EVERYBODY IN AND NOBODY OUT OPPORTUNITIES, NARRATIVE, AND THE RADICAL FLANK IN THE MOVEMENT FOR SINGLE-PAYER HEALTH CARE REFORM _______________________________________ A Dissertation presented to the Faculty of the Graduate School at the University of Missouri-Columbia _______________________________________________________ In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy _____________________________________________________ by LINDY S. F. HERN Dr. Clarence Lo, Dissertation Supervisor MAY 2012 The undersigned, appointed by the dean of the Graduate School, have examined the Dissertation entitled EVERYBODY IN AND NOBODY OUT: OPPORTUNITY, NARRATIVE, AND THE RADICAL FLANK IN THE MOVEMENT FOR SINGLE PAYER HEALTH CARE REFORM Presented by Lindy Hern A candidate for the degree of Doctor of Philosophy And hereby certify that, in their opinion, it is worthy of acceptance. Clarence Lo Joan Hermsen Victoria Johnson Mary Jo Neitz Marjorie Sable Acknowledgments There are many people to whom I owe my thanks and appreciation. First, I would like to thank my excellent dissertation committee for their advice and support throughout this very long process. I first began to work with Dr. Clarence Lo, my advisor and dissertation committee chair, in the spring of 2004. He has been a constant and enthusiastic advisor and reviewer throughout this process. Many of the ideas developed here bloomed as Dr. Lo listened to my ideas, read my written work, and gave me excellent and detailed feedback. I will forever be grateful for that. Dr. Victoria Johnson has also been an engaged and committed reviewer of the writing presented here. Many of her suggestions encouraged me to think more deeply about some of the issues that I was working through and led to a few of the Eureka! moments that are so helpful when working through complicated ideas. Dr. Joan Hermsen has also been one of the most important mentors during my intellectual development and has been a constant source of support and encouragement. Her criticism, as well as her encouragement, has helped me to become a better scholar and activist. I owe much to Dr. Mary Jo Neitz. It was in her seminars that I had my awakening as a feminist scholar and developed many of the methodological tools that are so important to my research. Her support and enthusiasm for my work have encouraged me to continue to develop as a feminist scholar. Dr. Marjorie Sable’s interest in and support for my work has also been very important for my development as a scholar of social movements for health care reform. Her ii knowledge dealing with the particularities of the health care system made her an invaluable resource as I developed this analysis of health care reform. I would also like to thank a few other members of the sociological community who have been important to my development as a scholar. Dr. Andrew Twaddle has played a central role in my development as a scholar of social movements for health care reform. He was my initial contact through which I met the “gate keepers” in the movement and his willingness to act as a reviewer and soundboard for my ideas even after retiring is commendable. I thank him for his mentorship and continued guidance. Dr. Mike Hirsch, my under graduate advisor, has continued to be a supportive and attentive mentor throughout my graduate school career. I thank him for his time, support, and continued interest in my work and in my development as a scholar of sociology. Dr. Jaber Gubrium first introduced me to narrative analysis in his seminar on “Narrative and Identity” and I thank him for this. Finally, I would like to thank Mary Oakes and Debbie Friedrich for their constant support in the Sociology Office. Without their support with day to day tasks, as well as their emotional support and encouragement, I would not be writing this. I would like to thank my family and friends. Matthew Humphrey has been my day to day source of support and unconditional love. Even during the times when we would not speak for hours because I was writing, he was always in the other room with an encouraging smile, hug, or bowl of popcorn. I can only hope that he knows how much this means to me. Kyle and Marie Hern have been my constant source of support and unconditional love since birth. Without their presence in my life, none of this would iii have been possible. Jennifer Lux has also been a consistent source of support and is one of the only people for whom encouragement could take on a harsher tone when I needed it. Dr. Brooke Williams has always been available for a supportive phone conversation over vast distances. I also thank Kathleen Krueger for her laugh, keen eye for grammatical errors, and those late night deliveries of cups of coffee. Dr. Candace Korasick, Colin Suchland, Derek Evans, Roslyn Fraser, and Veronica Medina have also been important sources of encouragement and review. I would like to thank the activists that have been so important in my research and who I am now happy to call my friends. Many of them make appearances in this text and I thank them all. I would like to specifically thank Julia Lamborn, Mimi Signor, Mary Jane Shutzius, Donna Smith, and Katie Robbins. Julia introduced me to the world of single-payer and without her fierce support of single-payer and of my research, this study may have never started. Mimi has been a consistent source of expert knowledge of the health care system and she has always been willing to act as a sound board for my ideas. Mary Jane allowed me to utilize her immaculately kept files for the historical portion of my research. Donna is an untiring supporter of single-payer movement and she has brought enthusiasm and light to my research. I thank all four of these women for also being consistently willing to engage in discussion with my students, even when it meant travelling over great distances. I thank Katie Robbins for her devotion to the single-payer movement and for long telephone conversations during which we discussed many of the issues presented here. iv Finally, I would like to dedicate this text to Marilyn Clement who, until her death in 2009, was one of the many rocks on which the movement for single-payer was built. She welcomed me into the Health Care NOW community with open arms and was consistently supportive of my research. She will forever be remembered and will forever be missed. As she would say, “Onward to Single Payer”. v Table of Contents Acknowledgments ...................................................................................................... ii List of Tables and Figures ............................................................................................ x Abstract ..................................................................................................................... xi Chapter 1 ................................................................................................................... 1 The Story of Ants: Opportunity and The Narrative of Health Care Reform The Narrative of Health Care Reform The Weak Welfare State and Health Care Reform The Single Payer Story: Chapter Summary Chapter 2 ................................................................................................................. 29 The Environment of Opportunity Model: Power, Opportunity, Narrative, and Pragmatic Liberation in the Process of Social Change Power and Social Change Narrative and Power Opportunity and Social Change Political Opportunity Cultural Opportunity Economic Opportunity Grassroots Opportunity Pragmatic Liberation Chapter 3 ................................................................................................................. 60 From Stalker to Board Member: Navigating the Borderland of Scholar-Activism in the Movement for Health Care Reform vi Methodology Methods Participant Observation Qualitative Content Analysis Oral History and Semi-Structured Interviewing Analysis of Narrative Analysis of Narrative Practice My Story: Becoming a Scholar Activist From Stalker to Board Member Navigating the Borderland: Scholar Activism Chapter 4 ................................................................................................................. 89 A Single Prayer for Single Payer: Origin Stories, Identity, and Structure in the Movement for Single Payer Health Care The Origin of Missourians for Single Payer: The Canada Model Health Care NOW – The New Civil Rights Movement The Ties That Bind: Health Care NOW and MoSP The Narrative Practice of Origin Stories Chapter 5 ................................................................................................................120 The Clinton Era of Health Care Reform: Narratives of Political Opportunity and Action in the Context of “Not Politically Feasible” “First They Ignore You”: Rising Action of Clinton Health Security “Then They Laugh at You”: Clinton Health Security Proposed “They They Fight You”: Single-Payer in the States vii “And Then You … Win?”: The “Death” of Health Care Reform Chapter 6 ................................................................................................................ 161 A Contract with America: The Narrative Practice of Countering Hegemonic Economic Narratives in an Era of Institutional Change “Dead in the Water?”: Falling Action in the Movement for Single – Payer “Newt – erd”: A Contract With America The Rise of Managed Care “U2K or There Is NO Way!” “Single-payer, It’s Who We Are” Incremental Steps to Health Justice The War on Terror: A redefined economic narrative?