The Scrum

David Brooks thinks that President Obama is trying to do an end run around the healthcare reform process. After months of vague promises, Congressional hearings and drafts, and so on here’s what Mr. Brooks thinks the president will do:

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).

The scrum will be an ugly, all-out scramble for dough. You can probably get expanded coverage out of it. You can hammer the hospitals and get much of the $1.2 trillion to pay for the expansion. 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.

which will create an arbitrary, undemocratic, illegitimate reform. If it works, nobody will care. If it doesn’t work, there won’t be anybody to complain to.