By Evan Falchuk

When absolutely sure you’re right about something, it can be so frustrating to have to convince people of it.

In a democratic system, especially ours, you need to have broad-based consensus to do “Big Important Things.”  Health care reform is the latest Big Important Thing.  And whatever you think about it, one thing is clear: there is no broad-based consensus.

Some people are looking for creative ways around the consensus problem.

Writing in the Washington Post, Ezra Klein gives his support to the idea of turning a little-known congressional agency called MedPAC into a sort of “Federal Reserve” for Medicare.  The notion is that MedPAC could quickly put in place changes that every doctor and hospital would have to follow.  Klein seems most attracted by the potential of MedPAC to do an end-run around the democratic process:

But the reason health reform is so infrequent is that it’s structurally difficult.  Small tweaks are too technically complex for Congress to easily conduct and so are dominated by lobbyists.  Large reforms attract broad interest but are impeded by polarization and the threat of filibuster.  The MedPAC changes under discussion are, in other words, nothing less than a new process for health care cost reforms.  They empower experts who won’t be intimidated by the intricacy of the issues and sidestep the filibuster’s ability to halt change in its tracks.

Unknown experts in little known agencies, making decisions that affect everyone.  Appointed officials, free from the burden of having to convince anyone that they are right, or even taking into account the views of those they govern.

Getting away from set ups like this is the whole reason America was created in the first place.  The democratic process may be slow, burdensome and messy.  It may mean that some important issues get dealt with while others don’t. But the premise of our system is that no one has a monopoly on what is right and wrong.  It is designed to force people to confront difficult issues and battle them out.  Yes, this may make some things “structurally difficult,” but this is a design feature, not a bug.

We need to reform our health care system.  But removing health care from the rough and tumble of the democratic process isn’t a solution.