Last week, some of my fellow bloggers became involved in a discussion about whether the US system enables people to use a label of disability as an excuse or a "cop out." I found it interesting then to compare the US system with the UK system. Here in the UK, there is the national benefits system; the closest US relative would be a combination of welfare and/or social security. One can receive benefits if one is unemployed, disabled, a "carer" (looking after someone else who is disabled), a parent (for limited periods of time) or a foster parent (ongoing benefits).
There is a great national sense of duty to look after the citizens here, regardless of their circumstances. In its purest form, that is very admirable. Unfortunately, many abuses of the system exist. One of the most common reasons for being on disability is agoraphobia. I've run into rather a few of them at the local shopping center. Yes, you did read that correctly. I had a patient who didn't want to work on strengthening his legs because of a fear that he wouldn't be eligible for a power wheelchair. I can't point out to him that he might be abusing the system because that might hurt his self-esteem and make him feel badly about himself in that somebody questioned his belief in his disability. No, not kidding.
In the States, I could be viewed as a bleeding-heart liberal. On this side of the pond, I could be viewed as a draconian Thatcherist Tory. I haven't changed, but the environment I work in now is dramatically different.
Social safety nets are designed with the best of intentions; however, they require watchdogs to ensure they are utilized fairly and not abused. We all know about how some providers raped the Medicare system in the 1980's and '90's. So it is possible to abuse systems from either the patient's side or the provider's side. In either case, it is the public who pays the price in the end.