the national interest

Did Health-Care Reform Cost Democrats the House?

Speaker of the House Nancy Pelosi (D-CA) (C) walks through Statuary Hall on her way to the House Chamber ahead of a historic vote on health care reform at the U.S. Capitoll March 21, 2010 in Washington, DC.
House Democrats march to their doom. Photo: Chip Somodevilla/Getty Images

Some of my favorite bloggy political scientists have a new paper out about the political effects of health-care reform. The paper argues, “health care reform may have cost Democrats their House majority.” It’s going to grab enormous attention — finally, proof of what many conservatives had long been warning, that Democrats blundered enormously by passing health-care reform in 2010.

Unfortunately, the paper doesn’t really demonstrate that. Indeed, I’m not sure the authors are actually trying to demonstrate that. What they show is that individual members of the House who voted against for the health-care bill in 2010 fared worse — about a half-dozen percentage points worse — than members who didn’t.

It’s a convincing demonstration that individual members were better off voting against the bill. Yet the authors leap to the conclusion that the House Democrats in the aggregate would have been better off letting the bill die. It’s just as possible, however, that they’re measuring a kind of prisoners’ dilemma, in which every member would be best off voting against a bill that passes, but worse off if so many of them vote no that the bill fails.

The paper is based on the assumption that the counter-factual isn’t all that important — if more members had voted against the bill in 2010, nothing much would have changed except that more of them would have kept their jobs. When you think about the counter-factuals in any detail, that assumption looks extremely shaky.

First: In the paper they note — without incorporating into their conclusion — that a world in which the bill died would have looked different than the real world. Spending a year crafting a huge bill that attracts massive political attacks while controlling all the branches of elected government during an economic catastrophe is going to be problematic. It’s going to be problematic if the bill passes, yes, but also problematic if the bill collapses in failure. So a world in which health care reform collapses in 2010 creates problems of its own, especially since voters hated some aspects of the health care bill but very much wanted some kind of reform to pass. Democrats were forced to defend an unpopular bill, but defending an unpopular status quo would have been no picnic, either.

Second, the paper doesn’t consider another way in which the political dynamic would have changed. The paper very interestingly identifies how the House vote hurt Democrats. Constituents used it as a proxy for liberalism, and assumed members who voted yes were more left-wing than those who voted no. But if the House had voted down health care reform, some other issue would have become the “big vote” and, probably, have become the proxy for out-of-control liberalism, or back-room dealing, or whatever voters didn’t like about Washington, right? There could have been renewed attention to stimulus, cap and trade, or many other things. Democrats in 1994 gave up on health care reform, but Republicans turned the crime bill – which Democrats intended as a political sop to the center – into the emblem of liberalism run amok.

Now, obviously, the content of the bill matters – a liberal vote to bus black militants into suburban towns to conduct gay marriage ceremonies with Muslims would be more harmful than a liberal vote for a crime bill with “midnight basketball.” But surely something would have occupied the “Washington liberals run amok spending your money during a crisis” political space.

The scenario becomes all the more acute when you realize that a majority of the House had already voted for health care reform in 2009. They passed a bill, and then the Senate passed a bill later in the year, and then in 2010 the House had to pass the Senate bill. That’s the vote the paper measures. But members who voted against the second bill after having supported the first one would surely have paid some kind of price. Republicans would still use that vote against them, and although it may not have been as damaging as using a second vote for a successful bill, it would have had at least some effect. And there would also have been at least some advocates of health care reform who refused to support a Democrat who supported health care reform in 2009 and flip-flopped the following year. (Keep in mind that voters angry the bill didn’t go far enough have always made up a crucial chunk of the electorate.)

If you’re a vulnerable member of Congress, there’s certainly value in voting against your caucus and signaling you’re closer to the center than other members of your party. But what works for individual members doesn’t necessarily work for a whole party.

Did Health-Care Reform Cost Democrats the House?