Presidential healthcare reform rhetoric

RHETORIC, POLITICS AND SOCIETY
GENERAL EDITORS: A. Finlayson; J. Martin; K. Phillips

PRESIDENTIAL HEALTHCARE
REFORM RHETORIC

Continuity, Change & Contested Values from Truman to Obama

Noam Schimmel


Rhetoric, Politics and Society

Series Editors
Alan Finlayson
University of East Anglia, UK
James Martin
Goldsmiths, University of London, UK
Kendall Phillips
University of Syracuse, USA


Aim of the Series
Rhetoric lies at the intersection of a variety of disciplinary approaches
and methods, drawing upon the study of language, history, culture and
philosophy to understand the persuasive aspects of communication in all
its modes: spoken, written, argued, depicted and performed. This series
presents the best international research in rhetoric that develops and
exemplifies the multifaceted and cross-disciplinary exploration of practices
of persuasion and communication. It seeks to publish texts that openly
explore and expand rhetorical knowledge and enquiry, be it in the form

of historical scholarship, theoretical analysis or contemporary cultural
and political critique. The editors welcome proposals for monographs
that explore contemporary rhetorical forms, rhetorical theories and
thinkers, and rhetorical themes inside and across disciplinary boundaries.
For informal enquiries, questions, as well as submitting proposals, please
contact the editors: Alan Finlayson: James Martin:
Kendall Phillips:

More information about this series at
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Noam Schimmel

Presidential
Healthcare Reform
Rhetoric
Continuity, Change & Contested Values from
Truman to Obama


Noam Schimmel
Kellogg College
University of Oxford
UK

Rhetoric, Politics and Society
ISBN 978-3-319-32959-8
ISBN 978-3-319-32960-4
DOI 10.1007/978-3-319-32960-4

(eBook)

Library of Congress Control Number: 2016948748
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PRAISE

FOR THIS BOOK

‘Contrasting the broader, more organic conception of the state as articulated
by Presidents Truman and Johnson, with a more limited version espoused
by Presidents Clinton and Obama, Schimmel uses health reform as an able

foil to get at deeper skirmishes in a divided society. We would all do well to
listen as carefully to our elected leaders as Dr. Schimmel does.’
—Professor Jonathan Engel, CUNY, USA
‘Noam Schimmel shows how the way we talk about American social policy
has changed dramatically over the last 70 years -- from talk of rights and
moral obligation to talk of efficiency and individual responsibility. Through
the prism of health care policy, we see vividly how profoundly the
conservatism of the 1970s and 1980s has affected Americans’ view of
themselves and their society.’
—Professor Emeritus David Zarefsky, Northwestern University, USA
‘Noam Schimmel has written a genuinely innovative book on the history
of American disputes over what used to be known as national health
insurance. Combining the scholarship of rhetoric with political portraiture
of the moral and practical presumptions of reformers and their critics,
Schimmel has informed our understanding by exposing the assumptions
of Presidents from Truman to Obama.’
—Professor Emeritus Theodore Marmor, Yale University, USA

v


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PRAISE FOR THIS BOOK

‘Noam Schimmel’s cogently argued and elegantly written monograph casts
important light on the rhetorical strategies liberal Democratic presidents
have employed to justify healthcare reform against conservative critiques of
big government. A must read book for students of the presidency and an
important contribution to political science.’

—Professor Iwan Morgan, University College London, UK
‘This is a milestone in rhetoric analysis and healthcare policy studies. It is the
first of its kind to examine historical change in presidential discourse on
healthcare. It is also the first to trace down and map out how historical
change in healthcare discourse is associated with broader change in American
political culture, moral norms, and social imaginaries. And it does so in a
rhetorical style that is itself eloquent, precise, and persuasive. A must-read.’
—Professor Lilie Chouliaraki, London School of Economics, UK


To the Teachers of Newton North High School and the Newton Public
Schools with Love and Gratitude for an Extraordinary Education



ACKNOWLEDGMENTS

Kellogg College, at Oxford University, has been an ideal research environment for developing and revising this manuscript and undertaking further
research. I am grateful for the Visiting Fellowship Kellogg College has
provided me during the 2015–2017 academic years, and for the care and
friendly and receptive way in which they have welcomed me to Oxford and
to life in college, and the opportunity they have given me to participate in
the incredibly diverse and energizing seminars, lectures, and cultural programs on offer at Oxford. It is a great pleasure to be a part of the Kellogg
community. Thank you to Professor Nazila Ghanea, of Kellogg College
and Oxford’s Masters in International Human Rights Law program,
for helping make this visiting fellowship possible with her characteristic
kindness, warmth, and goodness. Thank you also to Professor Andrew
Shacknove, co-director of Oxford’s Masters in International Human
Rights Law with Nazila, whose teaching, leadership, and conversations
have taught me so much and have given form and direction to my human

rights research, and whose gentle smile, wisdom, and humane and humble
manner make him the best ambassador Oxford could have. I am honored
to be your student and grateful for your sensitivity toward the needs and
perspectives of students and your receptiveness to us.
The Masters program was a superlative experience in so many ways—
educational, social, and experiential—and the beauty and magic of Oxford
permeated it throughout. The program enriched my understanding of
human rights enormously and was a great pleasure that will continue to
influence my research, writing, and teaching. My cohort was extraordinarily inspiring in their commitment to human rights, as well as their
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ACKNOWLEDGMENTS

humility, ethical awareness and sincerity of reflection and engagement,
openness, capacity for humor, generosity of spirit, and mutual support.
They were also enormous fun and great inspiration.
My dissertation advisor at the London School of Economics, Lilie
Chouliaraki, is frankly phenomenal. She was extraordinarily generous and
supportive and I am deeply grateful for her patience, wisdom, and mentorship. I immensely enjoyed working with her and learning from her, and
have been humbled in the best possible way by having her as a mentor.
More than an advisor, she has been my teacher and a constant source of
inspiration, pushing me to think and write more rigorously and clearly,
and challenging me to grow as a student and researcher. I am grateful
beyond measure and so much appreciate her kindness, understanding, and
empathy, which helped to bring my dissertation to fruition despite sometimes perilous shoals.
Nick Anstead came on board as an additional supervisor in the final two
years of my doctoral research and brought an essential perspective and skill

set which greatly enhanced my research and writing. I am grateful to him
for the positive energy he brings to research and writing and his receptiveness to my interests and ideas. His warmth, candor, generosity, openness,
enthusiasm, and always constructive and comprehensive comment and critique played a huge role in the completion of my dissertation.
Luc Bovens served as my secondary supervisor during the initial two
years of my dissertation research. He provided crucial feedback and advice
with characteristic warmth, analytical rigor, informality, and good cheer.
It has been a privilege to work with Luc once again. He also advised my
Masters thesis in Philosophy, Policy and Social Value in 2004. His teaching has been a longstanding inspiration, and he has supported my growth
as a student and researcher with generosity.
It has been a pleasure to research in a department that is collegial,
informal, and welcoming. My thanks to the Department of Media and
Communication at the London School of Economics for its funding of my
conference paper presentations and its rich program of seminars. Thanks
to faculty, staff, and students alike for making our department a place in
which it is easy to be at home, share ideas, laugh, critique, create, commiserate, cheer, and explore. The generous PhD scholarship the School
provided me enabled my studies and I am grateful for this support and for
LSE’s grants to fund conference paper presentations.
Goodenough College was a wonderful home and community, a vital
and dynamic place in which to live and write and a great pleasure during


ACKNOWLEDGMENTS

xi

my years in London and a place to which I am always happy to return. It
created just the right enabling environment for research and writing as
well as friendship, culture, fun, sun-dappled barbecues in Mecklenburgh
Square and all manner of delight—from film and music, to art and activism, holiday celebrations and many irreverent conversations. My thanks to
its staff and my fellow students for providing an ideal living environment

in which to pursue a PhD.
I am especially grateful to friends who were huge sources of support
during my doctoral studies and sources of meaning, fun, laughter, and joy.
Thank you for everything, great and small.
Thank you to the editors and peer reviewers at Human Rights Review
whose feedback enhanced my writing. A portion of this book was published in Volume 14, Number 1 (2013) issue of the journal. Thank you
also to reviewers and conference attendees at the annual meetings of
the American Political Science Association in 2011 (Seattle) and 2013
(Chicago), Northeastern Political Science Association 2011 (Philadelphia),
Policy History Conference 2012 (Richmond), and University of Indiana
Bloomington Conference on Empathy in 2011 for their feedback on
papers that reflected the research in this book and contributed to the
development of the book.
I appreciate the feedback of Alan Finlayson, Professor of Political and
Social Theory at the University of East Anglia, and Iwan Morgan, Professor
of US Studies and American History at University College London, who
were generous, supportive, and gracious in their encouragement of my
scholarship.
My interest in rhetoric, the social imaginary, and human rights was
inspired in large part by my studies at Yale with Professor Annick Louis.
I am grateful to her and to professors at Yale in the English and Political
Science departments and beyond for a college education that was incredibly enriching, engaging, and energizing, and that challenged me and
helped me grow in so many ways. The passion, creativity, openness and
critical orientation they brought to the classroom have inspired me personally and professionally.
I am particularly grateful to Yale’s Directed Studies program and the
animated and committed teaching, uncompromising intellectual and moral
integrity, stellar advising, and warmth of Professor Norma Thompson and
the late Professor Frank Turner, who taught me courses addressing history, politics, and ethics. Professor Thompson’s course, “The Intellectual Making of the Modern World,” was one of the most electric and

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ACKNOWLEDGMENTS

enjoyable classes in which I have ever enrolled and was a touchstone in my
education alongside Directed Studies, where I had the good fortune of
having Professor Thompson as my professor as well.
In the English department at Yale, Professor Priscilla Gilman brought
English to life in a singular way. My love of language and its capacity to
communicate in myriad forms was stoked by Professor Gilman’s teachings and by her exceptionally impassioned teaching and depth of care and
dedication to her students as learners and individuals. In my memories of
college, it is in her classes that I laughed, loved, and learned with greatest
intensity and sheer joy. Her warmth and closeness to students made her
not only a professor but also a friend. I fondly recall the way she used to
tease me when I would make a comment that seemed less English in orientation and more Political Science (I was a double major), accusing me
playfully of invoking “poli sci Noam” in the context of a class on poetry
and novels. Though in this particular publication, “poli sci Noam” has
emerged dominant, my interest in rhetoric and my love of English remain
as acute as ever, in no small part because of her teaching.
I wish to thank the teachers of Newton North High School and the
Newton Public Schools, whose teaching has had the profoundest impact
on my life and continues to inspire and inform my research and sustain my
intellectual curiosity. The education they gave me was and remains one of
the great sources of wonder and stimulation in my life. I am indebted to
them for the creativity, civic consciousness, and commitment to social justice which so informed their teaching and the values they transmitted. My
English and history teachers in particular, Annie Blais, Rob Stark, David
Moore, Ned Rossiter, John Amoroso, and the late Tom DePeter, inspired
my interest in history, politics, rhetoric, and social change. Learning with
them and from them was an enormous privilege. I am humbled and honored to have been their student.
An exercise in literary explication in Annie Blais’ American Studies

English class laid the seeds for this book. That course inspired an interest and love for American literature and American culture in me, and was
taught with intellectual rigor, warmth, creativity, and great sensitivity and
insight into education and pedagogy, particularly how to build a student
learning community and engage with students as individuals with distinctive interests and backgrounds. Studying with Ms. Blais, I experienced
intellectual freedom and its excitement with particular intensity. She
taught with amazing verve, humor, and wit. I am grateful for her sincere


ACKNOWLEDGMENTS

xiii

respect and care for her students and depth of commitment to teaching. I
often wish I could take her class again.
In my high school memories, it was in American Studies that I felt
especially passionate and understood and enabled to appreciate diversity of
life experiences and identities as reflected in and refracted by literature. We
laughed in class deeply, asked tough questions, discussed ethics and identity, and came to understand ourselves as individuals with increased insight
and humility. Our class had a strong emphasis on exploring how literature
illuminates issues of justice, equality, and diversity, and it was through Ms.
Blais’ teaching that I came to fully appreciate how literature and writing
can create empathy and expand understanding across boundaries of difference in all its forms.
Rob Stark taught history in a way that challenged students to think
critically and question a whole range of assumptions—moral, political, and
historical. He opened worlds and did it with humor, openness, and great
integrity. Matters of ethics, civics, justice, truth and social change took
center stage in our class, and were hugely formative in sensitizing me to
new ways of thinking and perspectives and knowledge that I would have
struggled to acquire on my own outside of class. Mr. Stark was a friend
and a mentor, someone who dared to push his students to exercise independent, critical thought, who built extraordinary rapport with students,

and for whom my affection and gratitude is deep. He took chances, gave
his students freedom, and had profound faith in them. His passion for
learning and for linking thought and action, ethical thought and the possibility of social change was powerful and palpable. He cultivated it in his
students like a gardener sowing seeds with joy and carefree confidence
in their eventual growth and maturation. He welcomed student initiative and helped students channel visceral emotions generated by learning
about injustice to constructive knowledge and self-reflection, and helped
us understand the link between individual and society.
David Moore’s course in US History pushed me to think, research,
read, and write with greater rigor than almost any other course in high
school and pushed me to my intellectual limits, and then some. He was
tough but caring. Undoubtedly the intensity of immersion in American
history, society, and culture in his course played a key role in my interest
in US politics and rhetoric. The historical texts we read were touchstones
in my understanding of American history and gave me a strong grounding
in the subject that showed me how immensely interesting and engaging
it is and can be. Together with Mr. Stark, he was a friend and a mentor,


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ACKNOWLEDGMENTS

someone who seemed to instinctively understand my interests and who
supported my learning both inside the classroom and in many informal
office conversations with him and Mr. Stark, which are amongst my happiest and most meaningful memories of high school and in which I felt
particularly at home.
Ned Rossiter taught me European history and nurtured my interests far
beyond that; in American history, in education, and in politics. His class
crackled with wit and laughter, intellectual exploration and conversation,
the examination of civilization and culture all made accessible and immediately relevant to high school students when it could have all too easily

remained distant and abstract. Learning with Mr. Rossiter was a pleasure
of the rare kind; collegial and fun, grounded in texts and historical fact,
but open to wide-ranging discussion and interpretation. He treated us
as equals, took great interest in our ideas and perspectives, understood
and respected the diverse ways in which students learn and develop intellectually, and took care to create pedagogic pathways that embraced and
enabled that learning. His seminar style classes were a highlight of my high
school learning and allowed students to learn as much from one another
as from the texts we studied. He was a mentor to me whose teaching
gave me intellectual tools and habits of mind and of learning, as well as a
knowledge base that, like those of Mr. Stark and Mr. Moore, profoundly
informed my journey as a student far beyond my high school years. His
early experiences as a teacher in Great Britain and his reflections on differences in American and British political culture and educational pedagogy
stoked my interest in living in the UK and planted the seeds that would
lead to my graduate studies at the LSE and at Oxford. He introduced
me to the historian Richard Hofstadter, whose writings on American history, politics, and culture informed my graduate studies. He recognized
and acknowledged my growing interest in history, and helped instil in me
the confidence to continue to pursue its study both in high school and
beyond.
John Amoroso communicated to his students great concern for justice and human rights, respect for human difference, and for the values of
democracy. His classes were fueled by love of learning and of history, and
reflected a commitment to fostering civic awareness and responsibility in
his students. His course on Ancient Greece and, in particular, a distinctive
memory I have of studying Pericles’ Funeral Oration informed my interest
in rhetoric and its powers. His classes invited extensive student reflection on
matters of ethics, politics, and ideas in a way that connected the ancient to


ACKNOWLEDGMENTS

xv

the present and made it relevant and dynamic. He introduced his students
to philosophies that were totally new to us and were consequently exhilarating with possibility and fascination—particularly Taoism—and expanded
our sense of reality and understanding of cultures and varied forms of consciousness and identity.
The late Tom DePeter taught me to appreciate good writing and tried
to teach me to write well. I was always humbled by this, as I had a long
way to go as a high school student to meet his standards and I am quite
sure that I still do. His courses in English and Philosophy were the stuff of
student legend for their sheer originality, offbeat and unusual assignments,
openness, and the seriousness with which they examined fundamental
questions of meaning, value, beauty, and purpose and their willingness
to allow students to think and write beyond the boundaries of convention. He always taught with an emphasis on genuine creativity in thought.
From teaching us about Zen meditation and giving us the opportunity to
experience it to inviting us to question what we read, the way we read, and
how and why we write his influence on me is continuous and very much a
constant in my life, for which I am grateful.
Though this book concerns itself with rhetoric in English, it is ultimately about language and culture. I was fortunate to be introduced to
Spanish by Julie Kaliakatsos, who opened a linguistic and cultural world
to me in my freshman year of high school and planted the seeds of my
engagement with Spanish language which would inform my studies of
Argentine political rhetoric during Argentina’s military dictatorship and
its human rights violations. I remember her kindness as a teacher, her
patience and receptivity to students, and her gentle presence.
Jessie Timberlake taught Spanish with so much exuberance, creativity,
and joy and conveyed love of the Spanish language, of teaching, and of her
students with playfulness and generosity of spirit that continues to inspire
me. I am forever indebted to her for my passion for Argentine literature,
politics, history, and culture. I always waited for her class with a sense
of excitement and anticipation. She recognized the personalities of her
students and honoured their individuality and aligned her teaching with

every student’s success. She made us all feel that she was our most passionate and dependable champion and co-conspirator in language and in life.
Carol Seitz taught Spanish with integrity and seriousness of purpose,
and with great care for her students and for the subject. She was nurturing
and sincere in her teaching and her interactions with students, and took
interest in her students as individuals as well as our learning. Like Jessie


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ACKNOWLEDGMENTS

Timberlake, she taught in creative ways that freed students to explore and
experiment with language, to gain confidence even as we made inevitable
errors, and to do so in an atmosphere of linguistic and cultural immersion
and sheer fun. Her teaching was touched by a motherly mix of affection
and gentle but firm guidance and correction, making for an ideal synthesis
that earned the respect and affection of her students.
Finally, with much love, to my mother and father and in memory of
my grandmother, Shoshana, who was a constant and boundless source of
love, happiness, strength, and inspiration in my life, who always welcomed
me into her home and her heart with unconditional love and warmth, and
who was a model of tolerance, kindness, generosity, resilience, and purity
of spirit.


CONTENTS

1

1

Introduction

2

History of American Liberal and Conservative
Healthcare Rhetoric and Public Policy

35

Methodology and Theory: The Social Imaginary
and its Moral Order

71

3

4

5

6

7

Harry Truman’s November 19, 1945 Address
to Congress on Healthcare Reform

111

Lyndon Baines Johnson’s Remarks at the Signing
of the Medicare Bill, July 30, 1965 and Related Speeches

143

Bill Clinton’s September 22, 1993 Address on
Healthcare Reform to Congress

177

Barack Obama’s September 9, 2009 Healthcare
Speech to Congress

217

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8

CONTENTS

Conclusion

255

Bibliography

279

Index

305


CHAPTER 1

Introduction

1.1

THE SIGNIFICANCE OF HEALTHCARE
MORAL ORDER
AND SOCIAL IMAGINARY

IN CONTESTATION OF THE AMERICAN

This book employs rhetoric analysis to illuminate the moral order and
social imaginary1 that Democrats, specifically Presidents Harry Truman,
Lyndon Baines Johnson, Bill Clinton, and Barack Obama, have offered as
justification for their healthcare reform plans to expand access to healthcare2 in the US irrespective of income. It is a temporal study of Democratic
presidential healthcare reform rhetoric between 1945 and 2013. It analyzes the rhetoric of these four presidents comparatively and examines
how Democratic presidential healthcare reform rhetoric has evolved. In
so doing, it also explores how it responds to opposing Republican social
imaginaries which have emphasized limited government and reject the
principle of universal or near-universal healthcare insurance to be guaranteed to American citizens by the government.
This change in the American moral order and social imaginary advanced
by Democratic presidents affirms the traditional liberal American values

of equality and liberty associated with the Constitution and Declaration
of Independence, but also seeks to expand the concept of liberty from
a primarily negative one restricting the government’s role in the lives
of citizens—reflected in the Constitution and the Declaration of
Independence—toward a positive one, in which the government actively

© The Editor(s) (if applicable) and The Author(s) 2016
Noam Schimmel, Presidential Healthcare Reform Rhetoric, Rhetoric,
Politics and Society, DOI 10.1007/978-3-319-32960-4_1

1


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N. SCHIMMEL

enables the welfare of citizens by providing a guarantee of health insurance to the economically disadvantaged and to all American citizens. In
this way it seeks to recognize vulnerable members of American society, to
mitigate their suffering and the injustice they face, and to address their
needs through a practical expression of communitarian social solidarity
that guarantees them access to quality healthcare and in so doing creates
greater equality of opportunity in American society.
In analyzing this Democratic presidential rhetoric I also consider how
these four presidents respond to Republican conservative discourse around
the issue of the size of the government and its corresponding characteristics and responsibilities.3 In Republican rhetoric4 the phrases “limited government” and “small government” focus at their most basic and obvious
level on matters of size. But the size of government is often a coded way
of referring to a range of implicit assumptions about which social issues
and sectors of the population deserve the attention and resources of the
government. Size entails much more than a quantitative measurement—it

is also a word loaded with qualitative ethical, ideological, and social meanings which merit examination. As David Shipler writes: “The liberal-conservative divide is not only about how big government should be; it is also
about what government should do. Liberalism is the use of the state for
some purposes; conservatism is the use of the state for other purposes.”5
A study of presidential rhetoric covers a wide range of fields of enquiry.6
These include efforts in the literature on politics and communication to
assess the persuasive power of rhetoric, often in relation to practical consequences in the form of voting trends and social attitudes as measured by
empirical surveys and statistical analysis.7 Scholars of speech and rhetoric
have examined presidential rhetoric thematically,8 stylistically,9 historically,10
as transmitted by the media,11 symbolically,12 discursively,13 culturally,14
ethically,15 and in relation to specific subjects such as war,16 new policy initiatives,17 presidential campaigning,18 current events and commemorative
events,19 and particular genres,20 such as presidential inaugural addresses21
and State of the Union addresses.22 This book addresses a cross-section of
these concerns, incorporating discursive, ethical, historical, thematic, and
cultural components of rhetoric analysis within the context of political science and public policy.
Thematically, healthcare is significant because it represents one of the
most fundamental human needs, along with shelter, access to food and
clothing, and education. The lack of universal healthcare for Americans has
been one of the great social injustices that tens of millions of Americans


INTRODUCTION

3

have suffered for almost a century; its impacts on life expectancy, quality of
life, individual freedom, family stability, economic productivity, and social
cohesion are substantial.23 Lack of health insurance has severe detrimental health impacts that can cause serious physiological and psychological
damage.24 Almost 45,000 Americans die of treatable medical problems
every year because they lack health insurance according to a 2009 research
study at Harvard Medical School.25 During the first half of the twentieth

century, as Harry Truman noted in one of his campaign speeches, that
number was substantially larger.26 As Jill Quadagno explains:
Many uninsured people do not have a regular family doctor and thus do not
receive preventive health services … As a result, their health problems are
often diagnosed at more advanced stages, resulting in higher mortality rates.
Frequently the care they do receive is in an emergency room where there is
no primary care and no follow-up care.27

The consequences are often devastating as illnesses and injuries that do
not receive regular medical attention increase in gravity and often become
more difficult and expensive to treat, as well as causing the deterioration
of an individual’s health.
I choose healthcare as a case study with which to analyze American
political discourse because it is one of the major policy areas that Democrats
and Republicans have fiercely contested for decades—indeed, in its most
comprehensive form since the 1940s and Harry Truman’s presidency and
his efforts to advance universal health insurance. As of 2013, over 45 million Americans lacked health insurance and over 20 million were underinsured,28 although by 2016, Obama’s Affordable Care Act substantially
lowered these figures and improved access to health insurance.29
The US is a highly unusual outlier in not providing universal or nearuniversal health insurance coverage (until the implementation of the
Affordable Care Act) among wealthy industrialized nations. Almost all
EU Member States, Canada, Australia, New Zealand, Japan, Taiwan, and
some Latin American countries provide universal health insurance to all
citizens.30 While the US under the leadership of Franklin Delano Roosevelt
adopted certain social insurance programs such as Social Security, and later
under Lyndon Baines Johnson the social insurance program of Medicare
and the social welfare program of Medicaid, a government guarantee of
universal access to health insurance has remained a key area of political
contention in the US since Theodore Roosevelt’s failed efforts to establish

4

N. SCHIMMEL

such a program in 1912. These failed in part because Roosevelt was not
re-elected and consequently did not have the opportunity to develop and
advance his reforms, but also because there was little precedent in American
policy, politics, and culture for such an effort to provide citizens with a comprehensive entitlement to a fundamental social provision. After Truman’s
failed efforts, several presidents made sustained efforts to create such a program, with Richard Nixon proposing expanding health insurance,31 Bill
Clinton universalizing it, and finally Barack Obama near-universalizing it.
All of these Presidents failed except for Obama. Given that Obama faced a
Congress and nation at its partisan apex, following three decades of increasingly hegemonic conservative power, his success is noteworthy.
Healthcare provision has a huge impact on the well-being of US citizens, and given the central place of healthcare reform in political conflicts
between Democrats and Republicans, it is appropriate to consider how
the debate over healthcare reflects the larger discursive struggle over the
moral and social obligations of the US government to its citizens. Enabling
healthcare reform or disabling it has profound implications on how
Americans imagine themselves, the moral and social bonds that tie them,
and the obligations of the government to US citizens. As Robert Asen
writes: “Implicated in struggles over meaning, policies express a nation’s
values, principles and priorities, hopes and ideals, and beliefs about citizens’
responsibilities and obligations to each other.”32 This book applies healthcare reform as a case study of wider American political and moral values and
their rhetorical contestation, revisions, and, ultimately, policy expression.

1.2

DEMOCRATIC AND REPUBLICAN
CONCEPTUALIZATIONS OF THE AMERICAN SOCIAL
IMAGINARY
The empirical assumption of my research is that the contemporary

American social imaginary, the ways in which people imagine their coexistence in a national space, and the moral values, relationships, and
responsibilities entailed are discursively constituted through the use of key
signifiers. These signifiers relate to the role of government in American
society as it applies to healthcare provision and to the politically contested
claims of citizens to have government-guaranteed healthcare insurance.
Republican rhetoric shows a strong tendency to favor the use of these
signifiers in ways that exclude and sometimes denigrate particular groups


INTRODUCTION

5

on the basis of economic class by a politically conservative discourse of
morality and political and social ideals.33 What emerges as a result of this
Republican conservative discourse is a struggle for the definition of just
forms of governance, with Republicans generally employing a definition of
justice that excludes human health and Democrats generally arguing that
human health is fundamental to a just society.34
Consequently, Democrats argue in defense of liberal values that the
government is obligated to do everything in its power to advance healthcare for all citizens equally, without discrimination on the basis of economic status.35 Democrats seek to reimagine and redefine the American
social imaginary and its moral order in order to include those very economically and socially disadvantaged groups whose needs are challenged
and marginalized by Republicans. But every Democratic president who
can reasonably be classified as “liberal” in orientation does so in a different
way. This book aims to explore the continuities and discontinuities in this
rhetoric, revealing the internal diversity found amongst these Democratic
presidents, each of whom shared a commitment to a more inclusive and
expansive moral order and social imaginary, but proposed in both rhetoric
and policy distinctive pathways towards their realization.
Obama’s 2008 presidential campaign and election victory is one example of this competing use of key signifiers towards different, egalitarian,

and inclusive ends by Democrats and which champions greater government involvement in provision of social services. These efforts have largely
been reactive in nature, as limited government conservatism exercised
hegemonic domination of American politics and much of American culture during the eight years of the George W. Bush administration, from
2001 to 2009.36 Prior to that, beginning in the early 1980s with the election of Ronald Reagan, limited government conservatism began an ascendant trajectory that enabled it to dominate American culture far beyond
the Republican Party.37 Its rhetorical tropes about justice, rights, and
responsibility largely excluded the principle of access to health insurance
on an equal basis.
Although the ideology of limited government had informed
Republican political ideology since the Truman era, the conservatism of
the Republican Party prior to the Reagan era was more open to government programming as a means of addressing inequality and less aggressively anti-statist and hostile to government. Reagan and his followers
defined government as intrinsically inefficient, hostile to the welfare of
citizens, unaccountable, intrusive, and unlikely to improve overall social


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N. SCHIMMEL

conditions.38 They conceived of healthcare as a capitalist commodity
rather than an entitlement of citizenship. This made it increasingly difficult to advance liberal arguments for government-guaranteed health
insurance without conflicting with dominant conservative definitions of
justice and rights centered on negative liberty and individual responsibility for finding healthcare. These presuppose that a government guarantee
of health insurance would inevitably violate the liberty of some Americans
by possibly requiring them to purchase health insurance39 and/or by limiting their insurance choices in the private market and demanding taxes
that would redistribute wealth from the rich to the middle class and the
poor.40 They deny the principle that healthcare is a right and/or a social
need that sustains both individual and communal well-being, and which
government must provide on an equitable basis.41
Transforming a social imaginary requires initiating a shift in socially
accepted ideas, beliefs, ethical values, and emotions about them. Michael

Freeden argues that:
Ideologies reflect, and attempt to determine, substantive collectively held
interpretations of the political world, such as: what change is legitimate?
How and with whom should we encourage social cooperation? What constitutes fair distribution? They compete with each other over the control of
political language necessary to further their views of the good society and
of the public policy that will realize those views. That control is no symbolic
sideshow but a vital means of moulding and directing a society. To monopolize, channel, or contain understandings prevailing in that society’s language
is also to preside over its practices and processes.42

My primary concern then is how liberal Democratic ideologies argue for
expanding healthcare access and quality, and the moral, social, emotional,
and policy components of their rhetorics.
I analyze how the rhetoric of individual Democratic American presidents seeks to create, shift, and revise the American social imaginary and,
in so doing, integrate two different approaches to political history, with an
emphasis on how on the micro-level, American presidents both attempt to
create and respond to the social imaginary on the macro-level. As we will
soon discuss, there are diverse components of the social imaginary and different parts of society that contribute to it—from politicians to the media,
business to academics, laypeople and professionals from various sectors
of the economy. American presidents are therefore prominent actors in
the creation, revision, and dynamic ongoing transformation of the social
imaginary which is never static.