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Rand Paul says "over half" of people on disability have anxiety or a bad back. Nope.

Sen. Rand Paul (R-KY) on January 21, 2015.
Sen. Rand Paul (R-KY) on January 21, 2015.
Mark Wilson/Getty Images
Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

Sen. Rand Paul (R-KY), in New Hampshire as part of his as-yet-unannounced 2016 presidential bid, argued that too many non-needy people are getting disability insurance:

The thing is that all of these programs, there’s always somebody who’s deserving. Everybody in this room knows somebody who’s gaming the system. I tell people that if you look like me and you hop out of your truck, you shouldn’t be getting a disability check. Over half the people on disability are either anxious or their back hurts. Join the club. Who doesn’t get up a little anxious for work every day and their back hurts? Everyone over 40 has a back pain. I'm not saying there aren't legitimately people who are disabled. But the people who are the malingerers are the ones taking the money away from people who are paraplegic, quadriplegic. We all know people who are horrifically disabled and can't work. But if you have able-bodied people taking the money, there's not enough money left for people who are truly disabled.

Two things:

  1. Over half the people on disability are not either anxious or their back hurts.
  2. Anxiety and back pain are real disabilities.

Who gets disability insurance

The Social Security Administration's official statistics don't break out "back pain" and "anxiety" as categories, but a 2013 report from Mathematica Policy Research does. According to Mathematica's data*, 3.3 percent of disability insurance recipients reported "anxiety disorders" as their "primary impairment." Back disorders accounted for 16.6 percent. That combines to 19.9 percent — much, much less than the "over half" Paul claimed.

The SSA's numbers are more recent but less specific. It reports that 30.5 percent of recipients reported "musculoskeletal" diseases and disorders (including back conditions) as their primary impairment, and 3.9 percent reported "other mental disorders" (including anxiety). That sums to 34.4 percent — still nowhere close to Paul's estimate. And remember, that figure is almost certainly too high.

When CNN's Jeremy Diamond asked where Paul got his numbers from, Paul spokesman Brian Darling replied, "If you study government data from the Social Security Administration, you find that the numbers come very close to Senator Paul's off-the-cuff ballpark estimate." You don't, though — and if you analyze more specific numbers, the numbers are further off still.

What it takes to get on disability

The other problem with Paul's statement is the idea that somehow qualifying for disability on the basis of anxiety or back pain is illegitimate. This is a sadly typical view. Anxiety is massively misunderstood as just having "nerves" or "jitters," and chronic debilitating back pain is conflated with the common discomfort that Paul describes. Both are less physically obvious to outsiders than, to use Paul's example, paralysis. But both are real conditions that can keep one from working, and under current law applicants are required to show that they really do keep them from working.

If you need to get disability benefits, it's not enough to be diagnosed with a condition like anxiety or back pain. Kathy Ruffing of the Center for Budget and Policy Priorities explains that a condition must have lasted at least five months, and be expected to last 12 months or more, or else result in death. Indeed, mortality rates are much higher for disability recipients than the general population:

The disability must also render the applicant unable to earn $1,090 or more a month. Not just unable to earn $1,090 in their current line of work, or their current geographic location, but unable to earn it "in the national economy," given the applicant's age, education level, and work experience. If you can switch your line of work, you are expected to do so.

It's no wonder, then, that disability recipients are disproportionately older and less educated, and thus less able to move to jobs where their disability won't affect them:

It's also no wonder that rejection rates for the program are very high. Only 25 percent of applicants are granted benefits on their first try:

Indeed, even people who are denied benefits — who really need to work to support themselves — rarely work after having their application denied, more evidence that, if anything, people who genuinely can't work are being excluded, rather than people who can being let in:

Reasonable people can disagree about the proper policy path forward for the disability program, whose finances really are in trouble at the moment. We could divert more of the Social Security payroll tax to it, as CBPP's Paul Van der Water proposes, or expand private disability insurance, as MIT's David Autor and Stanford's Mark Duggan suggest.

And it's reasonable to suggest that the program should do more to encourage people to transition into work. Chana Joffe-Walt's piece for This American Life made the argument that it's become a sort of shadow welfare or unemployment insurance program, a support system for people left out of an economy that needs unskilled physical labor less and less. Her piece implied the program should be less ready to rule that people are unable to work (it's worth noting that many experts, like Ruffing, the University of Chicago's Harold Pollack, and eight former SSA commissioners, took issue with the This American Life story).

But the idea that it's somehow full of barely-sick people gaming the system is offensive and wrong.

* This is a weighted average of Mathematica's estimates for "disability insurance-only" recipients and joint recipients with Supplemental Security Income (SSI). Thanks to Ruffing for doing the analysis.

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