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By Jay Cost

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The Democrats' Health Care Dilemma

Ben Nelson's reticence to vote for a bill that does not satisfy Nebraska Right to Life is a perfect example of American pluralism - the idea that our system grants a seat at the table to a wide array of diverse groups, each of which is empowered with a veto over policies that affect them. It's also a sign that the resolution of the health care fight will be trickier than many pundits have suggested.

I have frequently heard analysts propose that the Democrats will pass a bill because they must, because the party requires it to retain an appearance of competence (or, at a minimum, to avoid the appearance of incompetence). I would not dispute that this is a vital part of the calculus, but it is not the whole game. The way I view the politics of the health care debate is akin to a potential collective action dilemma. This type of interaction presents several complications to the "they will because they must" argument.

Before we get into those, it's important to remember two basic points about our system. First, the United States Congress does not represent the interests of the whole country. That's a fallacy of composition. Instead, it's the meeting place of all the representatives of the parts of the country. Thus, individual senators and congressmen ultimately rise or fall based not on how they serve the nation, but their local constituents. Second, and relatedly, nobody in Congress is electorally responsible to a national political party. Party affiliation in Congress is membership in a "long coalition" based on mutual interests. There is no blood oath to be taken, and a member of Congress can defect from the national party line and suffer few consequences if local constituents are comfortable with that decision. The bonds of partisan affiliation certainly help major legislation get passed, but they are rarely sufficient.


So, with those preliminaries out of the way, I'd suggest that there are three issues that complicate "they will because they must."

Complicating issue number one: each Democratic senator enjoys the benefit of an improved reputation individually, but some might enjoy it less than others. The most obvious way this point operates is that a third of the Senate is not up for reelection until 2014, by which point any reputational benefit for passing health care reform will have been greatly diminished. But the reputational benefit also depends on a senator's constituents. For instance, Pat Leahy is the senior senator from Vermont, one of the most liberal states in the country. His chances of reelection are near 100%, and any changes in the party's reputation will barely affect that. Meanwhile, Ben Nelson is the senior senator from Nebraska, one of the most conservative states in the country. He survives by cultivating his own reputation. Most Nebraska voters are Republican sympathizers, so Nelson wins reelection because they like him, not necessarily his party. Improving the Democratic Party's reputation will probably help Nelson, but only marginally.

In reality, the person whose reputation depends most upon the passage of a bill is Barack Obama. Yet he doesn't have a vote in the Senate anymore!

Complicating issue number two: each Democratic senator has to do something to deliver this reputational benefit. Namely, each must vote for final passage. For many Democrats, this is not going to be a problem. Their constituents like the bill, or at least trust their senators that it is the right thing to do. But that's not the case for other senators, who might face the wrath of their voters. Again, Pat Leahy won't pay a political cost for voting for the bill, but Blanche Lincoln of Arkansas probably will. Remember: Lincoln will have to pay an individual cost to help provide this collective benefit. Her chances of reelection in Arkansas are affected, not Pat Leahy's!

Complicating issue number three: the party leadership has very few carrots or sticks to coerce members. Joe Lieberman is a great case in point. He went so far as to endorse John McCain last year, and yet he has retained the gavel in the Homeland Security Committee. That's a sign that in the Senate the party leadership is very weak.


Here is how these three items add up to a potential collective action dilemma. Again, grant that Democrats will enjoy some benefit from an enhanced party reputation if they pass this bill. However, that's just one potential benefit of many, as well as many potential costs. Each senator must evaluate how these potential benefits and costs affect them personally, and then decide how to vote. If just one Democratic senator decides that the costs outweigh the benefits, the bill fails the cloture vote. Remember also: if a senator decides that the costs outweigh the benefits, there is very little that the relatively weak party leadership can do to alter his payoff calculus.

For instance, suppose Ben Nelson agrees that a better reputation for the Democratic party nationally will give him some benefit, but he also believes a yea vote will turn his constituents against him. Thus, he decides that his benefit from the party's reputation can't match the cost he suffers from his own diminished reputation. Harry Reid lacks the ability to alter this evaluation, so Nelson votes nay. Such an outcome would be another example of the the age-old problem of collective action, or how self-interested individuals (like senators) have trouble supporting the goals of a larger group (like a political party).

So far, we've outlined this dilemma in purely political terms: senators calculate their benefits and costs as a function of reelection. But the dilemma persists when we open up the analysis to include policy considerations. In fact, it begins to make even more sense. For instance, consider Bernie Sanders, also of Vermont. His position in the Senate is all but guaranteed, too. This means that he has only small political stakes in this. If he thinks that this bill will produce a policy result that is worse than the status quo - then he'll count that as a major cost. His electoral security means that an enhanced reputation for the party probably cannot overcome it. If it can't, Sanders will vote nay.

This is why the public option is such a big deal. Include the public option and you create a political and policy nightmare for moderate Democrats who do not want to see an expansion of the government's provision of health care. So, their costs start to outweigh the benefits. Remove it and you create a policy nightmare for liberal Democrats who see the result as a payoff to big business. Their costs start to outweigh the benefits. Ditto abortion. The leadership's choice on whether to include or exclude the Stupak language dramatically shifts the payoff calculus for both sides. It's on these massively important issues where the party's reputation starts to become a secondary consideration.

There is little that the party establishment can do besides patiently cajole members to keep searching for that middle ground. Majority Leader Harry Reid simply lacks the power to say to Ben Nelson, "Vote for this or else!" There is no "or else" in the United States Senate. So, his strategy thus far has been to (a) stay optimistic and talk up the progress being made; (b) say nice things about all 60 of his senators; (c) emphasize timelines to keep the players working diligently; (d) continue to negotiate on a piecemeal basis in the hope that this is not a zero-sum game, that making one senator happy does not necessarily aggravate another, and that common ground can ultimately be found.

This is as good a strategy as can be employed when dealing with an institution like the United States Senate. It's as if Harry Reid is trying to herd cats here. It remains to be seen whether he will succeed.

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-Jay Cost