Disability, Handicap & Society, Vol. 1, No. 2, 1986 121 Public Support for Rehabilitation Programs: the analysis of U.S. disability policy HARLAN HAHN Department of Political Science, University of Southern California, University Park, Los Angeles, California 90089-0044, USA ABSTRACT Although political scientists have displayed relatively little interest in research on disability thus far, a brief review of major issues in rehabilitation in the United States indicates the contribution that policy analysts can make to the study of this subject. This opportunity is enhanced by a recent shift in the definition of disability from a medical orientation, which emphasizes functional impairments, and from an economic approach, which stresses vocational limitations, to a socio-political perspective, which regards disability as the product of interac- tions between individuals and the environment, The latter definition has become the founda- tion for a new ‘minority-group’ model of disability that is challenging the traditional functional-limitations’ paradigm and that might profitably be utilized in future research. The development of rehabilitation, like all other professions, reflects a process of dynamic evolution. In recent years, many of the major tenets of this field have been challenged by a growing international movement of disabled persons and by an increasing emphasis on legal rights. Much of the confusion created by these trends probably has been exacerbated by a tendency of rehabilitation practicioners to focus on the needs of individual clients and by the relative neglect of broad issues in disability policy. By concentrating on policy research, therefore, important progress might be made in gaining an improved understanding of some of the major controversies confronting the study of rehabilitation. Despite the vast range of political issues that have received major research attention, relatively little prior interest has been devoted to the study of disability and rehabilitation policy. The subject of disability has emerged as a major focus of research in psychology (Shontz, 1975; McDaniel, 1976, Vash, 1981), sociology (Safilios-Rothschild, 1970; Albrecht, 1976), and economics (Berkowitz, Johnson & Murphy, 1976), as well as in several recent anthologies which combine the perspectives of various disciplines (Stubbins, 1977; Berkowitz, 1979; Spiegel & Podair, 1981; Rubin & La Porte, 1982; Eisenberg, Griggins & Duval, 1982). Yet, although political scientists are beginning to display a concern with disability policy (Stone, 1984; see also, however, Hahn, 1985b), the literature produced by resear-122 H. Hahn chers in this discipline interested in policy analysis has been virtually overshadowed by contributions from other fields. The relative neglect of this subject cannot be easily reconciled with the magnitude of the issue. According to Bowe (1978: 17), the “most widely quoted estimate” of the number of disabled persons in the United States is 36 million. Perhaps even more significantly, expenditures which seek to address the needs of this segment of the population comprise a substantial—and largely unrecognized—- portion of government budgets. Although researchers such as Erlanger & Roth (1985: 320) have cautioned about the “danger... that the cost figure will be... erro- neously judged too high on its face,” Berkowitz & Rubin (1977: 1) have calculated that the total amount of money spent for disability policies in the United States in 1975 was approximately $114 billion. (Federal appropriations provided about half of this amount, and state or local governments contributed another 12 percent). Unfortunately, “differing institutional arrangements and statistical difficulties” (Kohl, 1981: 320) seem to preclude the comparative analysis of variations in spending for similar purposes in other countries. Yet, there appears to be little doubt that efforts to cope with the problems of disability may require relatively large—and growing—governmental allocations throughout the world. In fact, Bowe (1980: ix-xvii) has proposed that attempts to resolve these problems are inextri- cably linked to the solution of other prominent social issues such as inflation, poverty, aging, and seemingly “uncontrollable” government costs. With advances in medical technology and increasing longevity, he has even predicted that the proportions of disabled and nondisabled persons in America could begin to approach equivalence by the year 2000. The subject of disability and rehabilitation policy cannot be neglected indefinitely. There are also important theoretical reasons for an increased emphasis on the study of disability policy. The prevalence of disability is, of course, closely related to the rising expense of health care and income-maintenance programs which has led some observers to fear for the future of the welfare state. In fact, Wilensky (1975: xiv) began his classic comparative study of public expenditures with the erroneous observation that a Swedish controversy over subway access to persons in wheel- chairs probably could not have happened in American cities. As policy analysts become more familiar with the widespread ramifications of disability, they may begin to recognize the centrality of this issue to research on many social welfare programs. Similarly, the examination of disability policy might help to illuminate the focus on the concept of risks (Aharoni, 1981; Douglas & Wildavsky, 1982) by suggesting the potential costs that could be incurred when governments fail to provide adequate protection against harm. Furthermore, the investigation of rehabil- itation and disability may provide an appropriate basis for approaching the evalua- tion of public investments in human resources as an instrument of economic policy. Far from being peripheral to the concerns of political and social scientists, the study of disability policy seems to be an essential component of the analysis of major government programs. In addition, research on disability policy represents a significant contribution to the coverage of policy issues. Disability policies comprise a large, growing, andU.S. Disability Policy 123 previously unrecognized facet of government activities; and an analysis of the values implicit in these policies could yield new approaches to needed improvements. Although there seems to be increasing acceptance of Nagi’s (1979: 3; 1981: 36) definition of disability as ‘a form of inability or limitation in performing roles and tasks expected of an individual within a social environment,” efforts to formulate policy in this field have been surrounded by an unusual amount of fragmentation and confusion. Perhaps this lack of conceptual clarity has been one consequence of the tendency by political scientists and policy researchers to avoid this issue. The purpose of this paper, therefore, is to examine the issue of public support for disability and rehabilitation programs as a basis for the development of a subfield or specialty focusing on disability politics and policy. The discussion concentrates primarily on disability and rehabilitation policy in the United States. The first section of the paper describes the gradual evolution of disability policy as a prelude to an assessment of rehabilitation programs. Finally, several major concep- tual issues in this field are examined; and an attempt is made to indicate the value of the perspective that policy analysts can contribute to research on disability and rehabilitation. The Development of Disability Policy One of the first groups to receive direct government assistance consisted of disabled veterans. In America, a law enacted by the Continenal Congress in 1776 sought to provide a lifetime pension for soldiers disabled in the Revolutionary War; but, like many later policies, the fulfillment of this purpose was impeded by financial instability (Obermann, 1965: 137-139). Another major source of disability policy stemmed from the movement to secure worker’s compensation laws that emerged in many industrialized countries around the turn of the century. The widespread adoption of veterans’ benefits and worker’s compensation programs might even be interpreted as reflecting an implicit assumption that persons who become disabled in service to the military or economic interests of the state were more worthy beneficiaries of government assistance than people who acquired a disability in other activities. The general responsibility of governments toward persons with disabili- ties, regardless of the cause of the impairment, apparently had not been established in many countries by the early part of the twentieth century. Although disabled people often are perceived as part of the ‘deserving poor’ who have experienced major losses through no fault of their own, there have been continuing struggles over issues concerning both the extent to which they should be provided with public benefits and the types of assistance that they ought to receive. Like many areas of social welfare policy, the United States has lagged behind other advanced industrialized nations in granting support to this segment of the popula- tion. The Social Security Act of 1935, which was the major fountainhead of welfare legislation in America, did not include major assistance to most disabled persons or any provision for disability insurance. Perhaps even more reflective of American attitudes toward disability in the first half of the twentieth century was the124 H. Hahn Randolph-Shepard Act of 1936 which provided blind persons with jobs at vending stands in public buildings. Income support or maintenance programs currently comprise the bulk of public expenditures for disability policies. In general, these government efforts tend to place disabled people in a dependent status rather than encouraging them to become independent or productive citizens; and they overshadow the size of rehabilitation policies designed to prepare disabled persons for employment. As Bowe (1980: 4) has pointed out, “America is spending ten dollars on dependence among disabled people for every dollar it expends upon programs helping them to become indepen- dent”. Public expenditures for income maintenance programs often are regarded as fixed, ‘uncontrollable’, and irreversible costs that are almost certain to grow continuously. Although inflation probably has accounted for most of the mounting expense of these policies, medical improvements are just as likely to result in an increase rather than a decline in the incidence of disability in the future (Berkowitz, Johnson & Murphy, 1976: 17). As a result, rising expenditures have imposed an increasing strain on government budgets throughout the world, which has prompted a search for new approaches to the problems of disability (Smith & Gebert, 1981; Noble, 1982). In the 1970s, government officials began to view the barriers facing disabled citizens as the consequences of discrimination; and increased efforts were made to gain legal or constitutional rights for this segment of the population (Scotch, 1984). Although the trend also emerged in many other countries, perhaps the most extensive policy changes based on this perspective occurred in the United States. In addition to numerous bills that sought to expand the civil rights of disabled Americans in education, transportation, and public accommodations, Congress enacted the Rehabilitation Act of 1973. This legislation created the Architectural and Transportation Barriers Compliance Board to promote the removal of artificial barriers which have prevented disabled citizens from participating in public life. In addition, affirmative action requirements for the hiring of disabled workers were extended to the more than 2 million companies which received more than $2,500 in grants or contracts with the federal government. Perhaps the most significant provision in this legislation, however, was Section 504 which stated simply: No otherwise qualified handicapped individual in the United States ... shall, solely by reason of his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. While this sweeping language was widely hailed as a crucial extension of the rights of disabled Americans, policymakers began to display an increasing reluctance to implement the law. The major stumbling block, as usual, seemed to involve money. The first administrative rules concerning this section were not issued until 1977 when demonstrations by disabled protestors finally compelled the Secretary of Health, Education, and Welfare to sign the regulations which carried a price tag of $2.4 billion, In view of the substantial expense of income support or maintenanceU.S. Disability Policy 125 programs, many critics apparently felt that the added costs of making the changes necessary to permit disabled individuals to become full participants in society were excessive or unnecessary. Whereas few political leaders were prepared to admit their opposition to such expenditures publicly, the issue of government spending has seemed to become a major device that allowed public officials to confine their activities on behalf of disabled persons to abstract expressions of sympathy and support while failing to provide the appropriations necessary to carry out their promises. The increased emphasis on legal or civil rights, however, has led to a growing recognition that physically disabled people comprise a minority group with many of the same problems as other disadvantaged segment of the population (Klienfield, 1979; Gliedman & Roth, 1980; Hahn, 1985a). Disabled persons not only form a sizeable portion of welfare recipients (Bowe, 1978: 28), but they also have one of the highest unemployment rates in the United States (Bowe, 1978: 27, 164; Bowe, 1980: 8-11). Disabled citizens have confronted barriers in architecture, transporta- tion, and public accommodations that have excluded them from common social, economic, and political activities even more effectively than the segregationist policies of racist governments. Most disabled children in America have been assigned to ‘special’ or separate schools, and many have not received any education whatsoever (Bowe, 1978: 143-151; Gliedman & Roth, 1980: 196-237; Levine & Wexler, 1981). Disabled individuals have been subjected not only to stereotyping, but also to stigmatizing that has made them the targets of aversion and ostracism (Goffman, 1963). Studies of public attitudes have revealed extensive intolerance of disabled persons that is related to indicators of discrimination against other minority groups (English, 1977). Like other minorities, the problems of disabled persons can be viewed as raising the fundamental issue of the extent to which a society is willing to take compensatory action for the discrimination and inequality it has imposed upon portions of the population that have become the objects of widespread prejudice. In many respects, the struggle of disabled persons to gain an increased share of public resources seems to be essentially similar to the strivings of other deprived and disadvantaged minorities. Disabled workers frequently have been the victims of economic exploitation especially in so-called ‘sheltered workshops’ which violate organizational purposes by retaining the most productive employees at sub-standand wages (Nelson, 1971); but, for most of recorded history, disabled people did not appear to be sufficiently numerous or threatening to pose a threat to the social and economic status of nondisabled members of society. In fact, some speculation has suggested that widespread aversion toward disabled individuals may be the product both of an ‘aesthetic’ anxiety, which narcissistically rejects marked deviations from ‘normal’ physical appearances, and of an ‘existential’ anxiety, which may find an implicit or projected danger of dehabilitating disability even more terrifying than the inevitability of death (Hahn, 1983). If additional support is found for these propositions, efforts to improve the status of disabled citizens might require a revolutionary change in social perceptions and behavior rather than mere economic or political tinkering.126 H. Hahn The problems created by disabilities present a critical challenge to modern governments. What are the most effective means of coping with these problems? The Assessment of Rehabilitation Although issues posed by disability have broader implications than most policymak- ers have been willing to acknowledge, perhaps the major political response to the problem is reflected by rehabilitation policies that are primarily designed to return disabled persons to productive employment. The United States passed a Rehabilita~ tion Act in 1920, shaped by the Smith-Hughes Act of 1917 for vocational education and by the Soldier Rehabilitation Act of 1918, which seemed to be a means of promoting economic growth (Obermann, 1965: 223-224, 250, 265). Many individu- als with serious disabilities were judged infeasible for employment or training, and the federal coordinating office of the program (quoted in Berkowitz, 1979: 44) admitted candidly that “the justification of vocational rehabilitation is based on its economic return”. ‘The rehabilitation program developed in the United States differs from coun- terparts elsewhere in several crucial respects. Unlike most European countries in which a person is determined eligible for rehabilitation initially and certified for disability or income maintenance programs only if rehabilitation proves to be unsuccessful, the process in America is reversed so that rehabilitation cannot be undertaken until a finding of disability is made (Smith & Gebert, 1981). Since the definition of disability also is linked to an inability to engage in “substantial gainful activity,” the American practice injects ambiguity and confusion into public policy. The American attitude toward the problem of unemployment has never seemed to reflect the emphasis on the value of human resources that has characterized policies in many European countries; and, unlike several of these nations, the United States also has not devised quotas to require employers to hire disabled workers (Hahn, 1984). Perhaps the most distinctive American contribution to rehabilitation policy, however, is the extensive role of professional rehabilitation counselors who tend to place more emphasis on therapy and counseling than upon the enforcement of legal rights in their efforts to prepare disabled clients for employment (Carnes, 1979). This approach may reflect the influence of the ‘clinical model’ and of a ‘romanti- cized individualism’ that has long permeated American culture and traditions (Stubbins, 1982). In almost all industrialized nations, however, disability and rehabilitation policy seems to reflect an implicit presumption that a person’s capacity to work is determined largely by his or her individual capabilities. While this assumption may have been appropriate to an economy founded upon manual labor, its relevance to an economy based primarily upon the provision of services or advanced technology might be subjected to increased scrutiny. In fact, the failure of disability and rehabilitation policies to reflect major social and economic changes may be the principal source of the fiscal problems that these programs have seemed to create. In many countries of the world, disability policies have imposed mounting strains on government budgets that seem to threaten the capacity of the state toU.S. Disability Policy 127 cope with other welfare issues. While definitional variations and discrepancies in the specific features of these laws are so diverse that they appear to preclude meaningful comparative analysis, most of the policies seem to be plagued by a common difficulty. Studies in the United States (Howards, Brehm & Nagi, 1980) and elsewhere (Smith & Gebert, 1981; Noble, 1982) have indicated that applications for disability or rehabilitation benefits, participation in these programs, and the costs of the policies are closely related to prevalent economic trends. In general, as economic conditions worsen and as employment declines, the demand for disability payments increases, the number of eligible recipients expands, and governmental costs climb at a time when declining revenues may create conditions of financial stringency. There are obviously several ways of interpreting these findings. Perhaps many disability and rehabilitation policies have subtly become an extension of public strategies for dealing with unemployment that have enabled many workers to find a relatively acceptable excuse for their joblessness and for the receipt of welfare benefits. These pressures seem to exert a burden on rehabilitation programs that may reduce the resources available to severely disabled persons. Alternatively, the effectiveness of vocational rehabilitation may be shaped more by social and eco- nomic circumstances than by the physical capacities or the occupational skills of individuals with various types of disabilities. The latter perspective seems to contain important implications for the develop- ment of appropriate means of coping with the issue of disability. As long as the ability to work is assumed to be a function of personal or physical capacities, income maintenance payments to disabled beneficiaries may continue to be regarded as fixed or ‘uncontrollable’ costs; and policymakers may display increasing resistance to the appropriation of additional sums for rehabilitation programs. On the other hand, if unemployment among disabled persons and the need for vocational rehabilitation are determined primarily by social and economic conditions rather than by indivi- dual characteristics, major problem associated with disability may not be insoluble. What many researchers appear to overlook is the fact that in the United States during World War II, when an exceptional demand for labor arose, there was a significant increase in the employment of disabled workers who compiled impressive records of productivity. Hence, many income support programs seem to be based on a faulty—or at least highly questionable—understanding of the relationship between disability and employability. Despite such considerations, rehabilitation activities that might potentially reduce the costs of income maintenance policies for disabled persons seldom have been granted substantial increases in government appropriations. The federal-state rehabilitation program in the United States has amassed an enviable ‘success ratio” in placing disabled clients in competitive employment; and there has been increasing agreement among rehabilitation professionals that, for every dollar spent in this effort, nine or more dollars are returned to the federal treasury through taxes on the incomes of rehabilitation workers (Bowe, 1978: 164, Bowe, 1980: 116). In 1981, Congress managed to defeat an effort by the Reagan administration to subsume the rehabilitation program within a general ‘block grant’ to the states where it would have had to compete with other interests for limited resources. Yet, while federal128 H. Hahn expenditures for rehabilitation now amount to approximately $1 billion annually, the program has not been greeted with intense political approval. This skepticism appears to be related to cost-benefit studies of rehabilitation programs that have yielded highly favorable results. Research on policies ranging from the federal-state program (Conley, 1965) to the Beneficiary Rehabilitation Program of Social Security Disability Insurance (Berkowitz, Horning, McConnell, Rubin & Worrall, 1982) has disclosed that rehabilitation expenses are substantially exceeded by the economic returns to the government and the economy yielded by expenditures for this purpose. Many of these studies have been sharply criticized by Levitan & Taggart (1977) for their failure to include control groups and for other methodological deficiencies. Yet, a careful review by Kiser (1973: 395) of eight major cost-benefit analyses of rehabilitation programs concluded: Even if we grant a wide margin of error to the results and arbitrarily reduce the ratios by one-half, the average returns to an investment in vocational rehabilitation are phenomenal. Investors should be rushing captial into this field, for there are few other areas where returns are so high. Perhaps part of the difficulty with cost-benefit analyses results from conflicting normative assumptions. In addition, however, there seems to be an implicit and frequently unstated tension between the theoretical orientation of cost-benefit research and studies concerning the legal rights of citizens with disabilities. If the major problems of disabled persons stem from discrimination and from the denial of civil rights in employment as well as other areas of life, government programs based on favorable cost-benefit calculations might even be perceived as somewhat irrelevant to the resolution of their principal difficulties. By contrast, many traditional economic analyses do not appear to reflect an awareness that bias and prejudice may play a fundamental role in the extraordinarily high rates of unemployment found among people with disabilities. Some attempts to reach a compromise between these positions may be reflected in legal regulations, which are strongly influenced by economic considerations, requiring employers to make “reasonable accommoda- tions” to the needs of disabled workers (Scotch, 1984). Yet the underlying conflict between the perspectives seems apt to provoke a continuing strain among econom- ists and political scientists or lawyers who engage in the analysis of rehabilitation policies. Surveys of the opinions of the American public and of political leaders also have indicated widespread support for additional government programs to improve the social and economic status of disabled people (Bowe, 1980: 12-16). Although there is evidence that sentiments about these programs are beginning to mirror the partisan divisions permeating most political issues (Kamieniecki, 1985), policies for disabled citizens still enjoy more extensive public approval than most other legisla- tive proposals. Since budgetary decisions often are guided by public attitudes, the explanation for the absence of a strong and concerted political movement to reduceU.S. Disability Policy 129 the expense of income maintenance or support programs for persons with disabili- ties by increasing allocations for rehabilitation must be sought in other sources. Part of the problem may be related to specific features of disability and rehabilitation policies. Traditionally, the successful placement of a disabled client in a rehabilitation program has been defined by a so-called ‘closure’, in which employment is secured for only a short period of time. Since the number of eligible applicants has almost always exceeded the number of persons admitted to rehabilita- tion programs, counselors have been vulnerable to the charge of ‘creaming’, or inflating their success rates by selecting cooperative clients who can be readily rehabilitated. Many rehabilitation counselors fear that the Rehabilitation Act of 1973, which requires them to assign the highest priority to severely disabled persons, will result in declining placement ratios which might, in turn, jeopardize the chances of continued government funding. In addition, disability policies have been plagued by the problems of “disincentives” (Berkowitz, 1981), which may encourage many recipients of disability benefits who are vulnerable to catastrophic medical costs to refrain from seeking employment due to the fear of losing health care protection, and of rehabilitation training that often prepares disabled persons only for positions in the secondary labor market that provides few opportunities for upward mobility (Feagin, 1975: 85-86). Perhaps the basic issue, however, is the assumption, contained in most disabil- ity policies, that the ability to work is determined principally by physical or other individual capacities. Rehabilitation programs generally are designed to achieve a modification of the disabled individual rather than an alteration of the environment —or the worksite—in which (s)he may be located. This approach may reflect some fundamental economic misconceptions. As Roth (1981: 200) has pointed out: A handicap is expressive of a contingent relationship between a different body and a given society. That relationship can be altered by changing the body or by adjusting to the conditions of the society. On the other hand the relationship can be changed by altering society. The same holds true for work as a central part of the society: One can change the person or change the work. But usually the handicapped person cannot be substan- tially changed... The other way would be to change the organization of production, a theoretical possiblity even if it is thought in practice to be too expensive; indeed, it may be the least expensive alternative in the long run. This analysis could be construed as suggesting that the mere spending of money might be a somewhat misleading issue in the development of disability and rehabilitation policy. Governments have been willing to allocate vast amounts for income support programs that have preserved the dependent status of disabled people, but they have been reluctant to increase appropirations for rehabilitation programs that could reduce public expenditures by granting disabled citizens enhanced independence. Perhaps more fundamental financial interests are at stake here. Although many social and economic roles are apparently planned for a mythical individual who has not experienced any decline in personal faculties, the130 H. Hahn prospect of making environmental modifications to accommodate people who represent a marked departure from conventional physical or behavioral character- istics may involve a threat to values that have a complex rather than a simple relationship to economic motives. One possible interpretation not only of the failure to expand government spending for rehabilitation programs to reduce the costs of disability but also of the relative neglect of this issue is suggested by the concept of paternalism, which has generally been ignored in the study of policy issues. In a fundamental sense, paternalism reflects a relationship of superiority and inferiority between segments of society occupying parental and child-like roles that are simultaneously benevolent and exploitive (Bennett, 1968). In fact, paternalistic relationships may mark a crucial stage in the struggle of deprived and disadvantaged minorities to fulfill their political goals. As noted elsewhere (Hahn, 1982): Paternalism enables the dominant elements of a society to express pro- found and sincere sympathy for the members of a minority group while, at the same time, keeping them in a position of social and economic subordination. It has allowed the nondisabled to act as the protectors, guides, leaders, role-models, and intermediaries for disabled individuals who, like children, are often assumed to be helpless, dependent, asexual, economically unproductive, physically limited, emotionally immature, and acceptable only when they are unobstrusive ... Politically, disabled people usually have been neither seen nor heard. Paternalistic attitudes, therefore, may be primarily responsible both for the ironic invisiblity of disabled persons and for the prior tendency to ignore this important area of public policy. Prior analyses apparently have not been sufficient to dislodge the attitudes and assumptions underlying an allocation of resources that has perpetuated the subservi- ant status of disabled persons. The problem appears to extend beyond simple budgetary considerations. To gain an adequate understanding of the issue of public support for disability and rehabilitation policy, there is a major need to reconceptu- alize the issue Conceptual Issues Perhaps the principal barrier to the evaluation of rehabilitation policy is the absence of extensive agreement about the nature and meaning of disability. At least three different definitions have been utilized in government plans for disabled individuals in the United States. Each of these perspectives encompasses diverse policy implications as well as distinctive approaches to the allocation of public resources. Popular understandings of disability usually reflect a stictly medical definition that stresses functional limitations. From this vantage point, disabilities are treated as distinct diagnostic categories, and little attempt is made to focus on their common. problems. In the formulation of most disability policy, the diagnosis of the origins of a bodily condition may have limited social, economic, or political significance.U.S. Disability Policy 131 Nonetheless, in disability and rehabilitation programs, a medical determination usually is an essential prerequisite for participation. As research has indicated (Stone, 1984), the difficulty of extrapolating vocational potential from medical diagnosis, and of weighing the many social and economic influences that may impinge upon a person’s capacity to gain productive employment, has been a major source of the problems confounding the administration of disability policies in the United States. The pervasiveness of a medical orientation to disability might be one facet of what Illich (1976) has termed “the medicalization of life”. This definition not only appears to impose an assumption of biological inferiority upon disabled individuals; but it also impedes a realization of the structural sources of disability. From a medical perspective, problems seem to arise primarily from deficiencies within a person’s body rather than from defects or flaws in an unadaptive society; and solutions must be pursued through individual rather than collective effort. Under the aegis of the health professions, important issues about disability are “depoliti- cized”. However, as Gliedman & Roth (1980: 301) have pointed out, assumptions about the functional limitations imposed by disability may ultimately prove to be little more than a “cultural invention”. Another definition of disability, widely adopted by government officials, fo- cuses almost exclusively on the economic problem of employment. This approach implies that a disability means a “health-related inability” or limitation on the amount or kind of work that can be performed (Berkowitz, Johnson & Murphy, 1976: 7-8). By suggesting that unemployment may stem from flaws in the economy rather than solely from the deficiencies of a disabled worker, research has moved toward indicating the connection between individual and social aspects of disability; but physical, behavioral, and vocational limitations are still viewed as the primary problems that prevent disabled men and women from gaining jobs. Policies based on this definition are usually controlled by officials and by counselors who do not question prevalent assumptions about disability and employability. In some situa- tions, disabled individuals who successfully secure employment may be classified as nondisabled; and, in other circumstances, unemployed nondisabled workers might be treated as disabled because there is no longer a demand for their skills. While the implications of an economic definition of disability seem to indicate a need for additional support for vocational rehabilitation, this perspective contains pitfalls that represent an incomplete solution to the problem. Policies founded on an economic understanding of disability also include features that are disadvantageous to disabled men and women. Many rehabilitation programs seem to assign an exaggerated stress on training for entry-level jobs and on manual labor. Not only is this focus incompatible with the demands of post- industrial economies; but it has also seemed to prevent disabled workers from upgrading their skills. Rehabilitation practices ofen have diverted attention from employer attitudes and bias or discrimination as a significant obstacle to employ- ment. The economic definition represents an essentially one-dimensional approach to the problems of disability. Many disabled people contend that it has transformed them into an economically managed but politically vulnerable segment of society.132 H. Hahn Both medical and economic conceptualizations are being increasingly challenged, however, by a new socio-political definition of disability. This trend reflects a steady progression from an inclination to identify disabled persons as a ‘deprived’ (Gellman, 1959) or a ‘disadvantaged’ group (Jordan, 1963), through an equivocal status (Safillios- Rothchild, 1970: 114~115), and ultimately to accord them the designation of a ‘minority’ (Kleinfield, 1979; Gliedman & Roth, 1980; Hahn, 1985a). Perhaps the major contribution of this approach, which has provided the foundation for a new emphases on legal and civil rights, is the recognition that improvements in the status of disabled people require changes primarily in the external environment rather than in their physical or economic skills. Fundamentally, the socio-political model implies that disability stems from the failure of a structured social environment to adjust to the needs and aspirations of citizens with disabilities rather than from the inability of a disabled individual to adapt to the demands of society. In part, the socio-political perspective on disability is drawn from sociological theories of stigmatizing (Goffman, 1963) and labeling (Bogdan & Biklen, 1981). Emphasis is directed at the consequences of perceptions that are formed on the basis of visible and permanent physical or behavioral characteristics. As a result, the socio-political definition is sufficiently expansive to encompass persons with mental as well as physical disabilities. Although precise distinctions between mental, physical, emotional, and learning impairments have not been drawn as yet, disabili- ties may eventually be regarded as similar to other personal attributes such as skin color, gender, or aging that have been employed as a means of differentiation and discrimination for centuries. Such traits have been used in much of recorded history to categorize individuals primarily on the basis of their appearance. In contrast to the definitions that reflect professional evaluations, this new perspective seeks to embody the social meaning of disability that is derived primarily from the lived experience of disabled men and women. The socio-political definition has become the foundation for a new ‘minority group’ paradigm that is currently competing with the traditional ‘functional limita- tions’ model in the study of disability (Hahn, 1985a). Unlike prior theories that have evolved primarily from the fields of education, psychology, medicine, and economics, the socio-political approach and the minority group model represent an effort to increase the congruence between the conceptualizations used in research on disability and the perceptions of disabled people themselves. The latter perspective is based on an explicit acknowledgement of the fact that many persons with disabilities identify discriminatory attitudes rather than functional impairments as the principal problem that they confront. The most prominent proponents of the minority group paradigm in the United States also have tended to be disabled researchers who have employed both personal experience with disability and acade- mic training in the development of their approach to the study of this subject. Hence, studies founded on a socio-political orientation reflect a significant attempt to bridge the gap between disability as a social construct, or the relatively abstract concepts guiding research and disability as a social creation, or the actual experi- ences of disabled citizens, which has been conspicously absent in most previous investigations of the issue.U.S. Disability Policy 133 The socio-political perspective also provides an important means of examining the linkage between governmental responses to disability and dominant modes of production. In many respects, it may seem relatively obvious and simple to argue that people with disabilities comprise an industrial reserve that is ordinarily excluded from the labor force, except in war-time or other emergencies, on the assumption that functional limitations interfere with productivity. While there appears to be little doubt that the massive joblessness of disabled adults has effectively reduced the social pressures of unemployment on governments and that disabilities often have been utilized by employers to eliminate workers who are presumed to possess less vitality than their nondisabled counterparts, this interpre- tation fails to take adequate account of the discrimination that has been imposed upon disabled people and other minorities because of visible differences in their appearance. A more sophisticated explanation of the relationship between industrial- ization and the prevalent unemployment of persons with disabilities in the United States might also include an examination of the rise of an economy of consumption, the extraordinary promotion of products designed to reshape personal appearance, the prevalence of advertising and other visual messages subtly indicating the human attributes that may be devalued in the labor market or elsewhere as well as the almost unattainable standards that consumers are expected to approximate, and the continuous reinforcement of these images by the mass media. From this perspective, the presence of a disability may be viewed in the same manner as skin color, gender, or aging as a basis for excluding persons with such characteristics from competition for positions in the work force and in other social activities. Hence, the prejudice evoked by visible physical or behavioral differences is not irrelevant to an interpre- tation of the role of people with disabilities in a capitalistic economy. Moreover, the effort to reduce discrimination by legislation or other official means may not necessarily be a futile or self-defeating endeavor. On the contrary, the adoption of anti-discrimination policies might represent an essential stage in a process that could lead to the emergence of new values to replace the narissistic symbols of the dominant majority that permeate modern society. In a fundamental sense, the ultimate origins of the problems facing disabled citizens probably can be traced to the nature of economic systems such as capitalism, but this viewpoint need not deter active participation in the struggle to expand the civil rights of this segment of the population. Ideally, solutions to the problems identified by the socio-political approach seem to require a revolutionary change in thinking that would enable human beings to evaluate others on the basis of characteristics that are not overshadowed by the visible and salient manifestations of a disability. Yet, significant progress can be accomplished through efforts that are designed to alter laws, institutions, and behavior. To cite only a few examples, the removal of architectural barriers, the ‘mainstreaming’ or integration of disabled students in regular classrooms, and attempts to eliminate discrimination in transportation, housing, and public accommodations could provide disabled and nondisabled citizens with increasing opportunities to interact as equals. On the basis of such experiences, both groups might gain valuable insights about tolerance, acceptance, and the dignity and worth of human beings.134. H. Hahn There is probably no area of public policy that is untouched by the problem of disability; and the task of creating the conditions that would permit disabled persons to achieve true equality and freedom may comprise a much more imposing political agenda than government officials currently realize. While the costs of such an effort are largely unknown, they must be weighed in relation both to ethical considerations and to present expenditures for government programs that have kept most disabled persons in a dependent and subservient position. In the long run, the price of equality may be much lower than is commonly supposed. In the past, disabled citizens have seemingly been smothered by a form of paternalism that has made it difficult for them to protest their social, economic, and political oppression. Public leaders have usually appeared to be sympathetic to their plight; but policy decisions regarding this segment of the population have been dominated by professionals. Traditionally, disabled citizens have been consigned to the role of passive onlookers in the political process. Although abstract promises frequently have not been followed by effective implementation, issues regarding disability and rehabilitation policy seldom have provoked extensive conflict. If political activation among disabled citizens requires both a positive self-image and a realistic recognition of the negative views that are projected on them by society (Anspach, 1979), the customarily dormant political status of this segment of the population may be readily understandable. The recent emergency of a socio-political orientation founded on an experiential understanding of disability might produce a radical transformation of this position. Perhaps most importantly, political leaders may find it increasingly difficult to raise financial arguments as a defense against the failure to fulfill the goals of disabled people. Prior policies seem to have been based on major misconceptions about the nature of disability that have imposed serious burdens on government budgets. While the precise costs of programs reflecting a new approach to the problem cannot be determined as yet, they could prove to be less expensive and more beneficial than their predecessors. Moreover, disability and rehabilitation policy might represent a field in which it is necessary to spend money in order to save. As a realistic point of departure for the serious exploration of this alternative, Bowe (1980) has proposed a ten-year program of $22 billion a year to reduce the effects of disability by expanding research and development; removing architectural, transportation, and communication barriers; training disabled persons; and reforming dependence-oriented programs. Perhaps much of the prior cost of disability policy resulted from an indequate appreciation of the many dimensions of the problem. While a medical definition of disability seemed to prompt a demand for increasing expenditures for health care, an economic perspective appeared to contribute to growing allocations for income maintenance programs. In large measure, therefore, appropriations to expand the civil rights of disabled persons through the removal of educational, architectural, transportation, and other barriers need not be regarded as an additional expense. Instead, the development of policies based upon a socio-political definition of disability reflects an alternative approach that has a significant potential of reducing the costs of earlier measures. What appears to have been overlooked in the analysis of disability and rehabilitation programs is that the definition of disability isUS. Disability Policy 135 fundamentally a policy question. In seeking appropriate and effective means of ameliorating this problem, government decision makers are not required to accept the theoretical orientations and assumptions that have guided prior efforts. On the contrary, the ability to escape the constricting influence of the past may be essential to the formulation of innovative policies. In this assessment of support for disability and rehabilitation programs, an attempt has been made to indicate the usefulness of policy analysis for the clarification of political alternatives. By probing the assumptions and values that have formed the foundations of these policies, some important insights may be gained concerning the allocation of public resources. Perhaps more importantly, an effort has been made to correct the prior neglect of a significant area of public policy. 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