Rush Limbaugh, Exercise and Health Care

Recently Rush Limbaugh claimed that “exercise freaks” are running up the cost of health care. Audio and a transcript of his quote are below.

Rush_Limbaugh

I think those of you that regularly exercise — playing softball, baseball, basketball, soccer, mountain biking, running, rock climbing, skiing, skating, running — you’re the people getting injured. You’re the people showing up at the hospital with busted knees and tendons and skin cancer, ankle sprains, knee and hip replacements, broken bones, concussions, muscle, ligament, tendon, cartilage strains and tears, tendinitis, rotator cuff tears. All you exercise freaks, you’re the ones putting stress on the health care system. What happens when people don’t regularly exercise and keep their weight relatively under control? Nothing! They probably don’t even know their doctors’ names. So you’re urging to go out there do all of this stuff and you’re ending up in the hospital all the time with these injuries and some people think these injuries are badges of honor. A knee surgery scars a badge of honor shows toughness. Yeah. Toughness, somebody else has to pay for.

I want to live in a world where statements like these can be verified as easily as asking a search engine. Such verification would be demonstrably unbiased and non-partisian. Unfortunately we don’t live in that world yet, but one of the aims of this blog is to give you a glimpse into that world. We’ll use Rush’s statements as an example.

First, it’s not as simple as asking “is that true?”. The response may well be “is what true?” We’ll first have to turn Rush’s outburst into a precise statement. Despite the long list of specific exercise activities and injuries he cites, he is clearly arguing for the general point. Thus he claims that “exercise freaks” have higher health care expenses than sedentary but normal weight people.

Next, he complains about paying for someone else’s health care. In any sort of insurance plan this is precisely the idea. Namely, that everyone in the plan pays the average with the consequence that those who end up needing more get that paid for by those who end up needing less. So on the surface that is a silly complaint but the activities he’s talking about are voluntary and that puts a different spin on it. People can choose to play basketball or ski or sit at home, or smoke. So he may be saying that sports injuries are the largest component of controllable health care expenses. To be able to test this though we’ll need a few other examples of lifestyle choices that affect health care. For our purposes we’ll choose smoking.

Thus in my ideal world we’d be able to go to a search engine  and compare the health care expenses of 3 groups of people:

  • exercise freaks
  • smokers
  • “normal weight” people who are neither exercise freaks nor smokers

and we’d see which of these end up with the larger burden on the health care system. Unfortunately it is very hard to get precise statistics for these 3 groups. It is possible to get statistics for injuries, but those frequently mix sports-related injuries with non-sports related injuries. We’ll have to estimate the effects of sports-only activities. It’s a bit easier to get statistics for smoking related health care costs. Various anti-smoking groups keep these statistics. And it’s flat out impossible to get hard statistics on the health care costs of a normal weight but sedentary lifestyle. While there are some studies that indicate normal weight but sedentary people are less healthy than those who get some exercise, we’ll give Rush the benefit of the doubt here and assume these folks have essentially zero additional health care costs.

But let’s pause for a moment and consider what the answer may be. What is Rush advocating? Is he suggesting that people stop engaging in basketball, baseball, skiing, running etc? Doubtful as then he’d be advocating for a nanny state, something republicans abhor. More likely he’s advocating that exercise freaks pay their own way. But this too seems a little off as many insurance plans aim to capture your overall health and behavior into the risk plan. It could be that Rush is creating a straw-man argument assuming that any new government plan would ignore health and behavior choices and arrive at another mechanism to charge people for insurance. If something along these lines is what he’s complaining about then the question is one of significance.

To address the issue of significance we’ll need to know how high the controllable aspect of health care are, ie your lifestyle choices (specifically exercise freaks and smokers) and how the health effects of these choices rank in relation to the overall health care bill. If this controllable aspect of health care was a small fraction, say 5% or 1% of someone’s total health bill then Rush could still be “right” but most of us would say “so what” because the fraction is so small. Indeed, it’s conceivable that the fraction could be so small that it would cost everyone more to track and charge “exercise freaks” an additional amount for their behavior than it would be to simply spread the cost around.

Alternatively it could be that these controllable aspects are large but evenly distributed. In our case, it could be that exercise freaks and smokers each represent 10% of total health care costs. But if there were 8 other lifestyle segments each costing 10% of the total health care cost most of us may consider that a wash. “Yea, I lead a reckless lifestyle, but so do you, aren’t we lucky our health care costs are the same!”

Rush though seems to believe in a 3rd outcome, namely that the added health care costs of exercise freaks are both significant in comparison to over all health care costs, and larger than other controllable lifestyle choices. His words were that it is exercise freaks “who are putting stress on the health care system“. No one would believe an expense of 1% was putting stress on the system. And no one would blame a single expense of 10% as putting stress on the system if there are 5 or so other expenses also of 10%.

At this point you’re probably saying to yourself “numbersguy, you sure are digging into this way more than Rush Limbaugh intended”. But that’s the point. In my future world ill-phrased and half thought out outbursts like Rush’s wouldn’t get air time because it’d be a trivial matter to get the facts. And indeed, in the process of getting the facts you would be forced to think more clearly about the stances you’re advocating.

We just finished our “clear thinking” exercise, what do the numbers say?

HealthCare2004

As a fraction of the total health care cost, exercise freaks account for only 2%. A small number, Rush is wrong. Smoking, another lifestyle choice that affects health care is 10%, and 5 times larger than the health care effects of exercise freaks. If I had to pick one of those 2 to spend my precious radio talk show time eschewing, smoking would win hands down. Again, Rush is wrong.

These are the facts. In my hypothetical future world getting access to facts like these would be easy. What would remain hard is the interpretation. Whether you consider 2% or 10% to be an extreme burden on society, extreme enough to cause regulation and restrictions of freedoms is a personal opinion. For my part 10% is close but 2% is clearly too small to worry about.

References

The year 2004 was chosen because it was the easiest year to get comparable numbers across all these areas.
Total Health Care Expenditures: $963B – 2004
Agency for Healthcare Research and Quality. Total Health Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2006. Medical Expenditure Panel Survey Component Data. Generated interactively. (June 30, 2009)

Smoking health care expenses: $96B/year

Sports injury health care expenses: $20.7B
This is a tough statistic to get. Cost Information is available on all injuries, accidental and intentional (shootings, suicide attempts), sports related or work related or motor vehicle and is not broken out specifically by sports activity. Additionally incident information is available broken out by sports injury. That is, while we don’t know the cost of sports injuries, we do how many there were in comparison to total injuries. So we took the total cost for all injuries and assumed that the average sports injury was as expensive as the average non-sports injury. Also, Rush specifically calls out skin cancer as an “exercise freak” injury. We disagree thinking that some fraction of people get skin cancer because their job has them working outside, but regardless, we’ll put 100% of this number in the “exercise freak” category. This gives:

2002 all injuries were about 10% of total health care costs
1997 all injuries were about 11% of total health care costs
It looks either flat or going down. For 2004 we’ll assume an average of 10.5%

1997-1998 22% of injuries were sports injury related.
2000 – 2001 15.7% of injuries were sports related.
Averaging 22% and 16% gives 19%

Melanoma 2004: $1.5B

Total Sports Injury is: 10.5% * $963B * 19% + $1.5B for melanoma

12 comments for “Rush Limbaugh, Exercise and Health Care

  1. July 14, 2009 at 4:40 pm

    I’d be curious to see the cost impact of sedentary people who “keep their weight relatively under control”. I would suspect that this population places a substantial burden on the health care system due to a higher incidence of type II diabetes and heart disease. Both of which, require continued long term treatment, as opposed to sports injuries from which most patients fully recover.

  2. numbersguy
    July 16, 2009 at 12:31 pm

    I would too, but new research on various benefits of exercise are still being revealed so unambiguous numbers are hard to come by.

    Regardless I still believe part of Rush’s point was to compare “extreme” exercise fitness practices (eg skiing) to “safe” fitness practices (eg walking). He said “sedentary” but on re-examination I’m sure he’d revise to include something like walking.

    But yea, I suspect a comparison of the costs between “extreme” and “weight under control but sedentary” would reveal that the costs of these 2 groups may be similar for the adverse effects of a sedentary lifestyle you cite.

  3. Robert
    August 20, 2009 at 10:02 pm

    I see that exercise related injuries were just 2%. What about the long term effects of these injuries. Such as a young guy may tear his ACL in soccer have it fixed but some 4-5 years later it tear again not related to a sport or exercise. It will now not be counted as an exercise related injury. Then later on down the road he has premature arthritis and ends up with a total knee replacement. All of this can be directly related to his injury. Also all athletes where something out very early. Like a baseball players shoulder. He will end up having to have an arthroscopy sooner or later. This is not a direct injury but a indirect occurrence of what is to come. None of these are thought about in these types of studies. Every little hospital visit from a smoker is counted. I have been interested in this because I work at a sports medicine clinic and I see tons of things. I dont smoke and I definitively will not play sports. There are many repeats and chronic patients. This is just food for thought.

    Thanks for your time,
    Robert

  4. numbersguy
    August 21, 2009 at 8:40 am

    Hi Robert:

    You raise a fair point. Unfortunately there’s no easy way to get at the statistics you suggest. And indeed I’m a little concerned about the smoking statistic coming from the anti-smoking advocacy groups and their being more liberal in attributing health problems to smoking than the mechanism for attributing health costs to sports injuries.

    However, the stories I aim for in this blog are those where one aspect of the data stands out like a sore thumb. Such examples ideally are so glaring that even if you find other ways to collect the data the underlying conclusion remains unchanged.

    For example, one way to ball-park estimate the effect you suggest is to double or even triple the current sports health care cost. The justification for this might be that people return for similar treatment an average of 2 or 3 times during remainder of their lives for the original injury (and these treatments would not be classified as sports related in the data I used earlier). Such an assumption can be argued to be an over-count for a whole bunch of reasons, but even at that we get a 6% vs 10% split between sports and smoking. And (IMHO) Rush’s conclusion that sports alone is putting stress on the system is still incorrect.

  5. Brian
    September 1, 2009 at 12:48 pm

    Mr. Limbaugh’s exercise freaks have been proven to learn and work better than their sedentary counterparts. Univ. of Ill. Researchers Dr. C. Hillman, Dr. D. Castelli, & Dr. Buck analyzed hundreds of elementary school age children. They initially performed a regression analysis to look for correlations between academic performance and a host of other attributes. They found aerobic fitness the clearest indicator of academic performance. Surprised by the result, they wanted to determine whether this was a cause, effect, or simultaneous unrelated phenomena. They broke a group of kids into two groups, fat and fit. Using EEG brain mapping they found that exercise not only ties directly to higher cognitive functioning, but also enabled better learning. (See e.g. Effects of Aerobic Exercise on Overweight Children’s Cognitive Functioning: A Randomized Controlled Trial. Dec. 1, 2007. Research Quarterly for Exercise and Sport).
    As far as Robert’s analysis regarding fully considering the net present value of future consequent health care costs stemming from a current sports injury, that is only, and I would posit, looking at far less than half of the equation. Harvard’s long running (began in 1976) study on the long term health habits of nurses found that those who were or became overweight were the least likely to survive breast cancer; those over 70 who merely walked 90 minutes a week had cognitive functioning of someone 1.5 years younger. In short, the health care costs of not being an exercise freak and staggering and pervasive.

  6. numbersguy
    September 2, 2009 at 8:48 am

    Excellent info Brian. Spot on target. It reminds me of an episode of Penn and Teller’s “Bull Shit” where they basically compared “fat and unfit”, “fat and fit”, “thin and fit” and “thin and unfit”. As I recall the unfit’s were the worse in their adhoc comparison, the big surprise was how unfit the “thin and unfit” person was. BS is not really scientific by any means, but it does underscore your observations about how unhealthy even “thin and unfit” can be, and of course, how wrong Rush was.

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  9. August 4, 2011 at 1:21 pm

    Rush Limbaugh
    The guy that was on your show complaining what was on the Obama Care. This has been going on for a very long time. A person that has any medical sufferings & injuries and health destroyed by hatefulness, crime, & injustices knows personally the difficulties trying to get any medical help throughout the years. I was denied medical care all the time just about for pre-existing conditions, or I couldn’t afford the excessive amount / costly insurance to cover, and or couldn’t pay for the treatment out right. Individually sought out private insurance wouldn’t cover me or help, most employment insurance wouldn’t cover any issues that I was already dealing with, and of course the free type of clinics wouldn’t cover most things. These places would either downplaying or quick to give a pill, instead of treatment or the quality & correct medical care. If most of us in this position sought out legal help it isn’t in a timely manner. For instance, workman’s comp would continually deny medical treatment & care. Any free place is overwhelmed and has been the same issues for a very long time. You would understand if you had experiences over and over like I’ve mentioned. Neither you nor the ones you love do you wish to suffer. Many of friends and loved ones died due to not being approved for medical care and treatment. Oh, but these insurance companies, drug companies, doctors, politicians, & attorneys get paid well with great benefits. Many nurses, doctors, union workers, state, federal, and those that are making six figures or more don’t have to worry about being denied medical care that they need and if they don’t receive it other medical complications will onset and or suffer greatly with issues that are not being allowed to be alleviated, healed / recovered or helped to have some relief to attempt somewhat a manageable life. Medical corporations & insurance companies have made billions of dollars over the last 50 years. We don’t want to lose our love ones, have them suffer, or be forced to be denied and continue to suffer, especially if it was carried out by ill willed actions, crime, & injustices that were not held accountable or allowed accountability financial legal responsibility what was carried out, harmed, and or taking their career. It is difficult recovery from a debilitating injuries, when you already have a disease that was intentionally induced with irreversible conditions without correct quality enough medical care.

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