated under EMTAALA.
Of course, I also work side by side with a bunch of people who don't feel any differently about people with crippling substance abuse issues than those with crippling genetic defects, so I must admit there's a certain validity to an informed opinion disagreeing with me.