The Health Care See-Saw

One way to think about the health care debate as it plays out in congress is in terms of vote-buying. The closer from passage a health overhaul gets, the more valuable everyone’s votes become, and the more reasonable it becomes for members to start raising all sorts of objections to try to maximize their share of the surplus. But anytime the prospects for reform start looking bleak, there’s a bubble in vote prices that collapses. The 218th House vote is very valuable, but the 112th is worthless. That creates incentives for members to make their asks cheaper and then things move forward.

A consequence of this is that the metaphor of “momentum” is very misleading—it’s more like a pendulum. Which I think is borne out by what you see on the ground. Something like the House passing a version of reform doesn’t, via momentum, eliminate objections in the senate. Rather, it leads to an intensification of intra-caucus animosity. What relaxes tensions is the prospect of failure.

It’s not clear to me if the final settling place of this dynamic is passage or failure, but I think it points toward passage. Another point is that Republicans, by taking themselves out of the game, are ceding a huge amount of bargaining power to the Democrats. If Republican members were willing to be more creative and buck their leadership, they could gain a ton for themselves.