The London School of Economics and Political Science Presidential Rhetoric Justifying Healthcare Reform: Continuity, Change & the Contested American Moral Order and Social Imaginary from Truman to Obama Noam Schimmel A Thesis Submitted to the Department of Media and Communications of the London School of Economics for the Degree of Doctor of Philosophy, London, September 2013 1 Declaration I certify that the thesis I have presented for examination for the PhD degree of the London School of Economics and Political Science is solely my own work other than where I have clearly indicated that it is the work of others (in which case the extent of any work carried out jointly by me and any other person is clearly identified in it.) The copyright of this thesis rests with the author. Quotation from it is permitted, provided that full acknowledgment is made. This thesis may not be reproduced without my prior consent. I warrant that this authorization does not, to the best of my belief, infringe the rights of any third party. I declare that my thesis is 98, 147 words. 2 Abstract The original contribution to knowledge of my thesis is a comparative historical analysis of the rhetoric used by four Democratic presidents to expand access to and affordability of healthcare. Specifically, the thesis situates Democratic presidential healthcare reform rhetoric in relation to opposing conservative Republican ideologies of limited government and prioritization of negative liberty and their increasing prominence in the post-Reagan era. It examines how the American moral order and social imaginary has evolved and how Democratic presidential healthcare reform rhetoric was both informed by and responded to it. I employ Aristotle’s tripartite categories of ethos, pathos and logos to undertake rhetorical analysis. I illuminate how each president sought to persuade audiences, what rhetorical strategies they used and how they justified their healthcare reform efforts. I pay particular attention to the compromises entailed by the usage of specific strategies and their rhetorical effects. The thesis illustrates how Presidents Harry Truman and Lyndon Baines Johnson contextualized healthcare reform within their broader efforts to secure positive liberty and social and economic rights in the Fair Deal and Great Society, respectively. This is in contrast to Presidents Bill Clinton and Barack Obama who did not advance a comprehensive vision of government guaranteed positive liberty and citizen welfare. Rather, they made arguments for healthcare reform based on pragmatism and economic efficiency and appropriated tropes of conservative rhetoric such as efficiency to critique market failure. They showed deference to the conservative principle of maximizing the role of the private sector in healthcare provision. There is a marked contrast between Truman and Johnson’s explicit expressions of care for economically disadvantaged and working class Americans and Clinton and Obama’s rhetorical elision of these populations, and their focus on the ‘middle class.’ Despite these substantive differences a major continuity in the rhetoric is an enduring appeal to communitarian solidarity. 3 Acknowledgments My advisor, Lilie Chouliaraki has been frankly phenomenal. She is 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 Lilie’s kindness, understanding, and compassion which helped to bring my thesis to fruition despite sometimes perilous shoals. Nick Anstead came on board as an additional supervisor in the final two years of my thesis 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 PhD 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 the thesis. Luc Bovens served as my secondary supervisor during the initial two years of my thesis research. Luc provided crucial feedback and advice with characteristic warmth, analytical rigor, informality, and good cheer. It has been a privilege to return to working with Luc, who also advised my MSc thesis in 2004 and whose teaching has been a longstanding inspiration and who 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 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 very grateful for this support. The LSE Financial Support Office has been particularly helpful in providing me with crucial funding during the final year of my writing. Thank you also for being exceptionally generous with funding to enable me to present my research at various conferences. Goodenough College has been a wonderful home and community, a vital and dynamic place in which to live and write and a great pleasure during my years in London. It created just the right enabling environment for research and writing as well as friendship, culture, fun and 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 have been huge sources of support during my doctoral studies and sources of meaning and joy. Thank you for everything, great and small. 4 Thank you to editors and peer reviewers at Human Rights Review whose feedback enhanced my writing and sharpened my thesis. A portion of this thesis was published in the 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 thesis and contributed to its development. I appreciate the willingness of my examiners, Professors Alan Finlayson and Iwan Morgan, for examining this thesis and providing me with helpful comments. 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. 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 that they brought to the classroom inspire me not only intellectually but also personally to pursue an academic career. 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 the late Professor Frank Turner and Professor Norma Thompson 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 enjoyable classes in which I have ever enrolled and a touchstone in my education alongside Directed Studies, where I had the good fortune of having Professor Thompson as my teacher as well. In the English department Professor Priscilla Gilman brought English to life in a way that no other professor of mine ever has. 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. 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 generosity. 5 Table of Contents Declaration………………………………………………………………………… 2 Abstract…………………………………………………………………………….. 3 Acknowledgements………………………………………………………………... 4 Table of Contents………………………………………………………………….. 6 1. Chapter 1 : Introduction…………………………………………………………12 1.1 The Significance of Healthcare in Contestation of the American Moral Order and Social Imaginary……………………………………………….