Killin' Time

I once saw my granddaddy hit a pig between the eyes with the blunt end of an axe. Someone else then slit the pigs throat, and many others began to work on the carcas, all with knives. I was at a time honored Eastern North Carolina tradition of a 'hog killin' conducted during cold weather, when animals are rendered and processed into their various consumable forms--including sausage. The next morning, I had some of that sausage on a biscuit. I like sausage, but having that much inside information about your breakfast does make it taste a bit different.

So is the case with the health reform legislation.

While many are decrying a rush job, middle of the night secret votes and the like, the reality is that most people have paid far more attention to the health reform debate than they typically do to the Congressional process. In line at the Mall on Sunday, I overhead a conversation about cloture and whether the filibuster is in the Constitution or not (it is not; it is a Senate rule), and then discussing whether a conference bill can be filibustered in the Senate (it can) and whether it can be amended (it can't). Then they talked about why 3 committees in the House and 2 in the Senate had jurisdiction for health.

The health reform debate has, therefore, been a bit of a civics lesson. I would submit there has never been as much public discussion of the committee structure in Congress since I have been alive as there has been around health reform. So, the average person has learned much more about the process and the substance than is typical. That is partly because the issue being discussed is so important, partly because we have been talking about it for so long (the basic outline and approach of the bills are unchanged since Labor Day), and partly because there have been so many unreasonable things said in the debate that have obscured true choices--the salacious always gets more attention than nitty gritty policy. And much of what people have learned about the process, they don't like. And with good reason.

But, the unsavory factors about the process have always been around: the last holdout always gets the most; the system incentivizes brinksmanship; lobbyists having direct access while normal citizens are just one in 307 Million; the noisy getting the slots on Sunday talk shows while the quiet workers, work quietly; small states having disproportionate influence and so on. It is just that more people are looking at this process and bill than is typical.

That doesn't mean it produces the best policy. Far from it. In fact, if you weren't willing to just let me make all the decisions (what a missed opportunity!) I would take sight unseen the health policy program that President Obama's health policy team would negotiate with Mark McClellan, Gail Wilensky, and Bill Roper (all Republican directors of Medicare and Medicaid under Republican administrations). Because they all know health policy. The facts, and not just the slogans.

But, that is not what the Constitution says. It doesn't allow 6 or 7 experts to completely develop our nation's health policy. They can work together and submit reports and the like, but in the end, our elected representatives are the only ones that can make laws, or choose not to do so.

Analogies usually break down as some point. However, the one about not wanting to see laws or sausage being made is particularly apt. And very clear to me this cold morning, as I think of my granddaddy and making sausage.