SPUTNIK I

THE SOVIET R-7, THE SPUTNIK LAUNCH VEHICLE.

HAPPPY 5OTH BIRTHDAY, SPUTNIK!

Tomorrow, October 4th, is the 50th anniversary of the launch of the first man-made satellite. On October 4th, 1957, the Soviet Union stunned the United States with the launch of Sputnik.

The successful launch of Sputnik sent horripilations through the American military and American political leadership. The message was clear and unmistakable. The launch vehicle for Sputnik, the Soviet R-7, was an intercontinental ballistic missile capable of striking the Continental US.

Russia followed up with Sputnik 1 with the launch of Sputnik II on November 3rd, 1957. Sputnik I weighed 84.45 kilograms. Sputnik II came in at 508 kilograms. Sputnik II also carried a doomed dog name Laika. There was no ability to return the dog to earth.

The United States did not launch its first satellite, Vanguard I, until January 31st, 1958. It weighed only 1.4 kilograms, about the weight of a grapefruit. Vanguard I is reportedly still in orbit, while Sputnik I plunged to earth only months after its launch.

SPUTNIK STARTED THE RACE.

It is commonly stated that the Soviet Union’s early lead in outer space exploration caused President Kennedy to ramp up American space exploration. Including the pledge to put humans on the moon. This commitment was kept when American astronauts landed on the moon in July of 1969. The first moon launch is fading into history, and occurred nearly 40 years ago.

But for this moment, let us honor the Soviet Sputnik.

SCIENTIFIC STRIDES STEP ACROSS ALL BORDERS IN THE DESERT OF THE REAL!

OVERUTILIZATION OR UNDERUTILIZATION? WHICH COSTS MORE?

The Author has been detoured for a day or two engaging in futile attempts at educating a hard right ideologue (is the root of “ideologue” idiot?) on the high costs and lower quality of American healthcare when compared with all other Western democracies. (Most of the Author's colleagues in healthcare policy, economics or reimbursement, whatever their political leanings, acknowledge these great issues in American healthcare. We just disagree on the methods to address them.)

The discussions took place on a motorcycle site, and the Author is generally aware that sociopathic individuals and individuals that suffer from undiagnosed borderline personality disorder are well-represented in the motorcycling community and on cycle websites.

The exchanges went like this. The Author sets out (generally undisputed) the facts and statistics related to a matter.

The respondent says:

“No, I don’t believe that’, without citing counter points or statistics that would back up his claims.

Or this line of drek. “All you have given me are your opinions”, when the Author provided documented figures and citations.

And, when easily verifiable figures are presented, such as the approximate 3% administrative cost for the Medicare program, “I’m not buying it”.

The Author gave the individual the last word and bowed out with the snide comment that the individual apparently did not understand was aimed directly at him, his rantings, and his patent ignorance. The Author repeated an Arab folk saying about the futility of reasoning with the unreasonable:

“When dogs bark, don’t bark back.”

Arf. Arf.

IS HEALTHCARE BACK ON THE TABLE?

The Author recognized in the course of the discussions that he had forgotten more healthcare economics and policy knowledge while taking Beta Blockers than most people will ever acquire. [AUTHOR’S NOTE: OR DOES HE FLATTER HIMSELF?] And it was kind of fun getting back into research on healthcare costs, comparative healthcare systems analysis and intractable problems in American healthcare. So the Author may do a little more posting on healthcare economics and reimbursement.

As most readers know, the Author underwent open-heart surgery early in the summer for repair of an aortic aneurysm and replacement of the aortic heart valve. The recovery went well, and the Author is in better physical shape now that he has been in the past year or so.

The main reason the Author is in great physical shape is that he underwent cardiac rehabilitation. Basically, exercise and, if necessary, some dietary and lifestyle changes. Since the Author is a vegetarian, he already enjoys a heart-healthy diet.

His healthcare payor will reimburse the Health Institute in Albuquerque for about 40 rehabilitation sessions. Medicare will pay for 36 sessions. So the Author has taken full advantage of these sessions (with co-pays) and is in good shape with good cardio-related readings.

Yet, as a black-hearted wannabe healthcare economist, the Author was surprised that payors would reimburse what is basically aerobic (and some anaerobic) exercise. A healthcare center, a gym, for post-cardiac patients. Seems like an area ripe for overutilization.

COULD THE AUTHOR HAVE BEEN MISTAKEN? COULD MY FRIEND ON THE MOTORCYCLE SITE UNCOVERED THE AUTHOR’S MOST HIDDEN SECRET?

It turns out that Medicare reimburses facilities like the Heart Institute for cardiac rehab. And it may be UNDERUTILIZED, not overutilized. This from an article entitled “Rehabilitation significantly underused after heart attack and bypass surgery”:

Despite strong evidence that cardiac rehabilitation reduces disability and prolongs life, fewer than one in five people receive rehabilitation services after a heart attack or coronary bypass surgery, according to a Brandeis study in Circulation: Journal of the American Heart Association…

Overall, the study found that, despite Medicare coverage of cardiac rehabilitation sessions, among Medicare beneficiaries aged 65 and above, women participated less than men, older people less than younger, and non-whites significantly less than whites. Additionally, the researchers noted striking geographic differences in the use of cardiac rehabilitation after cardiac hospitalizations, ranging from 53.5 percent of patients in Nebraska to 6.6 percent in Idaho.

At the time of the study, Medicare (the primary health insurer for people age 65 and older) provided coverage for up to 36 sessions (three per week for three months) of cardiac rehabilitation after heart attack, bypass surgery, or stable angina. Rehabilitation patients in this study had an average of 24 sessions. In 2006, Medicare expanded to include patients undergoing heart and lung
transplants, heart valve surgery and procedures such as stenting and angioplasty.

OLDER AND SICKER, WHO NEED REHAB THE MOST, GET LESS OF IT.

In the study, use of cardiac rehabilitation differed by age and gender. Overall, the use of cardiac rehab in men (22.1 percent) was significantly higher than in women (14.3 percent). Compared with men age 65 – 74, the likelihood of receiving cardiac rehab was:

• 2 percent lower in women age 65–74;
• 13 percent lower in men and 31 percent lower in women age 75–84;
• 71 percent lower in men and 83 percent lower in women age 85 and older.

“I think differences in the use of cardiac rehabilitation for different age groups reflects physicians’ preconceptions about less value in older people rather than a careful look at the clinical evidence. There is an increasing body of research showing that increased exercise is just as valuable, if not more so, in older people, and is important in preserving their ability to function,” Stason [William B. Stason, M.D., M.Sci., study co-author and senior scientist at the Heller School] said.

Overall, use of cardiac rehab was twice as great in white as in non-white patients. Lower-income elders who were eligible for Medicaid as well as Medicare, were far less likely (5.2 percent) to receive rehabilitation than those not on Medicaid (20.3 percent). Furthermore, patients with co-existing medical conditions, such as diabetes, a previous stroke, congestive heart failure or cancer, were significantly less likely to participate in cardiac rehab, according to the report.


LIKE ALL STUDIES, IT CONTAINS A CALL FOR MORE STUDY.

Shepard [Donald S. Shepard, Ph.D., professor at the Heller School] said that further study is needed of potential approaches to increase use of this effective service. These include analyzing reimbursement rates for cardiac rehabilitation in relation to their costs, studying referral patterns in high use states, and seeing whether the utilization rate of rehabilitation services among Medicare patients should be made a quality indicator for cardiac care.

GIVE US THE DATA AND WE WILL DO WITHOUT THE ANECTDOTES IN THE DESERT OF THE REAL!