Friday healthcare

ON CAPITOL HILL:

— The White House might have resubmitted Medicare chief Donald Berwick to the Senate for a confirmation hearing, but Democratic leaders appear intent not to hold such a thing. 

Despite threats from GOP leaders that Berwick’s recess appointment threatens his legitimacy atop the agency (not to mention his working relationship with Republicans), Senate Finance Committee Chairman Max Baucus says he wants to “focus on the work before us.” 

The Montana Democrat said he was “troubled” and “disappointed” when the White House sidestepped the Senate to install Berwick, but “apparently not disappointed enough to schedule a hearing,” a Washington Post editorial notes Friday.

That reluctance to force Berwick to explain his views, the Post writes, “lends credence to suggestions that the administration was motivated not only by the asserted need for speed but also by a desire to avoid a public debate about Dr. Berwick’s views.”

The saga is not just political. A failure of the Senate to confirm Berwick also means that his term expires at the end of 2011.

Baucus’s office this week declined to comment.

NEWS:

— House Democrats on Thursday unveiled legislation to create a public insurance option to compete with private plans on state-based exchanges. That concept was killed during the healthcare reform debate by moderate Senate Democrats who feared it would erode private markets. But the $68 billion the proposal is estimated to save must be tempting for lawmakers hoping to slash deficits. 

— GOP Sens. Chuck Grassley (Iowa) and Mike Enzi (Wyo.) want the Obama administration to explain how it came to estimate that the cumulative effect of the “patient’s bill of rights” will be to raise across-the-board insurance premiums less than 1 percent. 

— Massey CEO Don Blankenship tells a Washington audience that congressional efforts to prevent mine accidents are futile. “The physics of natural law and God trump whatever man tries to do.”

— Legislation requiring the federal government to cover the malpractice liabilities of physicians who volunteer at community clinics is moving through the House. 

OVERHEARD:

— Harvard-based pediatrician Dennis Rosen warns that, while the lure of specialty salaries might have created a shortage of primary care docs in general, within the field of pediatrics, it’s a lack of sub-specialists that’s threatening the quality of care. 

“There are plenty of general pediatricians in the United States — about 70 per 100,000 children. But according to the American Board of Pediatrics, there are only 751 practicing pediatric pulmonologists in the country: one for every 100,000 children,” Rosen writes in an op-ed in Friday’s New York Times. “The numbers are similar for other pediatric subspecialties, leading to a shortage of doctors trained to treat problems many children face, like asthma, digestive issues and cancer.”

He thinks Congress should do more to invest in training and debt-forgiveness for pediatric sub-specialists. 

— Harlan Krumholz, a cardiologist at Yale, notes the often unheralded value of “negative” medical studies: those revealing that a therapy actually doesn’t have much health benefit. 

“Rather than a letdown, the failure to find an advantage in an expensive strategy opens the door to doing less and spending less without worsening patient care — and in some cases improving it,” Krumholz writes in a Friday Washington Post op-ed. “It’s simply the case that many popular medical strategies have little or no rigorous scientific evidence of their effectiveness regarding patient outcomes.”

CALENDAR:

The National Association of Insurance Commissioners will wrap up a two-day Washington conference on the implementation of healthcare reform.