A couple of weeks ago, Sen. Rand Paul (R-Ky.) raised a few eyebrows by complaining about Americans receiving disability benefits . “Over half of the people on disability are either anxious or their back hurts. Join the club,” the senator said at a New Hampshire event. “Who doesn’t get up a little anxious for work every day and their back hurts? Everybody over 40 has a little back pain.”

Since I took note of Paul’s comments, it’s only fair to also mention that the senator’s office has since elaborated on the same point. Whether or not he’s made things better or worse is a matter of perspective.

Paul spokesman Brian Darling pointed to two data points – 27.7 percent of disabled beneficiaries are diagnosed as having ailments related to “Musculoskeletal system and connective tissue” and that 14 percent have “mood disorders.” That adds up to 42 percent, he noted. (There’s also nearly 4 percent who cite injuries, which presumably could cover back injuries.)

Obviously, quibbling over the difference between “over half” and “42 percent” seems unnecessary. Indeed, if the only problem with Paul’s comment was arithmetic, this would hardly be worth highlighting.

But there’s a far more substantive concern here. At his campaign stop, Paul referenced anxiety as effectively meaningless – practically everyone, he said, gets “a little anxious for work every day.” His office, however, pointed to “mood disorders,” which as Glenn Kessler’s report explained, refers to the part of the population that suffers from “conditions like bipolar disorder, major depressive disorder, and dysthymia (persistent depressive disorder).”

The senator seemed to think this was some kind of punchline, as if those with bipolar disorder just get “a little anxious” before leaving for work.

Or more to the point, Paul seems to believe that those dealing with severe mental health issues are necessarily undeserving of disability benefits – or as he put it at the time, “gaming the system.”

What’s more, as Dylan Matthews explained , the senator doesn’t seem to fully understand the system he’s complaining about.

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:

Rand Paul’s broader point seemed to be that there’s waste in government programs, and then in a Paul administration, officials would go after disability insurance claims, confident that most of the applicants don’t deserve benefits.