David Brooks has a piece in today’s NY Times in which he explains how Barack Obama will pass health care reform. The solution can be summed up in two words: Deception and Tyranny.
After allowing the political process (and all those messy bad interest groups) to put forth their ideas, a large health care reform package will be proposed in a rush to the finish line:
This brings you to the final stage, the scrum. This is the set of all-night meetings at the end of the Congressional summer session when all the different pieces actually get put together.
You want the scrum to be quick so that the bill is passed before some of the interests groups realize that they’ve been decapitated. You want the scrum to be frantic so you can tell your allies that their reservations might destroy the whole effort (this is how you are going to get the liberals to water down the public plan and the moderates to loosen their fiscal rectitude).
Notice not a hint of concern on Brooks’ part about deception being the key to passage of sweeping health care reform. We’ve been there, and done that, as in the February 2009 stimulus package. How quaint is the concept of people actually knowing what they are getting in legislation.
After the deception, will come the tyranny, in the form of MedPac, the unaccountable commission which will make life and death decisions for the nation as to which surgical or medical procedures, services and medications are cost effective for the nation. As in Britain and elsewhere, these decisions will have life and death consequences for patients, who will have no redress against this supposedly benign health care dictator:
But you won’t be able to honestly address the toughest issues and still hold your coalition. You won’t get the kind of structural change that will bring down costs long-term. In the scrum, Congress will embrace the easy stuff and bury the hard stuff.
Which is why you have MedPAC. That’s the Medicare Payment Advisory Commission that you want to turn into a health care Federal Reserve Board — an aloof technocratic body of experts that will make tough decisions beyond the reach of politics. You can take every thorny issue, throw it to MedPac and consider it solved.
Conservatives will claim you’re giving enormous power to an unelected bunch of wonks. They’ll say that health care is too complicated to be run by experts from Washington. But you’ll say that you are rising above politics. You’ll have your (partial) health care victory.
Brooks attitude about “experts” making health care decisions smacks of elitism; an unelected, unimpeachable panel will deprive you of the right to treatment not because the treatment will not help you, but because the treatment is too expensive for the system of government health insurance. If empowering individuals and doctors to make these decisions is politicizing health care, then call me political.
While I disagree with Brooks’ attitude, I fear he is correct in the ultimate point. The only way the Obama administration and Democrats can force through the types of changes they envision for the health care system is through deception and tyranny. Honesty and freedom have no place in a system of national health care.
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