Orszag tossed out some ideas that, if enacted, could make it even harder to get disability benefits, at least from the government. He argued that once people begin to receive benefits, they will probably never enter the work force again. “Recipients become permanently dependent on the program,” he wrote.

One idea is to privatize disability benefits by requiring employers to offer their workers private disability insurance. Such policies are sold now; they are expensive and filled with lots of provisions that make it hard for workers to qualify for benefits. Since people applying for disability benefits usually have little income, it’s hard to see where they can come up with the dough to buy one of the most expensive products in the insurance industry’s product line. In the privatized arrangement, they would get limited benefits to replace their lost wages, but help with job retraining and workplace accommodation. After two years of this privatized arrangement, they could do on a government program. Sounds so simple. How people like Dobbs would fare under a changed disability system is not an academic exercise for think tank types. It could be a matter of survival.

“I did not choose to be disabled,” Dobbs said. ‘I didn’t want the stigma of being disabled.” As for privatizing any part of the system, he said: “I worked for an insurance company. They fired 10 percent of the twenty-five- and thirty-year people so their stock would go up. If you privatized it, those are the bastards who would run it.”

For more from Trudy Lieberman on Social Security and entitlement reform, click here.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.