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Society still perceives disability as a medical matter. That is, society associates disability with physiological, anatomical, or mental "defects" and holds these conditions responsible for the disabled person's lack of full participation in the economic life of our society, rather than viewing their exclusion for what it is — a matter of hard constructed socio-economic relations that impose isolation and poverty upon disabled people. The medical model persists despite the Disability Rights Movement's efforts via the Americans with Disabilities Act of 1990 (modeled on the Rehabilitation Act of 1973) to substitute a minority/social model of disability over the dominant medical/clinical model.

From Integration to Segregation

Just as "medicine" played a significant role in propping up racism by theorizing blacks were an inferior race based on biological research and professional "expertise," medicine has also defined which bodies are "normal" and desirable, thus acceptable. It has pathologized characteristics such as blindness, deafness and impairment which have naturally appeared in the human race throughout history. As medicine explained, then justified and created racial categories, similarly the medicalization of disablement has relegated disabled persons to isolation and exclusion from society. Even today in San Francisco, activists have to sue the County for using Medicaid funding to warehouse people in a hospital rather than provide in-home services. "A de facto policy bias toward institutional care exists," states the Disability Rights Education and Defense Fund in Mouth Magazine.

Civil Rights activist and key advocate of the ADA, Rep. Major R. Owens (D-NY) answered, "Segregation," when asked what is the greatest enemy facing disabled people today. By placing the focus on curing the so-called abnormality, and segregating those who could not be cured into the administrative category of "disabled," medicine bolstered the capitalist business interest - to shove less exploitable workers with impairments out of the workforce.

Much of this had to do with control of the labor supply. Deborah Stone, in The Disabled State, convincingly argues that in order to restructure the workforce for the demands of early capitalist production it was first necessary to eradicate all viable alternatives to wage labor for the mass of the population. History tells us that categories separating those who could work from those who "could not" first appeared in the period leading up to the industrial revolution in Britain. Leeds Scholar Mark Priestly shows that English statutes in the15th and 16th centuries had a two pronged approach - surveillance and discipline for those whose labor could fruitfully be exploited; surveillance and confinement for those the market could not profitably employ. By 1597, statutes defined "not able to work" as "...the lame, impotent, old, blind and such other among them. . ." Priestly concludes, "People with impairments did experience a transition from integration in the private sphere to segregation, surveillance, and control and that process seems to have begun in the first half of the sixteenth century."

Scholars suggest that under the feudalist system, disabled people were seen as subhuman, and like many people suffered greatly under difficult conditions, but most were integrated into their communities. Some survived by doing what work they could in the fields or kitchen. Some became skilled artisans, exerting control over a trade which, importantly, allowed them to work at their own pace. The requirements of industrial capitalism, however, effectively segregated the "fit" from the "unfit," decreasing disabled people's ability to function as productive members of the community. The new production dynamics further de-valued disabled bodies. Capitalists valued nondisabled workers because they could be pushed to produce at ever increasing rates of speed which in turn increased profits for the owner class. But as work became more compartmentalized, requiring precise mechanical movements of the body repeated in quicker succession, disabled people were seen as less "fit" to do the tasks then required of the working class.

The emerging market economy meant that disabled people who were perceived to be of no use to the competitive profit cycle would be excluded from work. There was no room under market tyranny to accommodate disability by providing work schedules or adjusting jobs to fit disabled people's needs (a goal of the ADA today); rather the disabled person was expected to conform to the needs of the industrialists, an impossible task for many. The social consequence would be that disabled persons were perceived as not capable of working at all. The injured workers, the congenitally disabled would be deemed "unfit," excluded from the workforce, driven into poverty, and eventually, institutionalized.

Disability: A Social Creation

"Disability" itself came to be defined in relation to a capitalist labor market. For instance, in U.S. workers' compensation statutes, a laborer's body is rated according to its functioning parts. One is rated a "10" if one has all one's fingers, arms, legs, but ones value is significantly altered to a 7.5 or less if any parts do not "work" by capitalist production standards. In Social Security law, disabled means unable to "engage in substantial work activity," that is, unable to perform work to a standard required to earn a living in a capitalist economy. This is to say that ableism is perpetuated through social policy built to serve the market economy instead of all members of the society.

While the medicalization of disability occupies center stage, these socio-economic origins of disablement and the fact that our economic system materially reproduces "disablement" are often overlooked — but disabled people's unemployment predicament can be traced to restraints imposed by the capitalist system today.

Advances in technology may have expanded the realm of jobs disabled workers could perform in the information age, however, the disabled employment rate has not budged from its pre-civil rights figure of 70 percent unemployed.

The Civil Rights Commission provided some insight when it reported in 1998 that one of employers' chief objections was how much it cost to employ disabled workers.

• Reduced Bottom Line: Disabled persons are often isolated and excluded from full participation in work life because from a business perspective, the hiring or retaining of a disabled employee represents nonstandard additional costs when calculated against a company's bottom line. Economist, Richard Epstein explains the business point of view, stating that employment provisions of the ADA are a "disguised subsidy" and that "successful enforcement under the guise of reasonable accommodation necessarily impedes the operation and efficiency of firms."
• Extra Risk: Since the ADA allows disabled workers to be classified and written up as a "risk" in private insurance, this expense often factors into employers decisions about hiring and firing. Employers, if they provide health care insurance at all, anticipate elevated premium costs for disabled workers, and speculate that a disabled employee may increase worker's compensation costs in the future. Insurance companies and managed care health networks often exempt "pre-existing" conditions from coverage or make other coverage exclusions based on chronic conditions, charging extremely high premiums for the person with a history of such health care needs. In addition, employers characteristically assume that they will encounter lowered productivity from a disabled worker.
• Discrimination: Disability discrimination, resting on employer assumptions that the disabled person cannot do the job or on employer-resistance to hiring a blind, deaf, mobility or otherwise impaired person (just as they might not want to hire blacks or women), undoubtedly contributes significantly to the high unemployment rate of disabled people. Disabled workers also face inherent economic discrimination within the capitalist system, stemming from employers' expectations of encountering additional nonstandard production costs when hiring a disabled worker as opposed to hiring a worker with no need for special accommodation, environmental modifications, liability insurance, maximum health care coverage or even health care coverage at all. Using this analysis, the prevailing rate of exploitation determines who is "disabled" and who is not. Disability thus represents a social creation — one that defines who is offered a job and who is not. An employee who is too costly (significantly disabled) will not likely become (or remain) an employee at all. Census data tend to support his view. For working-age persons with no disability the likelihood of having a job is 82.1 percent. For people with a non-severe disability, the rate is 76.9 percent; the rate drops to 26.1 percent for those with a significant disability. [BJELL]

Government Could Help in the Short Term

The ADA has not "leveled the playing field" - the goal of most civil rights legislation - by eliminating economic discrimination. In liberal capitalist economies, redistributionist laws (which will cost business if enforced) are necessarily in tension with business interests, which resist additional costs. So far, employers have resisted providing reasonable accommodations, and the business-biased courts consistently rule on behalf of employers, not workers with impairments. If capitalists benefit by not having to employ or retain a worker with an impairment, then many disabled workers are, and will continue to be, eliminated from mainstream economic activity. So the question becomes is it possible to reform business practices so that disabled persons are not excluded from the workforce?

• Remove Discriminatory Insurance Language: Bruce Robb, an advocate from South Carolina points out that "employers see disabled workers as a liability rather than as an asset, and this needs to be turned around." Robb proposes government remove the insurance language from ADA Title V which allows the insurance industry to write up a disabled employee as a risk for private insurance. Robb's logic is persuasive "If they [disabled people] are already a risk prior to their first guaranteed interview who will hire them?" But will the insurance industry revolutionize their liability and risk underwriting practices to boost the disabled employment rate?
• Reduce Risk to Employers: Government could offer subsidies to offset business costs to level the playing field. It has recently passed one such reform, the Work Incentives Improvement Act of 1999 (WIIA), a subsidy that will allow disabled workers to retain their public health care by permitting them to buy into Medicare and Medicaid. But typical of most reforms, this measure falls way short. For example, it is not mandatory that states adopt WIIA, rather the Act allows states to "experiment" with such an approach, so WIIA does not guarantee any improvement. Much will depend on how effective advocates can be implementing a good plan in their states.
• Facilitate Part-Time Work: Further, WIIA may be a modest first step towards disconnecting health benefits from indigency for those who can hold down a traditional full time job, but it will do nothing to alleviate the more complicated set of Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) pitfalls for the self-employed and those who must rely on part-time and sporadic work to survive. These individuals would need to have their personal assistance services, SSI/SSDI/and Medicaid share of cost recalculated every month they earn income, something these systems are not efficient enough to do without delays and shortfalls for the recipient. Nancy Becker Kennedy, an activist in the know from Los Angeles says, "It would be inadvisable for any disabled individual to work at part time or sporadic employment because they run the highly probable risk of throwing these very sluggish benefit systems into confusion." Experience shows that this often results in one losing their healthcare, living allowance, and money to pay their attendant for months or even years while Social Security Administration and other agencies sort it out (and hopefull get it right when they do).
• Enforce Minimum Wage Standards: Other dubious subsidies already exist. Section 504 of the Rehabilitation Act of 1973 provides that federally financed institutions are required to pay a "fair" or "commensurate" wage to disabled workers, but they are not required to meet even minimum wage standards. The traditional sheltered workshop is the prototype for justifying below-minimum wages for disabled people, based on the theory that such workers are not able to keep up with the average widget sorter. Any nonprofit employer is allowed to pay subminimum wage to disabled employees under federal law, if the employer can show that the disabled worker has "reduced productive capacity." 6,300 such U.S. workshops employ more than 391,000 disabled workers, some paying 20 to 30 percent of the minimum wage; others paying as little as $11 per week (Washington Post, Dec. 12, 1999 ). In reality, workers with disabilities in these workshops know that they are sometimes paid less, not because they lack productive capacity but because of the nature of segregated employment.
• Subsidize Accomodations: Government could pay for disabled workers' reasonable accommodations. Perhaps that would remove the issue of that added cost from the employer's bottom line and stop some employers from fighting disabled employees' much needed accommodations in court.
• Mandate Affirmative Action for disabled workers: unlike the Civil Rights Act of 1964, the ADA was not followed up with an affirmative action program. While the Labor Department can mandate affirmative action for women and minorities, it only urges employers to hire disabled workers.
• End Earnings Limitations: SSI/SSDI earnings limitations often sever people who will never become nondisabled from benefits and health care even when they are not earning enough money to live on or to replace their public health care. The cut off limits are not regularly adjusted to reflect actual costs of living. Highly punitive, administratively costly, earning limitations should be scrapped just as the government recently ended earnings limitations for seniors collecting retirement benefits.

But We Need Long-Term Solutions

Such reform, however, is not likely to make a difference in any substantive sense. For one, productivity is the center of capitalist accumulation. Labor is always, a priori, the retarding factor of productivity because labor can never produce fast enough or equivalently, at a low enough valued rate, to suit the expectation of an accelerating profit curve. It is likely that impaired persons (due to the reasons explained above) will always be seen as less than what is desirable to maximize profit. In addition, the put-into-practice theory of a natural unemployment rate assures that the Federal Reserve will see to it that large numbers of people are kept unemployed to preserve the "health" of the economy. Disabled persons are traditionally a part of this "reserve army of labor" which gets called to action when the unemployment rate is low. As the Los Angeles Times reported on July 8, 2000, the "healthy" economy means that many employers are "hiring ex-convicts, the disabled and others they once avoided recruiting." These undesirables will be the first to go jobless when the unemployment rate creeps back up again. It remains to be seen whether the ADA will protect disabled workers from being fired in the next downturn of the economy.

The liberal welfare state solution to this power of capital to dictate and control the labor force has been either to shift the "deserving" disabled, jobless, and needy onto government subsistence programs (in the U.S.below poverty level benefits), place them in paternalistic sheltered workshop environments or send them through administrative assistance to secure employment - like vocational rehabilitation. But disabled people are saying the liberal compromise, though well intended, hasn't worked very well. The evidence is that the disabled unemployment and poverty rates remain the highest in every nation in the world.

In the U.S., the unemployment rate remains 70 percent at a time when our economy has had the longest expansion in recorded history and 79 percent of working age disabled persons report that they want a job. The 1998 National Organization on Disability (NOD)/Louis Harris Survey, found that fully a third (34 percent) of adults with disabilities live in a household with an annual income of less than $15,000 compared to one in eight (12 percent) of those without disabilities - a 22 point gap. Poverty deepens for those on disability benefits.

Though we are still in the midst of the disability civil rights experiment and it is too early to draw definite conclusions as to how much will be accomplished, it is safe to say that any full solution to the unemployment predicament of disabled persons under capitalism cannot depend on liberal civil rights anti-discrimination measures and the random integration of disabled people into the economy that civil rights promise (but so far have not delivered).

If we drop our ideological defenses and take a new look, disability oppression exposes the tradeoffs we have made that unwittingly support a rotten system. Ending disability oppression will necessitate a radical structural transformation of the economic system. It will require confronting those who control the means of production with the fact that millions are forced into underemployment or unemployment against their will. What form that may take is beyond the scope of this article. However, in the search for envisioning a just new economy, it is certain that we must ask what is an economy for: to support market driven profits and models of production that exclude segments of the population or to sustain social bonds and encourage full participation for all — including those members of our society who have an impairment?

The short answer is that an economy is only working if it works for people, if it delivers health care, a living wage and a secure livelihood and income for every person. A government guarantee of full employment would require reorganizing the economy to allow everyone free choice among opportunities for useful and fulfilling paid employment or self-employment. In order to bring more excluded persons into the workforce, it will be necessary to expand the work environment beyond the capitalist profit motive and ensure that federal and state governments act as the employers of last resort. Base compensation must be set at a living real wage below which no renumeration for disabled or nondisabled workers is allowed to fall.

Because illness (as separate from impairment) can make it impossible for some to work for pay with a reasonable accommodation or to sustain a job, those individuals must have a government entitlement to an adequate standard of living which rises with increases with the wealth and productivity of society.

In the end, work is not the defining quality of our worth. Employability and aptitude for earning money are not the measure of what it means to live, to be a part of the human race. The goal of social justice must be to ensure the dignity of each and every person. To buy into the capitalist propaganda that human worth is measured by how much one contributes to capitalist profit serves only to oppress us all.

Resources:

Russell, Marta, "Backlash, the Political Economy, and Structural Exclusion," 21 Berkeley Journal of Employment and Labor Law, Feb. 2000, pp 348-349.

Mouth Magazine www.mouthmag.org

Priestly, Mark, "The Origins of a Legislative Disability Category in England," Disability Studies Quarterly, Vol. 17 No. 2, Spring 1997 pp. 87-93.

Oliver, Michael, The Politics of Disablement (New York: St. Martin's Press 1990).