Recently Rush Limbaugh claimed that “exercise freaks” are running up the cost of health care. Audio and a transcript of his quote are below.
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
- “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?
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.
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:
Melanoma 2004: $1.5B
Total Sports Injury is: 10.5% * $963B * 19% + $1.5B for melanoma