Booman Tribune

Gaming Out the Health Care Negotiations

by BooMan
Tue Mar 16th, 2010 at 12:12:23 PM EST

Nate Silver has a fascinating post up that pretty much confirms what I've thought all along. He gamed out the health care negotiations to test whether different strategies might have altered the outcome, and by how much. Here, he describes the model.

Recently, I've had several conversations with NYU political scientist Bruce Bueno de Mesquita in preparation for my book project. Bruce, in addition to being a Silver family friend, is a really brilliant guy who is trying to lend some much-needed rigor to the political science community. He is best known for a model he designed (as documented in his book, The Predictioneer's Game) to predict the outcomes of complex negotiations from relatively simple inputs. There is a scaled-down version of his model available at his website; I decided to run the numbers for health care and see what it came up with.

Silver assigned values to the various health care plans under discussion, from single-payer on the high side (100) to no reform (10) and complete deregulation (0) on the low side. Then he created 12 different groups at the negotiating table and assigned them levels of influence and flexibility, and noted it if they had effective veto power over the final product. What he found was that no matter what strategy that progressives chose, the strongest possible outcome was a weak public option (60). He also found the same for the White House, and he found that they could only have achieved that outcome by both increasing their engagement and decreasing their flexibility. The model predicted an outcome of 52, which is closest to the Senate Finance bill (50). Here is the part I found most interesting:

-- What happens, for instance, if we reduce the flexibility variable for the Progressive Democrats in Congress? That is, we make them more intransigent and demanding, as many bloggers suggested that they should have been? It turns out that nothing happens; the outcome of the negotiation is still a 52. Nor is there much change if we make the progressive position more flexible; the model comes up with a score of 53...

...-- I also tested the strategy of the group that I call unions/activists. The model seems to think that the groups that define the endpoints of a negotiation can play a reasonably important role in determining the outcome (the same is true of lobbyists), even if they aren't terribly influential relative to other parties. What's interesting is that, if I give the activists a less flexible position, the score increases to 58, meaning that a weak public option might have been obtained. But if I give the activists a more flexible position than the one I assumed them to have in the status quo, the score also increases, to 56. Although this is highly speculative, what the model seems to be suggesting in that the activist community might conceivably have gotten the worst of both worlds. Had they been more willing to compromise on a good-but-not-great bill (better than the one they got), they might have expedited the process toward that outcome rather than letting other (less liberal) groups influence the outcome instead. But had they dug their heels in even more, they might have succeeded in applying enough pressure to move the outcome (somewhat) to the left. The frustration that a lot of activists feel, I think, stems from the fact that they put a lot of money into the pot but then had to fold. It sure sounds good to say: oh, we need both pragmatists and idealists in the liberal community, but it's also possible that activists would have done better had either of these groups unilaterally dictated the strategy.

It's refreshing to see someone try to look at this somewhat scientifically, because over the last year I've seen more uninformed experts on the art of negotiation than I have substantive advice. I think Silver's model is well crafted, but it can only indirectly account for oddities in the negotiations, like the filibuster rule and the lack of a constant majority in both houses of Congress. He tries to account for this through the veto variable, but I think it lacks precision. Having assigned a value of 60 to the House bill and having found the White House maxing out at 59 with full engagement and minimal flexibility, it predicts a toss-up outcome. Add in the filibuster, and I think we're getting something close to optimal under the circumstances.



Display:
Again, this would have held true for the electronic voting bill:

had they dug their heels in even more, they might have succeeded in applying enough pressure to move the outcome (somewhat) to the left. The frustration that a lot of activists feel, I think, stems from the fact that they put a lot of money into the pot but then had to fold. It sure sounds good to say: oh, we need both pragmatists and idealists in the liberal community, but it's also possible that activists would have done better had either of these groups unilaterally dictated the strategy.


"If you look for the social economic motive, you will not have to wait for history to tell you what was propaganda and what was truth." - George Seldes
by Real History Lisa (lpeaseRemoveThis@gte.net) on Tue Mar 16th, 2010 at 12:22:31 PM EST
you know what the difference is between the idealists and the pragmatists?  The pragmatists don't give you a better or worse outcome on the merits, but they don't depress the base by raising unrealistic expectations.  
by BooMan on Tue Mar 16th, 2010 at 12:29:28 PM EST
[ Parent ]
I'm going to quote you on that. I think that's exactly right. When the idealists fail, people drop out. Not what we need!

"If you look for the social economic motive, you will not have to wait for history to tell you what was propaganda and what was truth." - George Seldes
by Real History Lisa (lpeaseRemoveThis@gte.net) on Tue Mar 16th, 2010 at 02:12:48 PM EST
[ Parent ]
Is this CBO score taking an unusally long time? Is it anything to worry about?

Sorry for the tangential post.

by Rachel Q on Tue Mar 16th, 2010 at 02:16:01 PM EST
I like Silver's description of "voters/public sentiment: Highly influential, but very distracted/disengaged. Position somewhat amorphous/flexible."

He might have added bored, exhausted, and fed up with the whole endless process. See today's chatter about whether Dems should use the "deem and pass" method: a "controversy" I can't imagine anyone but the most insider/junkie types remotely cares about.

by Lodus on Tue Mar 16th, 2010 at 02:20:39 PM EST

In turn, I defined 12 parties to the negotiation with the following characteristics; the score in parenthesis represents each group's desired policy outcome.

  • White House (70). Very highly influential but distracted (lower engagement). Extremely flexible; wants deal done. Veto point.
  • Nancy Pelosi (75). Influential, highly engaged, quite flexible. Veto point.
  • Harry Reid (67.5). Modestly influential (less than Pelosi), highly engaged, very flexible. Veto point.
  • Progressive Democrats (85). Modestly influential, engaged, modestly flexible.
  • Moderate Democrats (67.5). Modestly influential, reasonably engaged, very ambivalent/flexible.
  • Blue Dogs (52.5). Influential, engaged, fairly inflexible. Veto point.
  • Committee Chairs (60). Modestly influential, highly engaged, reasonably flexible. Veto point.
  • Olympia Snowe (42.5). Low influence (although high relative to other individual members of Congress), but engaged. Modestly flexible.
  • Republicans (20). Low influence, modest engagement. Completely inflexible.
  • Insurance Lobbiysts (0). Comparatively low influence, but very engaged. Modestly flexible -- not totally averse to compromise.
  • Liberal Activists/Unions (100). Low influence, engaged, somewhat inflexible relative to policy-makers.
  • Voters/public sentiment (45). Highly influential, but very distracted/disengaged. Position somewhat amorphous/flexible.

One thing that caught my eye in the Wikipedia profile was that the model being used has not been peer-reviewed and is considered proprietary.  That being the case, there could be anything between the inputs and the outputs including a reading of the front page of the New York Times.

But then there is this in Nate's inputs:


Progressive Democrats (85). Modestly influential, engaged, modestly flexible

But isn't that the whole criticism?  That progressive Democrats did not insist on being as influential as they could be.  They did not engage early and forcefully to shape the legislation.  And that they were too flexible and not persistent enough at the end of negotiations.  Progressives could have made themselves a veto point, but did not.

And then this:


Insurance Lobbiysts (0). Comparatively low influence, but very engaged. Modestly flexible -- not totally averse to compromise.

Insurance lobbyists provide the Senate Finance Committee with the data for evaluating alternatives during the Gang of Six drafting.  They had specific members of Congress who operated in the markups to block key items they did not want.  Their compromises did not often involve changes in policy but in promises not to air ads in opposition to healthcare reform.

Models are simplifications.  I'm not sure this model gives us any information that we didn't already have.  And not knowing the construction of the model, it is hard to ascribe any meaning to the result that no matter what progressives did the best they could hope for is a weak public option.

And the groups are not independent.  Some of the members of Congress from both parties really represented the influence of the insurance lobbyists.  Olympia Snowe  represented the engagement of the Republican leadership.

If you want to pull out specific individuals, you should add Ben Nelson, Bart Stupak, and Joe Lieberman to the model.

The set of rules applied to the inputs to create the results are not trivial.  I don't see how you can say that Nate's model is well-crafted not knowing how it applies its rules to the data.  And a variable cannot substitute for a rule.

50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

by TarheelDem on Tue Mar 16th, 2010 at 03:30:42 PM EST
[blockquote]It would probably not have been possible to get a strong public option (much less anything resembling single payer) even if a number of variables were changed within reasonable boundaries.[/blockquote]
It took me a long time to come to this realization but Nate hits the mark. After that, I'm just going with the flow and support the bill's passing.



Recommended by Hideo Kojima
by robertdsc on Tue Mar 16th, 2010 at 03:34:56 PM EST
Sometimes a little "cheer-leading" cheers the crowd - who are, after all, the ones who put those people in office.  I wouldn't mind a little more public show of bloody-mindedness from the left. Especially since, as Silver calculates, it wouldn't have changed the outcome.

But, what he doesn't have in his equation is the next election, which I'll be surprised if the left turns out in the same numbers as last time, possibly because no-one loudly cheered on their hope and change.

The right love the clarion call of a trumpet (and admittedly owns the media that trumpets loudest), so why don't we?  I'm a very rational pragmatist, a which means I understand the value of rallying the troops, and try to remember to not to leave it out of the equation just because I understand the hard-boiled aspects better.

by keres on Tue Mar 16th, 2010 at 06:37:00 PM EST


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