Disaggregating

“Disaggregation” means the process of distinguishing among several factors which may be at work in a single process. I near despair when I read something like this from Robert Samuelson:

For all the money we spend on health care, we are getting some dividends. From 1960 to 2011, the death rate from heart disease has dropped 69 percent; the decline for cancer is 13 percent.

Unfortunately for arguments like this healthcare is only one of the factors involved in either of those. For example, the rate at which Americans smoke cigarettes is half what it was in 1960. To be able to attribute the decline in heart disease or cancer to healthcare alone you must be able to prove that smoking cigarettes had nothing whatever to do with the death rates from heart disease or cancer. You must disaggregate care from smoking cessation and that’s actually a lot harder than it sounds.

And then, of course, the larger question is less what you die of than whether you die or what your quality of life is. The likelihood of mortality is 100%. We shouldn’t lose track of that. I also have a vague recollection that the mortality rate from many heart disease processes is unaltered by many pharmaceutical medical interventions. It’s possible that my memory is faulty here.

I for one don’t think that surviving a fatal heart attack at age 70 to continue in a vegetative state for the next decade is an improvement even though it would lower the stats for death due to heart disease.

Then there’s the difference in population between now and 1960. It’s pretty obvious to anyone who was alive then (and still alive now) that the genetic makeup of the United States population has changed over that period. To attribute the change in morbidity and mortality to care we’d need to be able to disaggregate care from genetic predisposition.

Not to mention differences in air and water quality, diet, and so on and so on.

There’s also the question of cost-benefit but I guess that’s an entirely different post.