So now we wait.

The hurry-up-and-wait that has characterized Congress’s movement on health reform is par for the legislative course, especially a bill such as important and many-parted as health reform. But much of that waiting wasn’t on deliberations of the full committee or mark ups but watching the picky-eater-at-dinnertime progress made by the Group of Six, a set of negotiators Sen. Max Baucus handpicked and strove to keep at the table. The Senators represented a lot of wide open spaces — Montana, Iowa, Wyoming, North Dakota, Maine and New Mexico – but not very many people.  8.4 million, to be more precise, or about pi percent of the U.S. population.

As the summer turned to fall, the Group of Six came to give new meaning to “bipartisanship,” and left the committee scrambling to nip and tuck the bill in order to wring from it some small measure of Republican support.  This week, there’s news that Senate Majority Leader Harry Reid is handpicking a smaller team from the Finance and HELP committees to merge the two Senate bills. So far, he’s up to two. Part of this is just the nature of the law-making process – bills get merged in rooms with a certain number of people in them, as Jonathan Chait at The Treatment pointed out.  But from a straight representative viewpoint, a table for three or four or six from land-rich, people-scarce parts of the country necessarily excludes the interests of the majority of the U.S.

The self-winnowing Group of Six experience stands in stark contrast to another big news-making decision made last month in Pittsburgh, when the informal economic group the G-8 decided to handoff its power to the G-20. Such a move acknowledges new global economic realities: the countries in the G-8 (Canada, France, Germany, Italy, Japan, Russia, U.K., and U.S.) represent about 14 percent of the world population, while those in the G-20 represent two-thirds of the world’s people and 85 percent of its gross national product.

I admit that population and economic production are just two of many, many metrics, and do not suggest that world economic decisions, or health care ones, must be closely-tied to some population algorithm. That’s not how things work. But symbolically speaking, expanding and sharing the decision-making power respects certain global realities, can build public buy-in and is, if incompletely, more democratic.  As with many acts of small-d democratization, having more people at the table makes the group more likely to make decisions that are good for more people.

Sure, it’s utilitarian of me to say so, but health reform, too, should be based on decisions that do more good for more people. But just by the numbers, that’s not how it has played out lately. You have to wonder if the unrepresentative nature of the process made it easier for the final product out of Senate Finance Committee to be tilted more toward the needs of special interests than to those of many low- and moderate-income people, especially the uninsured.

–Kate Petersen, Health Policy Hub blogger