The Complicated Politics of Health Care Reform


It’s more akin to a poker game than to statesmanship:

News reports filtering out of the House suggest that talks between Energy and Commerce Chairman Henry Waxman and the seven Blue Dogs on his committee have broken down. The situation is dire enough that Waxman is declaring his willingness to bypass his committee and bring the bill straight to the floor.

The central issue here is simple enough: The Blue Dogs want Waxman to make concessions he doesn’t want to make. The sticking points, according to sources close to the process, are the public plan — Blue Dogs still want a trigger option — and the administration’s proposal, which the Blue Dogs support, to create an independent commission able to set Medicare payment rates and make reforms. Waxman and others worry that a Republican administration and Congress could use this panel to undermine the Medicare program.

You can take Waxman’s statements one of a couple ways. His willingness to bring the bill directly to the floor undermines the bargaining power of the Blue Dogs: It means they don’t have veto power over the bill. This could, in other words, be a negotiating tactic on Waxman’s part to soften the Blue Dogs’ position. But if that doesn’t work, it could also mean exactly what it says: That he’s going to push the bill straight to the floor.

That would ensure some bad headlines, and an angry Blue Dog caucus. But versions of this bill have passed two other committees. Energy and Commerce isn’t strictly necessary. Waxman’s threat to bring the bill to the floor means that Pelosi and Waxman think they have the votes whether or not Energy and Commerce approves the legislation. And that may not be such a bad outcome, either for the Democrats or the Blue Dogs.

Some sources are speculating that the Blue Dogs are getting cold feet as they watch Max Baucus dither. Many of them felt burned by the hard and damaging vote on the cap-and-trade bill, as it looks like nothing will come of it in the Senate. Committing themselves to a health-care bill before the Senate shows its hand carries similar risks, and they’re no longer in a risk-taking mood. The worst outcome for conservative Democrats in the House is that they’re on record voting for a health-care reform bill that dies in the Senate and is judged a catastrophic example of liberal overreach.

The problem, of course, is that the more dissension there is among Democrats in the House, the less pressure there’ll be on the Senate Democrats to make a hard vote on health-care reform. This makes health-care reform something of a prisoner’s dilemma for conservative Democrats. If Blue Dogs in the House and centrists in the Senate both put it on the line to pass the bill, they’re both better off. But if one puts it on the line and the other whiffs, then the other pays the price.

Matthew Yglesias points out that no one is stopping conservative Democrats in the House and Senate from comparing notes:

… they call it a “prisoner’s dilemma” because the idea is that the players are held incommunicado in separate cells. House and Senate Democrats can all get together in a room and talk this stuff out. So while the dilemma is real, it’s a perfectly surmountable problem. Surmountable, that is, if moderate members in both houses of congress actually want health care reform to pass. If the will isn’t there, then there are plenty of ways—this dilemma is one of them—for indifference to kill reform even while everyone claims to want to see it happen.

The bottom line is, nobody knows just what the bottom line is, or it keeps changing depending on the day or the hour, or who you ask, but flux can be a good thing. Just think of it as the ferment of creativity.

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