View of Health Care Specifically by Determining the Way They Spoke – and Thus Thought – About the Issue of Universal Health Care

THE FAILURE TO MEET “THE CHALLENGE OF OUR TIME”: THE DEMISE OF

BILL CLINTON’S PLAN FOR UNIVERSAL HEALTH CARE

CHRISTOPHER MAYS

Submitted in partial fulfillment of the requirements

For the degree of Master of Arts

Thesis Advisor: Dr. Kimberly Emmons

Department of English

CASE WESTERN RESERVE UNIVERSITY

May, 2008 CASE WESTERN RESERVE UNIVERSITY

SCHOOL OF GRADUATE STUDIES

We hereby approve the thesis/dissertation of

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candidate for the ______degree *.

(signed)______(chair of the committee)

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*We also certify that written approval has been obtained for any proprietary material contained therein. Table of Contents

Abstract...... 2

Introduction...... 3

Chapter One: People? Or Profit?: The Reversal of Bill Clinton’s Proposal

for Universal Health Care...... 27

Chapter Two: The “Dramatic” Appropriation of the President’s Message:

Same Words, Different Story...... 57

Conclusion...... 82

Works Cited...... 95

The Failure to Meet “The Challenge of Our Time”: The Demise of Bill Clinton’s Plan

For Universal Health Care

Abstract

CHRISTOPHER MAYS

This thesis employs the theories of Kenneth Burke in an analysis of Bill Clinton’s failed

1993-1994 attempt to institute universal health care in the United States. My study examines Clinton’s initial televised address introducing his plan and the various media responses to it as an example of the ways a rhetor can motivate public opinion and public policy on a national stage. I argue that Clinton’s attempt to control the public response to his plan through the use of a humanitarian terministic screen ultimately failed because he simultaneously introduced a competing economic terministic screen. This allowed his opponents to appropriate his argument selectively and, ultimately, to prevent the public from comprehending the importance of the humanitarian arguments. Thus, this project demonstrates the power of public discourse to shape policy decisions and social realities.

Introduction

Can a single rhetorical moment shape public policy? On September 22, 1993,

President Bill Clinton gave a televised speech to the nation that at the time seemed destined to do just that. Clinton’s address, which was “one of the most comprehensive domestic policy proposals ever made by an American president” (West, Heith and

Goodwin 41), was essentially an attempt to persuade the American public to radically overhaul the existing system of health insurance by instituting guaranteed universal health care, and, as such, was a tremendously ambitious use of deliberative rhetoric to reshape social reality. Under Clinton’s proposed plan, almost every facet of the health care system would change, and this meant that almost every feature of every industry connected in some way to the system’s operation would be transformed; in short, everyone in the country would be affected by the implementation of the proposed system of health care, and thus all Americans had a reason to pay close attention to Clinton’s address. As public support of his plan was crucial to its chances for enactment, for

Clinton, his speech was a vital opportunity to generate the initial widespread enthusiasm for the plan that he hoped would create the conditions for its eventual success.

Of course, Clinton’s attempt to transform the system did not go unanswered. As the fate of Clinton’s bill had powerful and lasting ramifications for all areas of American society, his proposal was intensely scrutinized, and, in the months to follow, highly contested. Correspondingly, the massive public debate sparked by his initial address generated more media coverage on health care than in any other single period since the turn of the century (Laham xiii). As well, throughout the course of this melee, a flood of

special interest groups, political factions, and grassroots movements all took nuanced positions vis-à-vis Clinton’s plan, and as well all did their best to exert their own influence over its fate.

Initially, Clinton’s proposal was effectively able to harness preexisting support for a drastic makeover of the health care system. One week before Clinton made his speech, polls showed that 42% of Americans thought that “the American health care system has so much wrong with it that we need to completely rebuild it,” and, two days after his televised address 59% of the public was in favor of Clinton’s plan in particular (Jacobs and Shapiro 416-418). According to one poll, in fact, only 18% of the public was actually opposed to his plan (Stout B1). Despite this significant popular enthusiasm, however, in a matter of months support for Clinton’s plan had virtually evaporated. A Wall Street

Journal/NBC News poll conducted in March of 1994 – only six months after Clinton had unveiled his proposal – showed that 45% of Americans were specifically opposed to “the

Clinton plan.” Clearly, though Clinton’s September address had been effective, in the months to follow, his campaign to crystallize public support for the plan – and, in effect, to establish permanently the rhetorical foundation that had produced his initial success – had failed.

In this study, then, I intend to critically examine both Clinton’s initial speech and the tenor of the public debate that followed in order to better illuminate the reasons for

Clinton’s immediate success, and as well for his eventual failure. Essentially, in his address, Clinton attempted to control the way the public conceived of universal health care itself by refocusing public discourse about health care through a specific set of issues. In other words, within this study, I will analyze Clinton’s initial speech as an

attempt to influence the public’s view of health care specifically by determining the way they spoke – and thus thought – about the issue of universal health care. If Clinton were to be successful, then, he would have had to effectively convince the public to see the issue from his perspective, within which universal health care was a necessary and natural step in the progression of American social policy. In addition, though, Clinton’s rhetoric would have needed to establish his viewpoint in the public sphere in such a way that would be immune to the rhetorical counter-strategies of his opponents, who, in their myriad responses to his speech, would undoubtedly attempt to refocus the public’s view of health care in a way favorable to their own aims.

Though Clinton’s effort was ultimately unsuccessful, his initial success is evidence that his speech did have a significant effect on the public’s view of his plan – and as well on their view of universal health care in general. As I posit, the single rhetorical “moment” that was encompassed by Clinton’s address on September 22 undoubtedly did have the potential to shape public policy, and though he ultimately failed to do so, his lack of success was not due to the underlying impotence of this particular rhetorical situation, but rather was a result of the rhetorical failings present within the speech itself, as well as the effective rhetorical counter-strategies employed by Clinton’s opponents. My analysis of the progression of Clinton’s health care proposal thus can shed light not only on the way that rhetoric in specific situations affects public policy, but also on the reasons for the continuing lack of any major change to the health care system, even as popular support for reform, as well as the number of uninsured Americans, continues to grow.

Within this study, the work of Kenneth Burke will serve as the primary theoretical ground of analysis. Several aspects of Burke’s theories not only are centered around the determinative power of language that is at the core of my thesis, but also are effective organizing principles by which the complex rhetorical structure of Clinton’s discourse – which was a key factor in its initial success as well as in its eventual failure – can be examined both in extensively magnified detail, dissecting even its smallest elements, and from a broad overarching perspective, taking into account the sweeping themes employed throughout the address. In addition, of course, Burke’s theories can be applied to the variety of responses to Clinton’s speech, which not only took up the themes Clinton himself laid out, but also revealed a distinct rhetorical agenda, the imposition of which played a significant role in the shape and, thus, the outcome of the debate. With this in mind, then, a general introduction to Burke’s work is in order.

Kenneth Burke, Language and Society

When a bit of talking takes place, just what is doing the talking? Just where are the words coming from? [. . .] Do we simply use words, or do they not also use us? -Kenneth Burke, Language as Symbolic Action (6)

Kenneth Burke, among other things, was an unorthodox philosopher. His body of work refuses to be pigeonholed, as his theories have been borrowed, applied and expanded by scholars in a diversity of fields. Sociologists, literary critics, psychologists, and historians, among others, can all be counted as belonging to disciplines in which

Burke’s work has had a significant influence. Burke’s unorthodoxy has provoked a dizzying range of responses, as well. Joseph R. Gusfield, in the introduction to his anthology of Burke, acclaims: “In the scope of his thought, in the depth of his

understanding and in the originality of his insight Burke has produced a corpus of work with a richness and significance that deserves a high priority for sociologists” (45-46).

Literary critic John Crowe Ransom, while hesitant to embrace Burke’s theories wholeheartedly, nevertheless characterized him as “perspicuous and brilliantly original”

(158). Others, however, have not been so charitable, though their reactions have often been commensurately enthusiastic; philosopher and linguist Max Black characterized

Burke’s A Grammar of Motives as a “vast rambling edifice of quasi-sociological and quasi-psychoanalytical speculation [that] seems to rest on nothing more solid than a set of unexamined and uncriticized metaphysical assumptions” (168-169).

While not every scholar has felt that Burke’s work has had something useful to contribute to their respective field, his admirers – of whom there are many – have always recognized that though his theories straddle several disciplines, they are, at their core, unified. Burke’s firm belief in the primary importance of language to human thought and society is what ties together his wide-ranging body of work, and what has allowed him to transcend the boundaries of these supposedly-discrete academic disciplines

For Burke, the nature of symbol systems suffuses every aspect of human existence, and Burke’s myriad concepts all deal with the ways in which human beings act both using, and as a result of, their language. Humankind, he posits, is essentially a

“symbol-using animal” (Language 3), and therefore our perception of reality itself – and thus our collective behavior that is a response to this reality – is, ultimately, a product of our symbol systems. In short, our choice of terminology is immensely formative of our perception of the world.

If the terminology we use helps determine our reality – and thus is determinative of our actions – then the common characterization of language as a “tool” is ironic, since, as Burke creatively puts it, “words” in fact “use us.” Throughout Burke’s entire body of work runs this theme of language as a determining factor in our experience; at their core

Burke’s discussions of linguistic and rhetorical concepts, such as god-terms, terministic screens, and the assignment of motive – all dealt with extensively in several of his books

– refer to the way language organizes thought, and concomitantly organizes social behavior.

The great value of Burke’s ideas is that they provide an organized method of analysis with which to study and deconstruct ways that language operates upon both individuals and, on a broader scale, social groups. For example, when rhetors use words to effect change, the representation of reality that forms the basis of their speech is actually a product of the pattern of symbols they use. Their realities, and, thus, the reality they are attempting to get their audience to see as well, is at its base a highly structured – and highly circumscribed – arrangement of symbols, and the specific interpretation of the world engendered by this arrangement can be used to motivate a specific course of action advocated by the rhetor. In fact, rhetors often represent the world through the lens of a specific group of relationships, which, though not binding, are uncontested simply because they are taken for granted by both the audience and the rhetor. A critic who utilizes a Burkeian critique, then, as Gusfield puts it, “acts to make us aware of the assumptions we [in a society] take as unthinking constraints” (45).

Much of the time, this “Burkeian” criticism flies in the face of what has traditionally been taken for granted. Though there is a significant contingent of those who

would believe, as James Berlin has put it, that “language is never innocent” (131), words themselves are often viewed as benignly transparent representatives of the material world, and the Neo-Classical idea that language is the “dress of thought” continues to have currency in modern-era debates. Burke himself recognized this tendency of men and women to dismiss the idea that language has the power to determine social reality:

“Though man is typically the symbol-using animal,” he writes, “he clings to a kind of naïve verbal realism that refuses to realize the full extent of the role played by symbolicity in his notions of reality” (Language 5). Much of Burke’s work is devoted to dispelling just this sort of naiveté, as is much of the more recent criticism which has utilized his ideas and methods.

While Burke’s concepts all focus in some way on the determinative nature of language in relation to thought, the terms and ideas he explores in detail throughout his work are astonishingly diverse, and as such make condensing his work extremely difficult. In general, critics using his methods are forced to choose from among many applicable concepts, narrowing their focus in order to produce the most cogent analysis.

One of Burke’s most well-known concepts that highlights the way language can reductively determine thought is his notion of terministic screens. As Burke asserts, reality, in general, is a vast tangle of information that must be mediated by language. In the process of this mediation, however, reality is narrowed down by the choice of terms used to describe it. In other words, any description of a situation must necessarily use terms that “direct the attention to one field [of reality] rather than to another,” and this choice, Burke maintains, is unavoidably tendentious. As Burke explains:

What is our “reality” for today (beyond the paper-thin line of our own particular lives) but all this clutter of symbols about the past, combined with whatever

things we know mainly through maps, magazines, newspapers, and the like about the present? In school, as they go from class to class, students turn from one idiom to another. The various courses in the curriculum are in effect but so many different terminologies.

What Burke calls a “terminology” is in effect a terministic screen, which is a way of using a particular choice of terms to describe a situation, an object, or, on a broader level, a particular version of reality. Not only are descriptions, which are riddled with these terministic screens, “selection[s] of reality,” they are, as Burke avers, “deflection[s] of reality.” Burke uses a description of differing photographs of the same scene as a way to effectively convey the function of these screens:

When I speak of “terministic screens,” I have particularly in mind some photographs I once saw. They were different photographs of the same objects, the difference being that they were made with different color filters. Here something so “factual” as a photograph revealed notably distinctions in texture, and even in form, depending upon which color filter was used for the documentary description of the event being recorded.1

Thus, terministic screens speak to the distinctly subjective rhetorical interpretation (or

presentation) of a seemingly objective reality. As Burke writes, “‘observations’”

themselves “are but implications of the particular terminology in terms of which the observations are made.” With this theory, then, Burke dispels the notion that language is a transparent medium, declaring on the contrary that even “the most unemotional scientific nomenclatures” have a “necessarily suasive nature” (Language 44-48; emphasis in original).

It is important to note Burke’s use of the word “suasive” in his characterization of the way terministic screens – and in fact languages in general – work. Not only does a

1 Of course the use of the metaphor of a photograph is itself a use of a particular terministic screen; by rendering this rhetorical concept visually, Burke unavoidably highlights certain aspects of it that other characterizations would not. This variety of terministic screen, in fact, is often taken for granted; as Kress and van Leeuwen have noted, “seeing has, in our culture, become synonymous with understanding. We 'look' at a problem. We 'see' the point. We adopt a 'viewpoint’” (168). 10

rhetor’s choice of terms determine the nature of his or her observations, but this choice has an inherently motivating effect on an audience. Burke characterizes language, with this concept in mind, as literally “a species of action, symbolic action” (Language 15).

Thus, while persuasion is traditionally thought of as one use of language among many,

Burke goes further, asserting that persuasion is intrinsic to the very nature of language- use itself. Every time we speak, according to Burke, we adopt one of an infinite variety of

“strategies for the encompassing of situations” (Philosophy 1), which, unavoidably, makes these utterances all persuasive acts. As Judy Z. Segal succinctly sums up, “Burke sees all relations as discursive, all discourse as action, all action as motivated” (11).

Burke’s theory of Dramatism, which is arguably the set of ideas he is most well- known for, functions both as a technique of language analysis and as a theory of human social behavior. Burke stresses that since human beings act both using and because of patterns determined by language, collective social behavior conforms, on a broad level, to predictable patterns as well. These patterns can be seen, ultimately, as dramas, and Burke argues, then, that all collective social action is in fact dramatic action, with several defining and observable features that conform to a narrative structure. These dramas, according to Burke, have been repeated throughout human history, and their basic elements can be seen at work in the speeches and actions of human actors in diverse eras.

Many long-extinct social “movements,” in fact, are seen by Burke as responses to societal themes which, far from dying out, have resurfaced regularly throughout history:

“So far as I am concerned, I find nothing more ‘contemporary’ than the records of heresies, sects, and schisms that flourished centuries ago, which are by no means gone with their times, but are mutatis mutandis all vigorous today” (Philosophy xxi).

These broad themes of human behavior as summed up by Burke form the backbone of his theory of Dramatism, the endlessly-repeating pattern of which begins, as he writes, with the one term central to his scheme: action. “If action is to be our key term,” he explains, “then drama; for drama is the culminative form of action [. . .]. But if drama, then conflict. And if conflict, then victimage. Dramatism is always on the edge of this vexing problem, that comes to a culmination in tragedy, the song of the scapegoat”

(Language 54-55; emphasis in original). The drama of human behavior, then, is ultimately a tragedy, with the destruction of the symbolic scapegoat the end result of the

“confict” endemic to human society. Gusfield elaborates on the ramifications of Burke’s scheme, and in particular addresses the underlying catalyst that sets this progression in motion: humans’ inevitable tendency to violate their own hierarchical social order. As he puts it:

If there is hierarchy and social order, there is also the rejection of order and the consequent guilt. Here is the foundation of Burke’s society: if drama, then conflict. If conflict, then hierarchy. If hierarchy, then guilt. If guilt, then redemption. If redemption, then victimage. Rejection means the need to expiate the resulting guilt. Rituals, dramatic enactments, provide us with visible symbols in which hierarchy is built up and in which rejection is atoned for. The scapegoat, the victim, is essential to the order of society. [. . .] The sacrificial principle is essential. The Christian drama is enacted again and again. (33)

By their very nature, Burke says, human beings are irresistibly prone to reject the prohibitions which keep intact the organization of their own society. The result of this violation is guilt, which becomes the impetus for a behavioral chain reaction that attains completion in a “ritual” expiation. This final act is performed in a variety of ways – mortification, sacrifice, “dramatic enactments,” to name a few – but it is in fact language that enables the primary method of expiation: vicarious atonement via scapegoat.

Because of language’s unique quality as a means of “substitution,” Burke explains that

the designation of scapegoats is assigned at the rhetor’s own discretion, and thus humans are able to achieve a “transcendence” of their guilt via the destruction of a rhetorically- created scapegoat. This, then, is the culmination of the recurring drama of the “symbol- using animal,” which is repeated throughout the history of human societies. Indeed,

Burke finds this overarching behavioral pattern at work in such ostensibly disparate historical events as the crucifixion of Christ, and the rise of National Socialism.2

While many aspects of Burke’s theories are applicable within a diversity of

academic projects, perhaps the most fruitful site for their use is rhetorical analysis.

Burke’s own analysis of Hitler’s Mein Kampf, “The Rhetoric of Hitler’s ‘Battle,’” is an

illustration of the way Burke’s philosophy can be effectively used to explicate a

rhetorical object. Though his theory of Dramatism had not been fully elaborated at the

time of this essay’s publication, many elements that he would later systematize were used

in the analysis. Throughout the piece, Burke adroitly dissects the specifics of Hitler’s

destructively successful appeal, including his use of terministic screens, in “deflecting the

attention from the economic factors involved in modern conflict [. . .] by attacking ‘Jew

finance’ instead of finance,” and as well his use of Jews as scapegoats, whereby the

German people could achieve “purification” by handing over their internal, personal

“infirmities to a vessel, or ‘cause,’ outside the self, [so that they could] battle an external

enemy instead of battling an enemy within” (Philosophy 202-204; emphasis in original).

Both of these specific rhetorical aspects of Hitler’s appeal – one lexical (the choice of

terms – i.e. the specific terministic screen), the other ontological (the designation of

2 Despite this apparently negative vision of society his theory predicts, Burke does allow that his pattern could take a “happy route, along the lines of a Platonic dialectic” (Language 55). In this view, humanity, instead of being doomed to blindly repeat a vicious cycle which ends with the destruction of a scapegoat, is continuously progressing toward a more multifaceted and open-minded understanding of the world, which would entail the elimination – through self-awareness – of the need for these scapegoats. 13

scapegoats, Burke implies, has a deeply rooted appeal) – are intertwined, as are all of the other mechanisms of persuasion present in the work. Thus, this division between lexical and ontological appeals in Hitler’s rhetoric is shown to be a false one, as each of the components of his rhetorical strategy can be shown to display elements of both. The construction of this critique illustrates the genius of Burke’s method; namely, its capacity to simultaneously explicate the appeal of the rhetoric both as many discrete components and as one integrated whole.

One of the primary goals of persuasion, which Burke asserts Hitler was particularly successful at achieving, is identification. Fundamentally, a rhetor’s goal is to get his audience to agree with him or her, and, in some cases, to act collectively to support a particular cause. To do this, the rhetor must compel their audience to identify, both with each other (to establish collectivity) and with the rhetor (which more favorably disposes the audience to the rhetor’s ideas). As Burke explains, identification is essentially as simple as a joining of interests: “A is not identical with his colleague, B.

But insofar as their interests are joined, A is identified with B. Or he may identify himself with B even when their interests are not joined, if he assumes that they are, or is persuaded to believe so” (Rhetoric 20; emphasis in original). As Burke avers, the link between identification and persuasion is vital to the very cohesiveness of society:

To identify A with B is to make A ‘consubstantial’ with B. [. . .] A doctrine of consubstantiality, either explicit or implicit, may be necessary to any way of life. For substance, in the old philosophies, was an act; and a way of life is an acting- together; and in acting together, men have common sensations, concepts, images, ideas, attitudes that make them consubstantial. (Rhetoric 21; emphasis in original)

Humans, thus, need to have a common set of interests and to be united in purpose for their societies to function properly. This is why, according to Burke, rhetoric is so

important to a society. Its value in uniting – or enabling identification – is central to facilitating the “acting-together” of societies, and thus to their cohesive function as a unified group.

As a consequence of this, occasions when rhetors attempt to unite a group behind a common cause, or for a common purpose, are especially amenable to Burkeian analysis.

As Gusfield writes, for Burke, “society is best studied” primarily by examining its rhetoric, or the “symbolic content of its culture.” Specifically, though, Gusfield maintains that “examining not only language in the narrow sense of conveying information but the ceremonies and rituals through which that common culture is created and perpetuated” is what can be most valuable to study (29). In other words, discrete, socially formative rhetorical moments (such as Clinton’s address) are those occasions that are especially useful for an analysis within a Burkeian framework.

Given the value and effectiveness Burke’s theories can have when used as critical tools in the realm of rhetoric, it is no surprise that there have been numerous analyses that use Burke as a central reference point. In their comprehensive Methods of Rhetorical

Criticism: A Twentieth-Century Perspective, Brock, Scott and Chesebro explain that they selected Burke’s Dramatistic approach as one of the few anthologized in their work, first of all, because it “has been widely accepted as a critical method.” As well, they add that

“his theories of identification, substance, form, transcendence, representative anecdote, and pentad have been explained and interpreted” in a variety of disciplines, including

“speech communication,” “oral interpretation,” and “argumentation,” among a myriad of others (174-175).

In the realm of political (and, specifically, presidential) rhetorical analysis,

Burkeian criticism abounds. Robert L. Ivie’s 1974 article, “Presidential Motives For

War,” is a prototypical example of this genre. As Ivie explains, his work is an analysis of

“the vocabulary of selected American Presidents to locate the images they project in justification of war. These images, or vocabularies of motives, span nearly 150 years”

(337). The reference to “vocabulary of motive” is a Burkeian one,3 and throughout the

analysis, Ivie heavily relies on Burke’s notions of rhetorical appeals, including his theory

of Dramatism as well as specific components of this theory, in particular terministic

screens and sacrificial scapegoats. The essay’s grounding in Burkeian thought serves as

an effective method to lay bare several reasons for the successes – and failures – of

American presidents’ attempts to persuade the public to support military action in a variety of circumstances. Much like Hitler’s rhetorical attempt to unite the citizenry behind him (although ostensibly with less misanthropic designs), these presidents were all attempting to garner support for their causes by delineating a specific version of

reality that embraced particular verbal patterns, the adoption of which was remarkably

effective at engendering a sense of identification in their audience, which in turn was

determinative of the public’s support of the policies advocated by these political leaders.

In many respects, the work of Kenneth Burke encompasses an overwhelming

universe of ideas, with enough tortuous digressions to lose even the most diligent and

3 The phrase “vocabulary of motives” has historically been used as an abstraction of Burke’s ideas. Gusfield notes that this usage at times derives from a section of Burke’s Permanence and Change entitled “Motives are Shorthand Terms for Situations,” where Burke explains that differing attributions of motive are tantamount to differing interpretations of reality, or, as Burke puts it, “differences in our ways of sizing up an objective situation are expressed subjectively as differences in our assignment of motive” (Gusfield 11; Permanence and Change, 35). In addition, Burke’s concept of the Pentad, which is another of his key ideas (though not the focus of this study), is built around the various ways human beings conceive and verbalize motives. 16

skilled reader. Though his work is expansive and nuanced, the richness and depth of his theories makes their study well worth the effort. As Malcolm Cowley writes:

Burke is one of the authors who write to be read twice. [. . .] A second reading is like a second journey through a recently discovered mountain pass; the trail is marked now and we no longer get lost in ravines that end at the base of a cliff. There are, it is true, a few sentences that have to be walked around like boulders in the path; but most of the second journey is easy and we make it with a sense of exhilaration, as if we had suddenly learned to be at home in a strange country. What Burke teaches us on the journey is how to interpret human experience [. . .]. (250-251)

This “strange country” that has puzzled and intrigued Burke’s followers over the years has proven to have tremendous value in providing a means not only to analyze and understand the diverse mechanisms by which rhetoric works to affect an audience, but also to uncover new and important dimensions of our own supposedly-familiar social world.

The Centrality of Rhetoric in Health Care and Health Policy

In the past few decades the middle and lower classes’ accelerating difficulty in obtaining health insurance, primarily caused by the spiraling cost of medical care, has made the government’s responsibility for the delivery of health care to its citizens a salient political issue. In the period from 1950 through 1987, for example, total personal health expenditures in the U.S. increased from $12.7 billion to $497 billion, an increase of 3 percent per-year faster than personal spending in all other sections of the economy combined (Davis et. al 162-163). This astronomical increase has occurred essentially in concert with the proliferation of private insurance companies; the health insurance industry has expanded over the same 37-year period from a $1 billion to a $154.7 billion

industry (Davis et. al 166).4 This entrenchment of these private for-profit companies as

purveyors of health insurance to the majority of the population has exacerbated the

difficulty of obtaining this insurance for many individuals; since these companies have no

mandate to provide insurance to their customers, they are essentially free to pass the

rising costs of health care on to those dependent on their services, which has made it

increasingly difficult for these individuals to pay for their coverage. By the time Clinton

made his speech, in fact, the number of uninsured individuals was up to about 41 million

people (Laham 218), with the prospect of further increases exceedingly likely.5

While both the health insurance companies and the companies that provide

medical care itself have a significant financial stake in the maintenance of the status quo,

American consumers have perhaps the most at stake in this system, as a significant

portion of their income is tied up in the industry. In addition, those who are insured are

on the receiving end of the actual benefits and risks of medical care and insurance, which

means that they, above all other interest groups, would be the ones most affected by any

systemic change. Overall, health care in general is a firmly established part of American

thought and politics, and any major change in the centrality of private for-profit insurance

in its delivery would require a significant shift in Americans’ attitudes toward the system,

which would correspondingly require a significantly motivating political force.

Importantly, though, Americans’ attitudes toward health care are profoundly

shaped by discourse practices. This being the case, the rhetoric of health care is greatly

4 While publicly financed coverage does – as it did in 1987 – exist in the form of Medicare and Medicaid, and consumes a significant portion of the federal budget ($515 billion in 2005 alone [Samuelson 51]), only the elderly, indigent, and disabled members of society are eligible for these government-sponsored health insurance programs, which means that the majority of citizens are, in essence, left to fend for themselves, and are thus potential customers of these private health insurance companies. 5 This prospect has indeed been borne out, as the ranks of the uninsured have continued to grow each year; in 2006 the number of uninsured U.S. citizens was 47 million – 16% of the population (Tanne 471). 18

deserving of attention and study, and in recent years has begun to receive it. Judy Z.

Segal’s 2005 Health and the Rhetoric of Medicine, for example, is a study of the ways

“rhetorical theory can be mobilized to increase understanding in the realm of health and medicine” (153). Segal firmly believes that rhetoric-as-persuasion exists within every dimension of the health care system: “Medicine,” she writes, “is not only rhetorical as it is reproduced in published texts; it is also rhetorical as a system of norms and values operating discursively in doctor-patient interviews, in conversations in hospital corridors, in public debate on health policy, and in the apparatus of disease classification” (3). Her consideration of these discursive realms as “rhetorical” is to her a function of their fundamentally contestable nature, and as such she asserts that a rhetorical analysis of each can lead to a greater understanding of the way we think and talk about health and health policy issues in general. Throughout her work, Segal effectively weaves together her own ideas with those of a variety of rhetorical theorists – including Kenneth Burke – as she crafts a cogent argument which illustrates the undeniable basic link between rhetoric and medicine.

In his investigation of “The ‘Business’ Metaphor in the Delivery of Human

Services,” Richard Melito argues that the fundamental differences underlying “business” and “service” organizations have become blurred by the discourse surrounding the delivery of health services.6 According to Melito, the emphasis on profit that has arisen

with the use of the “business metaphor” has essentially devalued the centrality of the

patient within the doctor-patient relationship. Instead of a doctor serving his or her

6 Though Melito primarily refers to organizations that provide mental health services, his argument could equally be applied to all fields of health care, as the crux of his argument rests on the idea that the “prime beneficiaries” of business organizations are their owners, while the prime beneficiaries of human service organizations are the patients – which means that both mental health and standard health providers could be considered under this latter category (44). 19

patients and community, there is an “entrepreneur” attempting to profit from his or her

“customers.” As Melito writes, “the ‘business’ metaphor embodies not only a certain way of thinking about a server and a client but also a particular prescription for how they should relate to each other” (46-47).7

Part of Melito’s argument is reminiscent of Kenneth Burke’s concept of terministic screens. Burke asserts, in Language as Symbolic Action, that language in fact

“selects” reality, and “the nature of our terms affect[s] the nature of our observations, in the sense that the terms direct the attention to one field rather than to another” (46; emphasis in original). Paralleling Burke’s argument, Melito writes that “any particular metaphor also channels and constrains one’s thinking in certain directions that preclude the seeing of other kinds of novel and potentially useful relationships” (50). Because of this, Melito continues, the pervasive use of the “business” metaphor has had (and continues to have) a tangible effect on medical policy and practice. Though he does not directly refer to Burke’s work in this section of his essay, his use of this logic – and thus, by virtue of the parallel, Burke’s logic – allows Melito to convincingly show how the continued use of the business metaphor can actually close off several ways of thinking

important to a balanced understanding of the issues which surround the delivery of

psychiatric care. Melito concludes that a pervasive perception of medical care through the

lens of the business metaphor can have manifestly negative results, including, among

other consequences, the legitimization of the exclusion of the poor from medical care,

and, as well, the exacerbation of the adversarial relationship between doctor and patient –

7 While I would argue that the term “client” is still a reflection of the business metaphor, and that a more appropriate term would be “patient,” the discipline for which Melito is writing (this article appeared in Psychiatric Quarterly) generally uses the term “clients” and not “patients,” so his lexical choice is understandable. In this essay, though, I use the term “patient” intentionally. 20

the former consequence being tantamount to sanctioned classism and the latter being a potentially formidable obstacle to quality care for all.

Similarly avoiding direct references to Kenneth Burke, though clearly echoing his ideas, is Ruth E. Malone in her article “Policy as Product: Morality and Metaphor in

Health Policy Discourse.” Malone’s underlying point is that

the words we use and the common ways we talk about what we do have a great deal to do with who we are and how we act toward others. Words, in this view, do not merely label things; they maintain and modify the kinds of common understandings that set up our possibilities for action in any particular situation. (16; emphasis mine)

Malone later elaborates on this idea, explaining that metaphors themselves “bring forth certain aspects of [. . .] experience” while “hiding or silencing others,” and that this selectivity fundamentally determines our actions and behavior toward others (17). These passages, then, clearly recall Burke’s notion that our language determines our perception of the world, and, furthermore, that our acts are limited by the linguistic and rhetorical boundaries imposed by this selective perception.

Malone argues, in addition, that there are particular dominant metaphors that determine our parameters of discourse and thought, which strongly resembles Burke’s claim, expressed in The Philosophy of Literary Form, that “every perspective requires a metaphor, implicit or explicit, for its organizational base” (152). As a representative example of one of these “organizational” metaphors, Malone uses Lakoff and Johnson’s illustrative metaphor “argument is war.” According to them, concepts such as “winning” and “losing” arguments, as well as conceiving the person with whom one is arguing as an

“opponent,” are both ways of thinking that are structured by this overarching metaphor, and cause a person to behave very differently than if they thought of an argument as, for

example, a “dance” – a formulation which would entail a very different set of behaviors

(Lakoff and Johnson 4-5).

Malone, unlike Melito, is primarily concerned not with local examples of rhetorical interaction, such as between doctor and patient, but rather with the broader realm of governmental health policy discourse. Specifically, she asserts that the “market” metaphor has become dominant in this realm, and that its widespread use has had deleterious effects on society’s “moral” perception of health care and health care insurance. The institution of for-profit health insurance has heightened the prevalence of this metaphor, effectively giving license to the view of patients as means-to-an-end, with the “end” being profit. As Malone sees it, this rhetorical dehumanization of patients

“leaves little space” in the realm of health care “for the kinds of actions that embody different values – for example, generosity, mercy, or solidarity.” Perhaps more importantly, the crystallization of the market metaphor within social discourse means that large-scale debates over health care allocation and availability are prone to be conducted using reductive supply-and-demand terminology: “Thus it seems more ‘obvious’ to us that the difficulties with health care have to do with scarce resources, the very basis of a market economy” (19). Overall, Malone argues that this line of thinking tends to foreclose changes to the system that begin from the premise that health care availability is a society-wide moral obligation (such as would be featured in many arguments in favor of universal health care), reinforcing, instead, the notion that profit should be a primary guiding motive.

* * * * *

In the years following Clinton’s spectacular campaign on behalf of his “Health

Security Act,” (and, some might say, his spectacular failure), several “autopsies” were performed, though many either focused on the various political machinations surrounding the event, or viewed the actions of the citizens who eventually turned against Clinton as a result of innate psychological forces. In “The Clintons and the Health Care Crisis:

Opportunity Lost, Promise Unfulfilled,” Rachel L. Holloway argues that Clinton’s target audience, the middle class, was turned off by his plan due to the popular perception that he advocated a “‘big government,’ liberal position that met the needs of the under class at

[their] expense” (176). Specifically, she writes, the rhetorical positioning of his speech, and of his subsequent campaign, did not do enough to convince the majority of the public

(i.e. the middle class) that they would see a tangible benefit from his plan. This left

Clinton open to counterattacks by his political opponents, who “skillful[ly] [. . .] took advantage of the weaknesses in the Clintons’ strategies through a well-planned and well- financed negative campaign and, in the end, won the day” (159-160). Holloway stresses that these “weaknesses” were directly linked to the self-centered nature of Clinton’s audience, as according to her the entire issue of health care was “personal and personalized from the start” (164). Holloway’s analysis throughout assumes that the determining factor in the persuasiveness of Clinton’s rhetoric was whether or not it could convince members of the middle class that his plan would benefit them personally. In this sense, her argument is based on the premise that human beings act primarily out of self- interest, and persuasion is thus largely a matter of appealing to this fundamental motivation. While this logic comes naturally for those whose discourse is

epistemologically structured by the “business” metaphor, I would argue that the very notion of self-interest as a primary criterion for decision-making, as well as the general acceptance of the business metaphor, are both, at the very least, contested, and that part of Clinton’s problem was that his rhetoric accepted the terms of this discursive framework, and was thus fatally vulnerable to attacks which operated within the constraints of this particular form of “terministic screen.”

One of the more thorough analyses of the failure of Clinton’s plan is Nicholas

Laham’s A Lost Cause: Bill Clinton’s Campaign for National Health Insurance. In it,

Laham initially argues that “the single, central, overriding obstacle which has consistently prevented the establishment of national health insurance is the health care industry’s strident, vociferous, and unwavering opposition to the program” (1). The

“politically powerful” insurance companies and medical industry in general, Laham asserts, have a rational pragmatic interest in opposing the program, since “national health insurance poses a threat to [their] financial interests” (2). To protect these interests, then, the industry contributes heavily to the campaigns of several members of Congress, who as a result are “financially beholden to the industry,” and would “take no major action which is opposed by medical interest groups” (52). Ultimately, though, Laham’s explanation for Clinton’s failure rests, much like Holloway’s does, with the citizens themselves. “Clinton,” he writes, “could have overcome opposition from the health care industry and business to his national health insurance plan, albeit with great difficulty, had he succeeded in mobilizing public support for his program” (211). Laham ascribes the president’s failure to persuade the public to their unwillingness to give up any of their current benefits: “Clinton’s health care reform initiative failed precisely because the

president could and would not convince middle-class, privately insured individuals to give up some of their medical benefits in order to gain health security that they currently lack” (217). Laham, then, like Holloway, is also skeptical of the public’s ability to put anything other than self-interest first, though Laham’s phrasing of this point is significantly more blunt:

The current health care system is exactly the kind of system the public wants: a system which provides those who have insurance access to the best and most abundant health care services in the world, while leaving 41 million individuals with little or no access to medical care. (218)

Both Holloway and Laham, like many others who have analyzed the failure of

Clinton’s initiative, incorporate a rhetorical analysis of both Clinton and his opponents into their overall explanations. Holloway in particular highlights the way Clinton’s

“discourse” was “turned [. . .] against him” by his opponents (173). Ultimately for these critics, however, the underlying cause lay not in Clinton’s discourse, nor in the rhetorical strategies of the opponents of his plan, but rather in the political maneuverings of congresspeople, and in the shallow self-interest of the American people. While I would definitely agree that self-interest did play a part in the public’s eventual rejection of the

Clinton plan, and that politics per se is a prominent and unavoidable factor in all legislative battles, I would argue against any explanation of this episode in history that did not fully take into account the far-reaching ramifications of the rhetorical dimension of the debate. In particular, I would assert that Clinton’s own rhetorical weaknesses, combined with the strengths of the rhetorical strategies of his opponents, played a pivotal role in the erosion of public support for Clinton’s proposal, and, thus, its legislative defeat. If, as Kenneth Burke has written, a primary feature of the human race is our essence as “symbol-using animals,” and these symbols intrinsically possess “overt and

covert modes of persuasion” (Language 5), then surely things like “self-interest” do not lie at the root of either our motivations or our existence. To follow Burke, the power of language to persuade is, essentially, at the center of everything, and thus is always a major factor in situations where interested parties attempt to exert their influence. And though there may be psychological or political reasons for a group’s action that are diagnosed after the fact, the power of language to shape the situation is a crucial factor in creating the conditions for this action, and thus is certainly worth a thorough investigation.

People? Or Profit?: The Reversal of Bill Clinton’s Proposal for Universal Health Care

The fundamentally rhetorical nature of the concept of health care means that both the manner of its function and the extent to which it is ingrained in the structure of

American society are contingent upon a discursive framework, which, though pervasive, is ultimately contestable. Though several of the seemingly-intrinsic features of the health care system, such as its for-profit nature, are entrenched in the minds of most Americans, these existential “facts” are far from immutable. The reason, then, for the dominance of this mode of health care delivery is the rhetorical dominance of a version of reality, which has, in Burkeian terms, been selected at the expense of other “deflected” versions.

Therefore, while the system is not inevitable, it seems that way to those within this reality; from “the inside,” observations as to the nature of the American health care system reflect a necessary state of things, and all the practices and exigencies concomitant to it seem both logical and necessary. However, to paraphrase Burke again, these observations are only implications of the particular terminology in terms of which they are made, meaning that the concrete “facts” rendered by these observations are only reflections of the very assumptions on which they are grounded (Language 44-46). Thus, when Bill Clinton was outlining his health care plan in his address to the nation, he was attempting to do more than just advocate a specific policy proposal; in delineating a new

version of the reality of health care, he was in fact endeavoring to change the entire

rhetorical paradigm within which the public conceives of this system.8

8 My use of the term “paradigm” is derived, in part, from Thomas Kuhn’s usage in The Structure of Scientific Revolutions. For Kuhn, a person’s worldview is inescapably determined by an externally- imposed conceptual structure of knowledge: “[S]omething like a paradigm is a prerequisite to perception itself. What a man sees depends both upon what he looks at and also upon what his previous visual- 27

The fact that a system of health care is rhetorically constructed also means that it is perpetuated by the same types of verbal “dramas” that Burke describes in his work.

Therefore, both Clinton’s speech and the rhetoric of his opponents (which was forcefully put forward in the myriad negative responses to Clinton’s speech in the days, weeks, and months following its delivery) are, first and foremost, “dramatic” verbal representations of competing realities. As such, within both of these dramas can be found two key

Burkeian elements: terministic screens, which constitute the rhetorical underpinnings of these realities, and designated scapegoats, which are fundamentally appealing components of all Burkeian dramas, and thus are vital to their compelling nature.

Underlying the differences between the dominant version of health care and the one Clinton proposed was a basic binary distinction: medical care, and thus medical care insurance, within the dominant paradigm was considered a product, while within the new paradigm would be a right. No more, under Clinton’s system, would health care be given only as the fulfillment of a contract with insurance companies who have no obligation to make their services available to those they deem unacceptable risks. Instead, Clinton’s health care plan, as he puts it, would “guarantee every American comprehensive health benefits that can never be taken away” (par. 88; emphasis mine).9 Within the framework

of “the Clinton plan,” insurance would still be offered, but under this plan no person

could be denied this coverage. In effect, medical care would no longer be governed strictly by the rule of the market, where the monetary exigencies of the business owners

conceptual experience has taught him to see” (113). Kuhn, like Burke, then, argues that every human being’s perception of reality (i.e., their “version” of reality) is profoundly shaped by extra-cognitive restraints. While for both theorists these restraints are primarily social and epistemic, for Burke they are more specifically rhetorical. 9 Throughout this essay, unless otherwise indicated, the citations for Clinton’s speech refer to the “as delivered” version. 28

or of the shareholders ultimately dictate policy, but rather would be conceived as an undeniable basic human right, closely associated, Clinton implies, with the three classic rights of American democracy: life, liberty, and the pursuit of happiness.10

To convince the public that the current system must be radically overhauled, then,

Clinton in his address attempted to disrupt this dominant perception of health care by

“dramatically” limning a new version of reality, in which health care would be seen, rather than as a commodity that could be purchased, as a fundamental right of American

citizenship. Central to Clinton’s effort to recast health care in this way within his drama is

his use of what could be called a humanitarian terministic screen. Essentially, this rhetorical screen is one that selects those aspects of social reality which most effectively

portray health care as a basic human right, and deflects aspects of reality that suggest

health care is a product. Comparing the right of health security – which, in his plan,

would be guaranteed – with those rights enshrined in the Constitution is one example of

Clinton’s use of this rhetorically selective screen. Another aspect of reality this verbal

screen highlights is the notion of the individual as a member of a collective. This

particular association was vital to Clinton’s message; by highlighting collectivity Clinton

promoted in his audience members the sense that they were a part of a unified

community, and as such had a responsibility to ensure not just their own welfare, but the

welfare of everyone belonging to this community. As will be demonstrated, it is this

sense of unity that Clinton’s opponents eventually break down in the aftermath of his

address by rhetorically reasserting the dominance of the preexisting paradigm.

10 In the second paragraph of his address, Clinton asserts that “tonight we come together to write a new chapter in the American story.” In this way he suggests that, as each previous generation has worked to “strengthen the legacy” of “the American Dream – life, liberty, and the pursuit of happiness,” so does his audience have a chance to do the same for their generation. Enacting his health care plan, then, is the way to do this, as it would build on these quintessential rights by enshrining a new right of its own. 29

This existing paradigm, naturally, was centered around the notion that health care is an economic issue, not a humanitarian one. As Malone and Melito’s work has since demonstrated, the ascendancy of this way of thinking, which makes use of what could be called an economic terministic screen, has, following the failure of Clinton’s plan, continued to exert a powerfully formative influence on the conception of health care in this country, casting health care itself as a “product,” and health care delivery as a

“business.” At the moment Clinton delivers his speech, then, the reality supported by this economic screen was completely dominant, and thus the drama espoused by Clinton’s opponents was in effect a reaffirmation of it. Overall, it is the repetition of this

“oppositional drama,” which harnesses the power not only of this economic screen, but also of designated scapegoats, that is the primary means by which Clinton’s opponents attempted to undermine the unified support for Clinton’s own drama.

A rhetor’s unification of an audience, Burke asserts, is achieved by instilling in them a sense of identification, both with the goals of the rhetor and with each other. In fact, Burke argues that this goal of identification is central to rhetoric in general. As he puts it, “Rhetoric [. . .] is rooted in an essential function of language itself,” which is “the use of language as a symbolic means of inducing cooperation in beings that by nature respond to symbols” (Rhetoric 43). For Clinton’s speech, then, as for all rhetoric, its persuasive efficacy was contingent upon the degree to which he could get his audience to identify, both with him and with the other members of his audience (Clinton’s audience, of course, comprised the majority of the American public). The fact that Clinton’s drama involves the foregrounding of the humanitarian terministic screen, then, works in his favor, since the notions of collectivity that are emphasized by the use of this screen

engender a sense of unity that, as Burke argues, a rhetor needs to create to motivate an audience to action.

In the end, of course, Clinton’s attempt at massive change, inaugurated by this grand rhetorical effort, fell short. On a fundamental level, though, Clinton’s failure to effect a lasting unity, and to thus permanently instill a new (rhetorical) perception of reality, was in fact a direct function of his failure to be consistent within his own rhetoric.

Although the force of Clinton’s argument derives from his use of the humanitarian terministic screen, and, as well, the drama he attempted to create depends on this screen for its cohesion, for much of his address he made nearly-exclusive use of the economic terministic screen. Examined with the benefit of hindsight, it is clear that there was a defined subtext in Clinton’s speech that actually adopts the argument (and, therefore, the drama) of his opponents. In other words, by relying so heavily on the economic screen,

Clinton suggested the point, which is the foundation of all of the arguments against his plan (and thus is the generative principle of the drama of his opponents), that all policy proposals, in the end, must be evaluated in economic terms. The presence of this semi- implicit conclusion, underscored on several occasions in the later sections of his address, meant that the merit and persuasiveness of the reformulation of health care as a human right was ultimately subordinated in Clinton’s speech to arguments which addressed the economic viability of the plan. This turned out to be a catastrophic miscalculation by

Clinton, who perhaps thought that he was anticipating his opponents’ arguments by making them himself in his address. Instead of preempting these types of objections, however, Clinton gave his opponents more ammunition, and as well ceded valuable time in his address to issues that actually undermined the coherence – and the cogency – of the

reality he was trying to portray. It is a curious paradox, then, that though the institution of his version of reality would have entailed a major rhetorical de-emphasizing of these economic aspects of health care, Clinton insisted on keeping much of his speech grounded in these terms. This strategic decision, in fact, left Clinton especially vulnerable to accusations, grounded in the preexisting paradigm of reality, that his plan would “cost too much,” as well as to disparaging characterizations of his plan as a step away from economic efficiency (which, in the drama of his opponents, is a paramount goal). In short, though Clinton attempted to define a new rhetorical paradigm in his address, his own rhetoric failed, ultimately, to break out of the old one.

Making the Case

Immediately in his speech, Clinton foregrounds the historical importance of the occasion:

My fellow Americans, tonight we come together to write a new chapter in the American story. Our forebears enshrined the American Dream – life, liberty, the pursuit of happiness. Every generation of Americans has worked to strengthen that legacy, to make our country a place of freedom and opportunity, a place where people who work hard can rise to their full potential, a place where their children can have a better future. (par. 2)

This emphasis on the momentous historic nature of the occasion is crucial to the establishment of Clinton’s drama, and, as well, is an example of Clinton’s use of the humanitarian terministic screen; by juxtaposing his health care plan with the rights enshrined in the Declaration of Independence – and, later, by invoking other examples of what he portrays as the steady march of human progress – Clinton selects the aspects of his health care plan that most convincingly portray it as yet another noble and important step in this progress of rights. Notably, this portrayal of health care’s grand historic

significance displaces the more mundane aspects of the plan, such as its cost- effectiveness, which played such a prominent role in the drama of Clinton’s opponents.

In other words, by constructing his argument around the notion that his plan’s guarantee of health care is in fact a guarantee of a fundamental human right equivalent with those guaranteed by the Declaration of Independence, Clinton centers the debate around the notion of rights in general. This rhetorical strategy subordinates any discussions of his plan that center on economics, since the essence of the concept of “human rights” is such that they transcend more mundane cost concerns. Indeed, if Clinton’s goal is to forestall economic arguments, focusing his discourse on the question of rights is a wise strategy; now, if his opponents attempt to introduce such monetary issues into the debate, they would be pursuing a politically unpopular line of reasoning: attempting to put a price on that which is comparable to life, liberty, and the pursuit of happiness.

Throughout his speech Clinton continues to reinforce this elevation of his proposal to the status of a transcendent (i.e., human rights-centered) historical issue by explicitly drawing parallels to several well-known formative social moments in America and beyond, including the crumbling of the Berlin wall and the end of Apartheid (par.

89). At one point Clinton vividly outlines the plight of average citizens in America before the enactment of Social Security, in an attempt to associate his health care plan with this popular social program:

And now, it is our turn to strike a blow for freedom in this country. The freedom of Americans to live without fear that their own nation’s health care system won’t be there for them when they need it. It’s hard to believe that there was once a time in this century when that kind of fear gripped old age. When retirement was nearly synonymous with poverty, and older Americans died in the street. That’s unthinkable today, because over a half a [sic] century ago Americans had the courage to change – to create a Social Security system that ensures that no Americans will be forgotten in their later years. (par. 90)

The direct comparison to Franklin Roosevelt’s enactment of a bill guaranteeing post- retirement income for all Americans, which prevents “older Americans” from dying “in the street,” is dually beneficial to Clinton’s cause. First, it has the obvious effect of foregrounding the humanitarian aspects of the plan, since his plan would ostensibly prevent tragedies akin to those prevented by Social Security. In addition, though, this comparison emphasizes the notion that Americans should come together as a collective community to protect their more vulnerable members. This latter function is a key to his speech, since these notions of collectivity foster his audience’s identification with their fellow citizens, and thus create the unity so vital to Clinton’s cause.

Overall, Clinton’s comparison of his health care proposal with well-known historical achievements that have advanced the cause of human rights is a deft wielding of the humanitarian terministic screen. The net effect of this use is the reinforcement of the notion that health care should be considered, not as a worldly “product,” but rather as a right, and, thus, that the passage of Clinton’s Health Security Act would be an achievement in human progress itself. Clinton’s final lines are an almost hyperbolic extension of this notion, but perfectly epitomize the tone and the central message of his address; imploring his audience to seize the moment, and, correspondingly, to embrace his drama fully, Clinton proclaims: “This is our chance. This is our journey. And when our work is done, we will know that we have answered the call of history and met the challenge of our time” (par 92). Thus, for Clinton, his drama played out on a grand scale.

This was appropriate, though, since his aims – displacing the existing rhetorical paradigm of health care – were similarly broad. Part of the strength of Clinton’s appeal, then, was its majestic aspirations, and his focusing on human rights in these sections of his speech

was a direct result of the claim these concerns were somehow above those of economics.

This is why, in later sections of his speech, when Clinton lowers the plane of the debate to discussions of mundane economic specifics, he is actually counteracting these powerful aspects of his own rhetoric made clear early on in his address.

Organized via six categories, each section of Clinton’s address is labeled with a different “keyword” that speaks to a different strength of his plan. The accessible nature of the structure made Clinton’s appeal easily reducible for the public, as the six keywords succinctly sum up the six major sections of the speech, and, as well, each encapsulate a different persuasive point. These six “guiding stars” that Clinton asks his audience to

“follow on our journey toward health care reform” were crucial to the armature of his persuasive appeal (par. 82). By dividing the different aspects of his appeal so clearly, though, Clinton exacerbated the dichotomous nature of his address, since some of these individual principles explicitly foreground economic concerns. In other words, by dividing his address via these six categories, Clinton elevated the apparent importance of each one. By giving “savings,” for example, its own separate, and therefore memorable, category, Clinton made it easy for his opponents to zero in on this aspect of his speech; the discreteness of the categories, in other words, not only lent each individually- emphasized concept more importance, it made them easy targets.

The principle Clinton addresses first, which he refers to as the “most important” of the six, is “security,” which he avers “speaks to the human misery [. . .] we hear about every day – all of us – when people talk about their problems with the current system”

(par. 25). The notion that Clinton’s plan would guarantee Americans health care under all circumstances is the persuasive backbone of his speech, and, accordingly, most directly

invokes the concept of health care as a human right. Clinton’s language in this section consistently revolves around stories of hardship, and his descriptions of the plan here are inspiringly declarative; Clinton triumphantly states that “security means that those who do not now have health care coverage will have it; and for those who have it, it will never be taken away” (par. 25). His appeals here as well are especially colorful; in one passage he adroitly utilizes a specific pattern of repetition – epiphora – to illustrate the absolute guarantee of coverage his new “health care security card” would ensure:

With this card, if you lose your job or you switch jobs, you’re covered. If you leave your job to start a small business, you’re covered. If you’re an early retiree, you’re covered. If someone in your family has, unfortunately, had an illness that qualifies as a preexisting condition, you’re still covered. If you get sick or a member of your family gets sick, even if it’s a life threatening illness, you’re covered. And if an insurance company tries to drop you for any reason, you will still be covered, because that will be illegal. (par. 28)

Clinton’s disruption of the epiphora at the end of this sequence puts added lyrical stress on this last phrase; the rhetorical effect is such that a listener begins to swing along with the repetition at the end of his sentences, and this final disruption brings the harmony of the lines to a dead stop, aurally and conceptually reinforcing the incompatibility of any attempt by an insurance company to “drop you for any reason.” The point underscored by this poetic rhetorical construction is that Clinton’s plan would mandate the provision of health care, and this guarantee of “security” would thus put an end to the misery caused by the denial of this fundamental human right.

The opening section of Clinton’s oration, which is encompassed by the principle of “security,” is largely free from overt references to either the economics of his plan or any economic rationales for its implementation. Clinton does briefly allude to the fact that his plan wouldn’t require the enactment of “new broad-based taxes” (par. 19), and

makes a few brief references to other monetary concerns, but the primary emphasis of his rhetoric in this section avoids getting bogged down in any economic specifics.

It is not until Clinton gets to his second principle that more salient economic rationales begin creeping in. This next principle – “simplicity” – begins as a concept similar to security, in that its terminology is largely derived from the use of the humanitarian terministic screen. This rhetorical focus directs the audience’s attention to the individuals in Clinton’s drama who would most benefit from the plan’s implementation, thus emphasizing a fundamentally humanistic view of health care.

Clinton decries the unnecessary “paperwork” and “bureaucracy” that are impeding the efficiency of the current health care system, relating, as an illustrative example, the story of Lillian Beard: “A pediatrician, who said that she didn’t get into her profession to spend hours and hours – some doctors up to 25 hours a week [–] just filling out forms. She told us she became a doctor to keep children well and to help save those who got sick. We can relieve people like her of this burden” (par. 38). Focusing on the human element of this

“burden” and relating how needless paperwork acts as a drain on those who work in the health care industry keeps the rhetorical focus on the current system’s cold, inhuman nature, and reinforces the fact that Clinton’s new system would be greatly beneficial to the human actors in his drama – both those who work in the field, and, as well, the patients.

Immediately following the story of Lillian Beard, however, Clinton makes reference to the “administrators” who “told us they spend $2 million a year in one hospital filling out forms” (par. 38). By itself, this detail, which quantifies the problem instead of humanizing it, is not overly significant. However, this redirection of Clinton’s

rhetorical focus sets up the remainder of this section, in which he portrays “simplicity” as a fundamentally economic issue. In fact, at the end of the section, Clinton directs the attention of the audience away from the humanitarian aspects of this principle, and toward economic ones, stating: “I think we can save money in this system if we simplify it” (par. 39).

Again, standing alone, these references to economic justifications for his plan, which conclude Clinton’s second section, are not overly significant. However, in context, they are significant, since, in effect, they are the lead-in to Clinton’s third principle:

“savings.” This principle is far and away the most prominent one in the speech, despite the fact that it is positioned in the middle of it, and as well is in competition with

Clinton’s “most important” principle of “security.” However, from this point in the speech on, Clinton’s focus swings drastically toward economics, and though he often refers back to his supposedly-overriding concern for the security of health care access – i.e., those issues which make the most use of the humanitarian screen – the weight that is given to economic considerations in these later sections, purely by virtue of their frequent reoccurrence, is enough to severely undermine what until this point had been the primary unifying force in Clinton’s argument.

Clinton begins his section on savings by, in effect, redefining the problem with the current health care system in America:

Rampant medical inflation is eating away at our wages, our savings, our investment capital, our ability to create new jobs in the private sector and this public Treasury. [. . .] [W]e passed a budget which has Medicaid increases of between 16 and 11 percent a year over the next five years [. . .] in an environment where we assume inflation will be at 4 percent or less. We cannot continue to do this. Our competitiveness, our whole economy, the integrity of the way the government works and, ultimately, our living standards

depend upon our ability to achieve savings without harming the quality of health care. (pars. 42-43)

According to Clinton’s characterization of the situation in this section, the need for health security is not the primary reason he thinks his bill should be passed, but rather the need to enact a plan based on its economic viability is. Not the “human misery” created by the current system, but instead America’s “severe disadvantage” in “global competition” that is a result of the excessive cost of the current system is portrayed as the most severe and immediate threat posed by a failure to act to reform health care (par. 18). Throughout this entire section, in fact, Clinton cites a variety of monetary justifications for change, including the “$655 in income each year” that American workers would be losing “by the end of the decade” under the current system (par. 44), and the disproportionately high health care premiums currently paid by small businesses (par. 45).

Even at times, throughout the later sections, when Clinton references the benefits of his plan that revolve around humanitarian concerns, he often muddies the rhetorical waters by simultaneously asserting the importance of the plan’s financial benefits.

Sometimes this coincident use of the humanitarian screen and the economic screen even occurs in the same sentence; in one instance toward the end of the section on “savings,” for example, Clinton declares: “So I believe we can achieve large savings. And that large savings can be used to cover the unemployed uninsured, and will be used for people who realize those savings in the private sector to increase their ability to invest and grow”

(par. 51). Here, the humanitarian screen surfaces only briefly, and the relative dominance of economic terminology clearly privileges these types of justifications for his plan. In other words, while covering the “unemployed uninsured” is in fact a significant feature of his plan, and figures largely in the section on “security,” in this passage this concept

appears to be thrown in as an afterthought, not even meriting its own separate sentence.

Phrases in the passage that derive from the economic terministic screen such as “private sector” and “ability to invest and grow,” on the other hand, effectively reposition

Clinton’s humanitarian argument as one that is ultimately grounded in economics.

The later sections of Clinton’s argument – which deal with “choice,” “quality,” and “responsibility” – also foreground the economic benefits of Clinton’s proposed system. Both “choice” and “quality” are directly tied in with the free-market aspect of

Clinton’s plan; at one point during these sections, Clinton declares that his plan “will create report cards on health plans, so that consumers can choose the highest quality health care providers and reward them with their business” (par. 60). This line of thinking, where a “consumer” is “free” to choose amongst competing businesses who would provide health care as a service, is in fact a feature straight out of the preexisting system, and does little to advance the notion – central to the persuasive power of

Clinton’s speech – that his new version of health care reality would be substantially different from the old. In addition, in foregrounding these similarities to the preexisting system Clinton also foregrounds the economic screen, which makes it more difficult for his audience to associate his plan with the humanistic ideals Clinton claims are central to the need for its existence.

In most of Clinton’s lengthy final section he seems intent on proving that his plan would be economically feasible, and almost entirely turns his rhetorical attention to backing up this assertion. Though he eventually returns to humanitarian issues in his last few paragraphs, in the ones preceding Clinton laboriously expounds a series of dense economic arguments. Ostensibly, this section serves as a thorough explanation of the

specifics of his plan, but, in his effort to explain how “we can pay for this package” (par.

74), Clinton’s language becomes confusing and convoluted. Almost every new paragraph here references the painful specifics of the plan, with the overall emphasis being on what every sort of average American would have to pay. Often, these explanations are dizzying themselves in their complexity, and on the surface can even appear contradictory:

Now, what does this mean to an individual American citizen? Some will be asked to pay more. If you’re an employer and you aren’t insuring your workers at all, you’ll have to pay more. But if you’re a small business with fewer than 50 employees, you’ll get a subsidy. If you’re a firm that provides only very limited coverage, you many have to pay more. But some firms will pay the same or less for more coverage. (par. 77)

In this convoluted passage, Clinton’s painstaking explanation of who would pay what, and in what situation this could change, completely ignores the larger humanitarian picture – and the more persuasive argumentative focus – in favor of the types of details that encourage his audience to turn their attention to their existence as isolated, self- reliant individuals. This is a perfect illustration of Burke’s description of the effects of terministic screens, which, as he writes, “deflect the attention” to certain fields. It is quite possible, at this point in Clinton’s speech, that his audience had completely forgotten about the overarching collective benefits of Clinton’s plan, or the idea that this plan, as the guarantee of a human right, would be a forward step in human – and American – progress. Instead, Clinton’s audience, because of his own embrace here of the economic terministic screen, was likely trying to figure out what they, themselves, would have to pay if his plan were to be implemented.

Overall, when Clinton discusses, as he does repeatedly throughout this section, how he plans to pay for his plan, or how much money would be saved by its

implementation, or what else could be accomplished with the money saved under his plan, he is essentially dictating that his drama revolve around economics, which significantly undercuts his earlier use of the humanitarian screen. This is because, when health care debate is about those who are suffering under the current system, cost issues tend to seem secondary – most people, after all, would not deny life-saving care to a person simply because that person is indigent, and would cost the system too much money; doing so would contradict basic morality. However, when Clinton makes the debate about the economic benefits potentially gained from the implementation of his new system of health care, he obfuscates the centrality of these moral imperatives, and thus diminishes the efficacy of his foregrounding them. Perhaps for this very reason, in their responses to his address, Clinton’s opponents refused to deal with these moral issues altogether; consistently in the weeks and months following Clinton’s initial speech these opponents wisely picked their battles in order to avoid shifting the discussion onto the grounds where Clinton had the strongest rhetorical advantage. This tactic, though, was in fact facilitated by Clinton’s own dilution of his primary message; by wavering in his rhetorical focus throughout his speech, Clinton failed in his attempt to define this issue in such a way that was most beneficial to his persuasive aims, and thus opened the door himself to his opponents’ rhetorical strategies.

This, then, was perhaps an even greater negative consequence of the contradictory nature of Clinton’s rhetoric in these later sections: that because of the inconsistency of his discursive focus, Clinton did not sufficiently establish a new rhetorical paradigm, and thus could not prevent the terms of the ensuing debate from reflecting the preexisting one. Clinton’s opponents, faced with the choice of whether to debate Clinton on the

humanistic and moral grounds he lays out in the beginning of his speech – grounds, of course, which were distinctly alien to their own drama – or, to take up the themes expounded in these economically-centered sections, where Clinton’s own focus was on the costs of the plan, consistently chose the latter course.

The use of the economic terministic screen, then, was fundamentally inimical to the central theme of Clinton’s drama, which is based on the idea that his “Health Security

Act” was necessary because it provided just that: security of coverage. In deviating from the terms in which his drama is most effectively presented, then, Clinton allowed the oppositional drama, which revolves around individualized economic concerns, to dominate. When Rachel Holloway writes that the health care debate Clinton began was

“personal and personalized from the start”(164), she is indeed correct. Ultimately, though, this personalization was not the result of unavoidable issues intrinsic to the debate, but rather was a function of the foundation that Clinton himself laid. When

Americans, in town hall meetings following the speech, asked “how the president’s plan would help individual situations” (Holloway 170), and when insurance companies later ran television ads which emphasized that the plan was confusing or inadequate,11 it was

Clinton’s own framework that they were using for their discussions and critiques. If

Clinton had followed through on the original trajectory of his argument by continuing to stress that the reasons to support his plan transcended economic concerns, and that health

care was, above all, a human right, and that the “human misery” of the victims of the

current system constituted the primary impetus for change, then perhaps the counter-

11 The television advertisements known as the “Harry and Louise” ads, which were financed by the Health Insurance Association of America (HIAA) were the most famous of these. One of these shows the young couple sitting at breakfast, worrying about the specifics of Clinton’s plan. At the end of their discussion, in which Louise becomes visibly agitated, she defiantly exclaims: “‘There’s got to be a better way’” (Kolbert A1). 43

arguments, and as well the general discussions which surrounded this issue, would have picked up on that framework. At the very least, opponents would have had a significantly more difficult time arguing from an economic standpoint, or introducing economic concerns into the discussion, had this economic framework not been introduced explicitly by Clinton in his initial presentation of his plan to the nation.

* * * * *

Besides terministic screens, the other key component of Burkeian dramas salient within Clinton’s address is designated scapegoats. Scapegoats, ultimately, are the means by which society – or, an audience – is able to deal with the existence of victims. As

Burke asserts, “the principle of victimage is implicit in the nature of drama” (Language

18), and, within a drama, the effect of the invocation of these victims is to produce a sense of collective guilt in the audience, which correspondingly results in their desire for a scapegoat. In Clinton’s case, he didn’t have to look far to find vivid examples of suffering victims, and by highlighting these tragic stories he foregrounded the audience’s complicity with the health care system that produced these victims (and, he implies, was continuing to do so at an alarming rate). Clinton thus causally links his audience’s indifference to the suffering of these victims, urging his audience that they “can no longer afford to continue to ignore what is wrong” (par. 16).

In other words, to follow Burkeian logic, when Clinton invoked these powerful images of suffering, he created in his audience the desire to unburden themselves of their own guilt. This, of course, is where the scapegoats come in. Scapegoats are, as Burke

refers to them, “chosen vessels” of society’s guilt, and when Clinton implies that his scapegoats are to blame for the suffering of the victims, he creates a situation where the destruction (or, to Burke, “sacrificing”) of these scapegoats would allow the audience to fully expiate their own guilt, since, in effect, destroying the scapegoats also would destroy the root cause of the ills of the health care system, and thus would let the audience off the hook for their own complicity.

For Burke, this entire process is rhetorically represented within the dramas rhetors create, and can be broken down into several steps. Briefly, the audience is: (1) reminded of a problem within their social world, (2) led to feel an overriding sense of guilt as a result of their own (direct or indirect) responsibility for the problem, (3) presented with a designated scapegoat – or “chosen vessel” – into which they can deposit this guilt, and, finally, (4) guided to “transcendence” via the destruction (ritual or actual) of this scapegoat. Burke, in The Philosophy of Literary Form, metaphorically describes this dramatic arc as the transformation of a “chord” (several notes played simultaneously) into an “arpeggio” (the same notes, played sequentially):

Now if one introduces into a chord a note alien to the perfect harmony, the result is a discord. But if you stretch out this same chord into an arpeggio having the same components, the discordant ingredient you have introduced may become but a “passing note.” “Transcendence” is the solving of the logical problem by stretching it out into a narrative arpeggio, whereby a conflicting element can be introduced as a “passing note,” hence not felt as “discord.” (99-100)

Burke’s artful description makes clear the efficacious process by which a rhetor can verbally transform a social problem into a structured narrative. By extracting the elements of a given societal issue, and re-presenting them in an ordered dramatic fashion, a rhetor’s speech can exert a tremendous persuasive appeal on an audience. This is because, by clearly demarking the path by which an audience can transcend what had

seemed an insurmountable problem, this transcendence will, to the audience, seem completely attainable, as long as they follow this path proposed by the rhetor.

Within Clinton’s drama, the “discordant ingredient” in the American health care system was the egregious lack of the “security” of health insurance coverage, a situation that left most Americans bereft of assured access to medical care. Clinton vividly portrays this problem in his speech, and his graphic depictions of the victims only added to the power of his scapegoats to represent the evils of the system in existence, since, the more distasteful the problem was, the more the audience would want to transfer the blame to these external “vessels.” The path to “transcendence” Clinton lays out in his

“narrative arpeggio,” then, was fundamentally dependent on the destruction of these designated scapegoats, which, for Clinton, are the insurance and drug companies. These are the companies who, as he asserts, “profit from the current system” (par. 62), and were thus benefitting from the very misery of the victims this system produces.

For Clinton, effectively creating these scapegoats required only that he highlight the various ways these companies “profit” from the system – a system which of course was based on the concept of profit in the first place. Since, as was the norm for private- sector corporations, these institutions made decisions based on their own potential for financial gain, and not on the welfare of the people they serve, all Clinton had to do in his speech was point out this fact, and these companies would be “exposed” to the audience as evil and heartless. In this way, Clinton’s designation of scapegoats in his drama was logical and natural; since these companies essentially turn a blind eye to the misery endemic to the system in which they make a profit, they, as well as the system in which they operate, are natural targets to blame for this misery. Significantly, though, while

Clinton does a good job rhetorically emphasizing the flawed nature of this system, he makes sure to concentrate the blame on these avaricious insurance and drug companies themselves, who become embodied “vessels” of all accountability. The system itself, though implicated throughout Clinton’s speech as one in which dire consequences are endemic, is represented as essentially correctible; despite his condemnations, Clinton’s characterizations of the system ultimately revolve around the notion not that his plan would destroy this system, but rather that his plan would “fix” what had been wrong with it (par. 5).

It is the companies alone, then, who are subject to the enmity of his audience – in short, who become perfect scapegoats. “Insurance companies,” Clinton proclaims in his speech, enumerating a laundry list of injustices perpetrated by these entities, “should no longer be allowed to cast people aside when they get sick. [. . .] drug companies should no longer charge three times more per [sic] prescription drugs made in America here in the United States [sic] than they charge for the same drugs overseas” (par. 62). Pervading the system, he grandiloquently states, is “too much fraud and too much greed” (par. 6).

Throughout Clinton’s address, then, he makes it clear that a system based on profit will ultimately put profit before the welfare of those it serves, but, that it is the companies who operate within such a system that are the embodied agents of its malignity, and, thus, who must be destroyed.

By powerfully invoking the scope and severity of the suffering of the victims of these companies, Clinton sharpens his depiction of this aspect of his drama, ensuring that both his audience’s sense of guilt, and their corresponding desire for the destruction of his scapegoats, is sufficiently incited. Here Clinton’s talent as a storyteller emerges, as he

evocatively describes the burdens imposed on those without access to health insurance, assuring his audience that these stories speak “for millions of others” (par. 15).

Clinton begins by mentioning that his “Task Force,” along with the First Lady (to whom he has given partial control of the plan), had received “over 700,000 letters from ordinary citizens,” assumably detailing the hardships they had endured under the current system. Clinton goes into detail about one of these “ordinary citizens,” telling the story of

Kerry Kennedy, who, “like most small business owners, [had] poured his heart and soul, his sweat and blood into [his] business for years.” Kennedy, though, was recently told by his insurance company that “two of his workers had become high risks because of their advanced age.” Clinton then dramatically reveals that “the problem” is “that those two people were [Kennedy’s] mother and father, the people who founded the business and still worked in the store” (pars. 12-14). This revelation, withheld until the end of the story in order to produce the greatest degree of emotional response in his audience, evokes not only an increased sense of anger, but also a sense of shame: since the Kennedys were

“like most small business owners,” they were thus part of the same collective community as the audience, and because of the audience’s aforementioned failure to act, had effectively been abandoned by them. In this case, the notion of collectivity that is invoked by Clinton’s language has the twofold effect of both unifying his audience and evoking their guilt at turning a blind eye to the suffering of one of their own.

Establishing insurance companies as scapegoats, which Clinton does effectively throughout his speech by inserting, every so often, language that refers to their “greed”

(par. 6), or their tendency to “drop” people for financial reasons (such as having a preexisting condition) (par. 28), makes his entire appeal more persuasive, as his repeated

graphic depictions of sympathetic victims increases his audience’s guilt, which then increases their desire for the expiation of this guilt, and, thus, makes the opportunity to achieve this via the destruction of these scapegoats that much more inviting. In his peroration, Clinton directly targets this fundamental appeal of expiation, forcefully invoking the specter of victimage, and, correspondingly, further stoking feelings of guilt in his audience:

I ask you to remember the kind of people I met over the last year and a half – the elderly couple in New Hampshire that broke down and cried because of their shame at having an empty refrigerator to pay for their drugs; a woman who lost a $50,000-job that she used to support her six children because her youngest child was so ill that she couldn’t keep health insurance, and the only way to get care for the child was to get public assistance; a young couple that had a sick child and could only get insurance from one of the parents’ employers that was a nonprofit corporation with 20 employees, and so they had to face the question of whether to let this poor person with a sick child go or raise the premiums of every employee in the firm by $200. And on and on and on. (par. 86)

In addition to powerfully evoking his audience’s guilt, this foregrounding of the human element of his drama is Clinton’s use of the humanitarian terministic screen par excellence, and in passages like these, Clinton’s message has a twofold effect. First, his vivid illustration of these victims, such as the “elderly couple” who break down in

“shame” because of their empty refrigerator, or the woman who gives up her livelihood so that her ill youngest child could receive care, evokes maximum sympathy – and maximum guilt – from his audience. As well, though, this emphasis reinforces Clinton’s assertion that health care is a right, since the notion of human rights in general is closely associated with the prevention of human suffering. In other words, by powerfully invoking, through use of the humanitarian screen, the suffering pervasive in the preexisting paradigm of health care, Clinton is able to simultaneously make his case for the status of health care as a right, and as well intensify his audience’s identification, by

uniting them in their desire to expiate their guilt via his designated scapegoats. Both of these elements, ultimately, are vital to the appeal of the drama he creates.

By carefully setting up his scapegoats within his speech, and by successfully invoking the guilt of his audience through his dramatic portrayals of the victims of the health care system, Clinton made the destruction of these designated scapegoats vital to the efficacy of his address. With the destruction of these scapegoated insurance companies, in whom Clinton deposited all of the blame for the ills of the health care system, his audience could experience catharsis, or, as Burke would call it, “vicarious atonement” for the guilt caused by their collective transgression of fundamental moral codes (denying people care when they’re sick, or forcing them to choose between food and medical care, after all, clearly goes against basic social mores, and by ignoring the insurance and drug companies’ commission of these acts, the audience was just as guilty as were the companies). Passing his Health Security Act, then, became one note in the larger “arpeggio” – one step toward transcendence, and, because of this, the destruction of these scapegoats, in particular, was an important step in Clinton’s drama.

This dramatic progression set up in Clinton’s address, though, had one significant problem: health insurance under Clinton’s plan would actually continue to be administered by these same scapegoated companies. While Clinton didn’t explicitly use the term “insurance companies,” and instead referred to them as “plans,” it is obvious in his speech that he still would rely on their significant participation. “We want to let market forces enable plans to compete,” he explains, “we want to force these plans to compete on the basis of price and quality, not simply to allow them to continue making money by turning people away who are sick or old” (par. 46). While Clinton attempted to

claim that the sort of managed competition he had planned would significantly mitigate the worst of these companies’ business practices, the fact that his proposal still would rely on these entities – no matter what restrictions they would operate under – fundamentally and undeniably undermined the strength of his appeal, since, as the possibility of transcendence (enabled by the expiation of guilt) for his audience was contingent upon the destruction of these scapegoats, the fact that they would not be destroyed, in essence, invalidated the keystone of his entire drama.

This consequence is extremely important to the ultimate failure of Clinton’s proposal, and it brings us back to his failure to effectively distance himself from the economic realm, and his resultant vulnerability to opponents’ attacks made in these terms. In short, Clinton was unwilling to embrace fully what should have been a completely new rhetorical paradigm of health care. It was the profit-motivation that

Clinton implied had produced the evils of the existing system, yet it was this same profit- motivation that he failed to banish from his new plan, and every time he mentioned these

“plans” (which he did typically in terms filtered by the economic screen) this inherent contradiction was evident, and, thus, his rhetorical efficacy was diminished.

Exacerbating Clinton’s adoption of the economic terministic screen, which had the unfortunate effect of emphasizing the dramatic framework of his opponents, was

Clinton’s occasional adoption of the scapegoats of his opponents. As this oppositional designation of scapegoats, which will be discussed in detail in the following chapter, was bound up with the economic conception of health care, when Clinton himself delved into this rhetorical territory, he, perhaps unintentionally, wound up putting some of the blame on the same group of people as did his opponents – the victims. Taken out of the context

of Clinton’s speech, this notion, that Clinton would make scapegoats out of the very group his health care plan purported to help – and whose benefitting constituted the basis of his most effective persuasive argument – seems highly improbable. In the context of

Clinton’s liberal use of the economic terministic screen, however, and perhaps as proof of the guiding power of the terminology in which rhetors base their arguments, Clinton’s scapegoating of the indigent at certain points in his address seems almost unavoidable:

Unless everybody is covered – and this is a very important thing – unless everybody is covered, we will never be able to fully put the breaks [sic] on health care inflation. Why is that? Because when people don’t have any health insurance, they still get health care, but they get it when it’s too late, when it’s too expensive, often from the most expensive place of all, the emergency room. Usually by the time they show up, their illnesses are more severe and their mortality rates are much higher in our hospitals than those who have insurance. So they cost us more. And what else happens? Since they get the care but they don’t pay, who does pay? All the rest of us. We pay in higher hospital bills and higher insurance premiums. (pars. 48-49; emphasis mine)

This passage seems miles away from the stress on the “human misery” that Clinton averred was the primary ill his “most important” principle would remedy. Instead of a focus on these people as victims, or on health care as a human right, or on the fact that universal health care would serve the common good of the community, Clinton’s focus here is on the monetary “costs” that are concomitant to the current system. In making this point, then, Clinton was prefacing the claim that would be made repeatedly by his opponents in their many responses to his speech: that those without health insurance were the real scapegoats. His use of specific pronouns, in particular, sets up a fundamental separation between the “they” who do not have insurance and the “we” who do. If

Clinton was trying, in the first sections of his speech, to create a sense of continuity – of identification – between all the members of his audience – those with and without insurance, the middle and lower classes; in effect, all Americans – then suggesting that

the uninsured were to blame for the rapidly rising costs of health care would seem to be grossly counterproductive to this goal.

Ramifications

Overall, Clinton’s drama, while initially narrowly focused, by the end of his speech, was irreparably disjoined. In his attempts to define his plan both as a right, using the humanitarian terministic screen, and as cost-effective, using the economic terministic screen, Clinton undermined the former screen, and as well allowed his opponents to more legitimately object to his plan exclusively in terms of the latter screen. Exacerbating these inconsistencies were the contradictions implicit in Clinton’s drama itself. While constructing a narrative arpeggio that held the greedy insurance companies responsible for the ills of the system, Clinton at the same time patently used the villains of this drama as major elements in the foundation of his new health care plan. Furthermore, Clinton’s embrace of the economic terministic screen at one point led him to briefly suggest the scapegoating of those who were unable to afford health insurance, which is the same group of people who came to be scapegoated in the drama of his opponents.

As well, many of Clinton’s specific arguments that use the economic screen naturally forced his audience to think of the finances involved with such a massive project. By rhetorically delving into monetary specifics in an attempt to account for practically every dollar that would be needed to pay for his plan – at one point Clinton even mentions the specific new taxes that would be levied (on tobacco [par. 73]) –

Clinton himself brought the issue of cost into the minds of his audience. Not only does this open the door to his opponents’ latching on to this aspect of his speech in their

responses to it, it also raises the issues of each member of the audience’s personal economic stake in the plan.

When Nicholas Laham writes that “Clinton’s health care reform initiative failed precisely because the president could and would not convince middle-class, privately insured individuals to give up some of their medical benefits in order to gain health security that they currently lack,” and as well that “the public wants” to leave “41 million individuals with little or no access to medical care,” he illuminates the undeniably selfish ideals that, at least on the surface, motivated the public’s decision not to support

Clinton’s plan (217-218; emphasis mine). It is my contention, however, that this self- serving impulse exhibited by the public was a direct consequence of Clinton’s abandonment of the humanitarian terministic screen in his speech, which allowed the subsequent debates over his health care plan to be conducted strictly in these individuating economic terms. When Clinton, for example, referred to the “financial experts on health care” and the “actuaries from major accounting firms” who got together and “agree[d] on numbers,” he himself brought the issue of the credibility of his

“numbers” into the minds of his audience, and thus enabled his opponents to successfully foment this debate in the public sphere (pars. 75-76). This rhetorical move, in fact, opened the door to a host of questions about who, indeed, would pick up the slack if

Clinton’s “numbers” did not add up – questions that became a prime focus of the rhetoric of his opposition.

Of course the issue of personal financial sacrifice would eventually have to be dealt with, and at some point before the passage of the bill Americans would have found out what their own individual contributions would amount to. But, by putting these

economic concerns in a position of prominence in his speech, Clinton made these issues fundamental to the discussion itself, and cemented their importance as integral features of the debate to come. Considering his framework, in which the economic terministic screen was allowed to overshadow the humanitarian screen, it is no wonder that most of the counter-arguments to Clinton’s plan focused on the costs associated with it, and attempted to play to the public’s fear that the price of providing health care to all would end up to be a steep decline in quality. These counter-arguments completely ignored the issue of whether health care itself is a human right, and made barely a mention of the massive amounts of people who undoubtedly would continue to suffer under a system where health care, as a “product,” is only available to those who can afford to purchase it.

As with all versions of “reality” that are “selected” by certain terministic screens, there was some truth to the insurance companies’ version – economics were a significant component of Clinton’s plan. The fact remains, though, that by introducing this version of reality himself, Clinton severely weakened his own argument, which needed to focus on the humanitarian aspects of his plan in order to exert the greatest possible persuasive appeal. By trying too much, perhaps, to anticipate his opposition’s arguments, Clinton adopted their version of the reality of health care, and thus helped undermine the unity of his audience, which diminished their ability to resist these counterarguments. In the end,

Clinton’s opposition wanted to convince the public that health care was something that was only available to those who could pay for it, and in order to continue to enjoy this access as they had grown accustomed to, those who could not afford it, in a sense, had to be sacrificed. Stories of “rationing,” and of a steep decline in the quality of care were both used to paint this bleak picture of the future of health care under Clinton’s plan.

This, of course was a drastic redefinition of Clinton’s drama, but, unfortunately for him, was a redefinition which he had allowed his rhetoric to be susceptible to.

In the following chapter, I will explore in greater detail the drama presented by

Clinton’s opponents, and will as well examine the ways that reactions to Clinton’s speech were represented in the press. In the immediate aftermath of the address, despite all of the problems laid out in this chapter, “the Clinton plan” enjoyed significant public support. It took a few months of debate in the public sphere, in fact, before this support precipitously dropped off. Considering the timing of this evaporation, I would argue that Clinton’s rhetorical inconsistencies gave the message of his opponents a sense of relevance that allowed it to dominate in the press, and, therefore, in public discourse. Compounding this dominance was these opponents’ superiority in numbers and finances, which meant that they were able to completely saturate the entire public sphere with their message. In this way, the public experienced a sustained exposure to the drama of the opposition, and eventually came to see the issue as ultimately grounded in the terms foregrounded in their drama. The economic aspects of the debate, which had first been raised by Clinton himself, were those that were central to this oppositional drama, and thus the notion of health care as a product, and the divisiveness that inevitably accompanied this notion, defined the dominant discursive lens through which Clinton’s plan was perceived. Unlike

Clinton, then, who had been unable to clearly articulate a consistent message, his opponents relentlessly and homogeneously reiterated the details of their drama, which eventually came to dominate in the press as well as the public sphere, and, in the end, defined Clinton’s plan for him.

The “Dramatic” Appropriation of the President’s Message: Same Words, Different Story

To ensure passage of his Health Security Act, Bill Clinton needed to unite the

American people behind his cause not just for the duration of his speech itself, but for the many long months after his speech, during which his proposal (he hoped) would be debated and eventually voted on by Congress. If, during that time, politicians sensed that popular support continued to be solid, the chances of the plan being enacted would be significant. However, in a remarkable turn of events, support for “the Clinton plan” plummeted in the weeks and months following Clinton’s initial address, and thus it never really got off the ground in Congress, with the proposal eventually dying in the Senate before it even had a chance to come to a vote (Rockman 400-401). In defeating the proposal, Clinton’s opponents had effectively controlled the shape of the debate by consistently hewing to the message that was most favorable to their goals. In so doing, these opposition groups wove together their own Burkeian persuasive “dramatic” representation of the health care system, which made use of terministic screens and, just as Clinton had, designated a specific group as scapegoats for their version of the problem with health care in America.

In one sense, though, Clinton’s opponents’ task was much easier, since they did not have to effect a lasting unification of their audience, as Clinton did, but rather had only to undo the unification the President had created. As Burke asserts in A Rhetoric of

Motives, “division” within a social group, which is what Clinton’s opponents were attempting to foment, is actually the default, making it an inherently easier thing to produce: “Identification,” Burke writes, “is affirmed with earnestness precisely because

there is division. [. . .] If men were not apart from one another, there would be no need for the rhetorician to proclaim their unity” (22). In the case of the health care debate, then, Clinton’s opponents’ success was in engendering disunity amongst the American public – breaking down, in other words, the identification that Clinton had worked so hard in his speech to foster. The most important factor in this victory, however, was not the persuasiveness of the opponents’ message per se. Rather, it was the complete dominance of their message in the press, and, correspondingly, in the public sphere, which had enabled their dramatic version of health care to overwhelm and effectively displace the version delineated by Clinton in his address.

These opponents wanted to present Clinton’s plan as an exacerbation, not a solution, to the problems within the health care system, and by portraying the issue as a fundamentally economic one, and thus casting health care as a product, they were able to more effectively make the case that Clinton’s plan would give away too much “free” health care, and in so doing would deplete – and eventually ruin – the entire system.

Instead, then, of focusing on the victims of the current system, and, correspondingly, on the notion of Americans as members of a collective community (notions which the humanitarian terministic screen tended to highlight) these opponents used the economic terministic screen to foreground the fact that health care is expensive, and that there would likely not be enough to go around if everyone was covered. In other words, while

Clinton subordinated the economic elements of health care in favor of the humanitarian ones, his opponents did the exact opposite, using the economic screen to ground the humanitarian issues, thus making Clinton’s promise of “security” seem secondary to his

plan’s cost-feasibility. These fears could not be categorically dismissed by Clinton or his allies, since the economics of the plan, as will be discussed later, were far from settled.

Clinton’s opponents were doing more than simply intimating that security should be secondary to economics, though. This was really a battle fought over the dominant perception of health care, and thus, ultimately, a rhetorical one. Each side’s drama was predicated on the notion that the perception of health care should be focused discursively through a single set of issues. For Clinton, it was humanitarian issues that colored the other aspects of his drama (and, thus, his health care paradigm), while for his opponents it was economics that served as this governing discursive “filter.” For this reason, when opponents of Clinton reacted to his plan both in their advertisements and in the press, their characterizations of it portrayed his guarantee of security not as his plan’s distinguishing feature, but rather as a function of its potential to achieve cost-savings.12

While both Clinton and his opponents embraced radically different dramas, both

of their representations of reality necessarily dealt with the same problem: the health care

system itself, which, as Clinton describes, was “badly broken” (par. 5). The key

difference in their dramas, then, stemmed from their divergent use of terministic screens,

which contributed as well to their extremely divergent designation of scapegoats. While

Clinton used the insurance companies as his scapegoats for the problems endemic to the

12 This hierarchical depiction was exemplified in an article by Robert Pear appearing in the September 24 edition of The New York Times, which was entitled: “Experts’ Grades: ‘A’ in Security, ‘C’ in Simplicity, ‘D+’ in Savings.” In the article, which actually borrows the report card metaphor from a brief passage in Clinton’s address (par. 60), though Pear avers that “experts analyzing Mr. Clinton’s plan agreed that it would go far toward providing security of health insurance coverage for all Americans,” he later undercuts this statement directly in terms of cost, claiming that “if Mr. Clinton’s program is not adequately financed, the guarantee of ‘health security’ could be compromised because there would not be enough money to pay for all the promised benefits.” Pear’s article is typical of many of the characterizations of the debate in the press, in that it devotes most of its attention to the economic aspects of Clinton’s plan, and little, if any, to the humanitarian ones; in this case, of the twenty-one paragraphs comprised by the article, only two sentences affirm the plan’s guarantee of health security. 59

system, opponents of Clinton, on the other hand, used as their scapegoats those people who were unable to afford access to health care, and who under Clinton’s scheme would be given this access. While the problem for both sides remained the flawed health care system, for Clinton, in his initial (and most effective) argument, this was a fundamentally human problem, and by vividly portraying the victims of this system he emphasized the need to help them. For his opponents, however, the problem was more one of economics, with the perception of health care as a product a key factor. In the logic of this oppositional drama, the government would not have enough money to pay for everyone if everyone didn’t pay for their own share of these health services, ergo, those who were really to blame were those who used this system without being able to afford it. These individuals’ status as “victims” in this drama was downplayed, in part via the use of the economic terministic screen, as instead these victims became villains who were shown to be taking health care from citizens who could afford to pay for it. Naturally, then, if

Clinton’s plan was put into effect, and the forty-plus million uninsured Americans were given access to these services, this problem would be catastrophically exacerbated; as a result of the system becoming overloaded, shortages of care, as well as a marked decline in the overall quality of care, would both inevitably ensue. So, within this dramatic representation, while the guilt evoked from the audience was still a product of the flaws in the system, as it was in Clinton’s drama, the perspective on these flaws was drastically different, and, so was the designation of scapegoats. In other words, while Clinton blamed the insurance companies for the suffering of these impoverished victims of health care, Clinton’s opponents blamed this same group of people for their own situation, and implied as well that Clinton’s plan would allow this group to ruin the system for

everyone else. Clinton’s opponents’ scapegoating of the underclass, then, effected by the use of the economic screen, ultimately foregrounded the finitude of health care, and put the division in society between those with health care and those without into sharp relief.13 The economically-centered conclusions underlying this oppositional drama – that

human interest aspects of health care are secondary to cost-concerns – thus perfectly

align with this essentially economic criterion for the designation of scapegoats.

The Battle for (Dramatic) Ascendency

Throughout the debate, Clinton’s own words were extensively picked apart and

magnified, and thus even the smallest detail in his rhetoric had the potential to have

significant ramifications in the media. Importantly, however, Clinton himself did not

have full control over the way his speech would be appropriated and re-presented in the

press, and thus these ramifications were largely outside his sphere of influence. While

Clinton did have an army of staffers whose job it was to repeat and clarify his message,

once his speech was given his staffers were only a few voices among many. With this in

mind, the fact that Clinton strayed in his speech from his initial focus on “security” – and

therefore from his presentation of health care as a human right – in favor of a lengthy

digression about costs was an immensely risky maneuver. Though not all of the specific economic language he employed was likely to have been planned in advance, structuring nearly half his speech around economic issues must have been a volitional strategy. As his opponents used “cost” as the foundation of their drama, however, Clinton’s

13 This division between those with health care and those without could ostensibly be translated in terms of health care coverage alone. However, divisions based on wealth also played a major role in this, since in most cases those who had access to health care were likelier to be more economically well-off than those who did not, and thus Clinton’s audience would have been inclined to see this vital fracture as a de facto economic one. 61

apparently conscious decision to embrace economics proved catastrophic to his message.

In other words, Clinton’s own use of the economic terministic screen made it vastly easier for his opponents to focus on the issues it tended to foreground, and to correspondingly ignore those foregrounded by the humanitarian screen.14 As well,

Clinton’s opponents’ framing of their drama in part as a reaction to Clinton’s arguments gave their own rhetoric a relevance in the press that wouldn’t have existed if they had been perceived to be entirely changing the subject of the debate. As a result of Clinton’s use of the economic screen, then, the press treated economic issues as if they adequately represented the primary emphasis of both sides of the argument; Clinton’s “side” thus was narrowly portrayed in the press as rooted in economics, and those arguments that were rooted in the humanitarian screen, which in fact more accurately represented the core appeal of his address, were almost completely ignored.

Overall, since Clinton had only a modicum of control over his own message in the press, the dichotomous nature of his address made it particularly unlikely that his persuasive argument would be fully and accurately represented in the media. In fact instead of being able to respond to, and attack, his opponents in terms of the most unifying element of his own rhetoric (security), in the aftermath of his address Clinton ended up having to answer questions of cost that he himself had raised. This situation was an extremely unfortunate one for Clinton, as the notion of security of access to health care was an almost unassailable aspect of his appeal. The fact that his opponents eschewed this principle in their drama illustrated its importance to the overall success of

14 Illustrating the stark difference in the primary emphasis of each side of the debate, and, as well, the fact that Clinton’s opponents made no attempt to engage Clinton on any issues derived from the humanitarian screen, The Wall Street Journal reported that on the night of the debate, while Democrats wore pins that read: “‘Health Care That’s Always There,’” the Republicans’ pins, adroitly avoiding the humanitarian aspects of the issue, bore the simple question: “‘Who Pays?’” (Balz). 62

Clinton’s proposal; not only could Americans easily grasp the idea of secure health care coverage, but the personal stories of hardship which highlighted the need for this security also helped establish the identification in Clinton’s audience that was so vital to the overall persuasiveness of his appeal. Because they considered themselves as part of a collective community, as was encouraged by Clinton’s foregrounding of the humanitarian screen, these audience members were able to see themselves in those who had been abandoned by the system, and thus were more willing to support a plan that would prevent these injustices. Without security, on the other hand, Clinton’s plan was ultimately just a slew of numbers, which had little inherent persuasive appeal for his audience. As it turned out, Clinton’s address, instead of instilling a lasting sense of identification in his audience by consistently stressing the issue of security, opened the door to his opponents’ divisive use of the economic screen, and thus laid the groundwork for the proliferation of antagonism fostered by their drama.

In the days following Clinton’s address, it quickly became clear that the press was not nearly as interested in covering the administration’s attempts at controlling the conversation as they were in expounding on the raging economic debates that had been initiated by Clinton in his speech. Most of the articles in The New York Times as well as

The Washington Post that ran in the two days immediately following Clinton’s proposal highlighted concerns about its cost. In a typical example of this, Clifford Krauss of the

Times wrote a piece appearing under the general heading of “Reaction,” which was entitled: “Congress Praises President’s Plan, But Is Wary of Taxes and Costs.” In this case, the latter half of the headline is an accurate preview of the content of the article, as

Krauss spends little time on the potential benefits of the plan, and much time dissecting

the various objections and cautions the plan elicited – which were all in some way related to its cost. Krauss’ article is littered with questions about the plan’s fiscal solvency; the sources question everything from specifics – the plan, for instance, might “put undue financial pressures on small businesses” – to generalities – Krauss references the notion that the plan’s potential to “‘control costs’” is one of two overall “‘deal breakers.’” In another passage, Krauss quotes Senator Ernest F. Hollings, who basically reduces health care to an unnecessary and un-fundable fantasy; as Krauss puts it, Hollings “seemed to sum up the concerns about the costs of the proposed overhaul when he said, ‘We’re not paying for our entitlements now, and we’re starting to talk about instituting another entitlement without paying for it.’” Hollings’ quotation, and Krauss’ ascription of importance to it, not only exemplifies the fundamentally economic ground of the rhetoric of Clinton’s opponents; by reducing the plan to the level of just “another entitlement”

Hollings casts health care, fundamentally, as simply another monetary gift from the government to those who cannot afford to take care of themselves. This implication directly contravenes Clinton’s attempt to elevate the importance of his proposal as a human right, the passage of which would not be the creation of another quotidian legislative “entitlement,” but rather would constitute an “answer [to] the call of history”

(par. 92). In this case, then, the economic terministic screen defuses not only the humanitarian screen and notions of collectivity that are associated with it, but also

Clinton’s assertion that his proposal was of singular importance as a continuation of the historic progress of human rights. So, while Clinton had tried, especially in the early sections of his speech, to build up the importance of his proposal and thus transcend what were ostensibly more petty and provincial concerns about cost, Hollings, and thus

Krauss, re-centers the discussion on these economic issues, and defuses this potent aspect of Clinton’s rhetoric.

The power of this redirection of the discussion of health care exemplified by

Senator Hollings’ statement, which functions to deflect the rhetorical paradigm Clinton espouses and correspondingly select via the economic terministic screen the perception that health care as yet another unfeasible federal “entitlement,” ultimately is enabled by

Clinton’s own use of the economic screen in later portions of his speech. Of course, in all probability Senator Hollings would have made the same statement, or made a similar one, in reaction to Clinton’s proposal no matter what speech he gave, and as well Krauss would most likely have still included this or a similar quotation in his article. The fact, though, that Clinton brought up the subject of cost in his speech on his own, and subsequently devoted a significant amount of time elaborating it, gave comments such as

Hollings’ a degree of legitimacy and authority that did significant damage to the public’s perception of Clinton’s proposal.

An article from the September 24 edition of The Washington Post, entitled

“Clinton Challenged On Health Plan’s Cost, Impact,” is another noteworthy example of the many newspaper articles that included direct, harsh criticisms of the President’s plan that were couched as objections to the cost-projections he specifically lays out in his speech. The article begins by claiming that Clinton’s plan had drawn “sharp fire yesterday from many economists, who charged it was more expensive than the president claimed and could hurt the economy” (emphasis mine). While Clinton probably would have drawn similar criticism regardless of what he said in his speech, if he had not dwelled so long in his discussion of specific economic aspects of the plan his critics

would not have been able to position their remarks as objections to his claims. In other words, by going into long explanations of the specific financial elements of his plan,

Clinton actually gives the economists quoted in this article more to pick at in their analyses, and the debates generated by these quibbles thus give the newspaper reporters more to write about. The very next sentence of the Post article, in fact, sets up its general theme of challenging Clinton on specifics: “Martin S. Feldstein, chairman of President

Ronald Reagan's Council of Economic Advisers, asserted the plan would cost the government $120 billion more in its first year than Clinton administration officials have estimated, and disputed the president's claim that the program could help reduce the swollen federal budget deficit” (Chandler and Rich; emphasis mine). The article’s overall focus is not on Clinton’s numbers in themselves, rather the article deals with the controversy surrounding the President’s claims regarding the accuracy of these numbers, upon which, because of his own repeated insistence of their veracity, much of his credibility had come to rest. This, of course, meant that much of the persuasive efficacy of Clinton’s speech as well rested on the accuracy of these numbers, and their refutation would have entailed a significant diminishment of the public’s faith in him, and, therefore, his plan.

In a remarkable revelation, though, printed in the October 1 Wall Street Journal,

Clinton’s top designer of the health care plan, Ira Magaziner, admits that these numbers, which he was ultimately responsible for, were, in fact, educated guesses. The article, entitled: “To find out whether Clinton numbers add up in health plan, ask people who crunched them,” explains that Magaziner recognized that in order to effectively write health care legislation, he needed to come up with numbers that made sense – even if he

couldn’t guarantee they would end up correct. Or, as the authors put it, Magaziner had to

“take control of the numbers” when he designed the plan. In the article, this lead architect of the Clinton health care system reveals that only after all the decisions had been made about the plan did he submit his numbers to be “vetted” by senior budget office officials.

This meant, then, that at the moment Clinton was delivering his speech, the actual verification of his “numbers” had only just begun (Wessel and Wartzman).

Clinton’s assertion that is referenced in the Journal article: “So then we gave these numbers to actuaries from major accounting firms and major Fortune 500 companies who have no stake in this other than to see that our efforts succeed. So I believe our numbers are good and achievable,” is typical of the confident tone he uses when he discusses (as he does frequently in later sections of his speech) the reliability of his cost calculations (Clinton, par. 76). In itself, the fact that Clinton’s claim to accuracy is the subject of this entire Wall Street Journal article is more evidence of the pervasive focus on cost issues in the press. The truly interesting aspect of the article, however, is its conclusion – essentially, that there is no concrete way to predict what the health care

“numbers” will be. The authors (by proxy, since they use independent sources to make their argument) don’t dispute Clinton’s numbers by citing ones that are more accurate, instead they undermine the very idea that anyone can predict the costs or the savings of health care at all: “Health-care numbers are huge, even by government standards,” the authors explain; “the numbers are so big that administration officials call some disagreements over $2 billion a year ‘rounding errors.’” David Cutler, a White House economist who is “among the innercore [sic] of [Clinton’s] number-crunchers,” pithily sums up the authors’ argument; according to Cutler, the task of predicting accurate cost

figures for Clinton’s new health care system years in advance is impossible, akin to solving “‘a huge Rubik’s Cube.’” Overall, the Journal article, highlighted by

Magaziner’s startling revelation, makes a highly cogent argument against the possibility of Clinton being able to make accurate claims in his address (the authors of the article report that one of Clinton’s actuaries had actually “winced as he listened to [the aforementioned] particular passage in President Clinton’s health speech”) (Wessel and

Wartzman). This argument, then, aside from perpetuating an economic rhetorical emphasis that was distinctly unhelpful to Clinton’s aims, severely undercut his general credibility with the public.

The conclusions of the Journal article, then, which were echoed in several of the reactions to Clinton’s proposal featured in the press, raise the question: why, if Clinton couldn’t guarantee the exact reliability of his numbers at the moment when he made his speech, did he spend so much time, and allow so much of the credibility of his appeal to rest, on these persuasively impotent economic arguments? In other words, considering this fundamental unreliability – or, at least, contestability – of both the cost of Clinton’s proposed health care system, and as well any savings that might have been achieved by its implementation, it is slightly curious that he would have been so detailed, and so emphatic, about these elements of the plan in his speech. As diverting attention to, and subsequently undercutting, these economic aspects of his speech is a strategy Clinton’s opponents employed to perfection, by including them, Clinton practically ensured a barrage of objections – both significant and minor – to this facet of his plan. As just one example, the issue of “savings” was consistently referenced in both oppositional rhetoric and newspaper articles discussing the plan. Clinton’s pre-isolation of savings as one of

the six discrete “guiding stars” structuring his speech, however, had practically gift- wrapped this issue for his opponents; in other words, it was Clinton’s own structuring of his speech that had facilitated these types of targeted critiques, which skillfully dissected his plan in order to focus on those issues that were most vulnerable.15

The press quickly picked up on the tenor of the opposition’s argument; as Ben

Goddard, president of an influential advertising agency that ran ads criticizing the Clinton

plan, summed up in an interview: “The press loves a dogfight. That’s what they like to

cover” (qtd. in West, Heith and Goodwin 49). Therefore, when claims that the President’s

numbers were faulty gave rise to counterclaims by Clinton officials, media coverage zeroed in on these disputes. Practically all of the opposition politician and interest group objections to the plan discursively revolved around economics, thus, concerns over the need for collectivity, about the status of health care as a human right, and, as well, the humanitarian screen which accompanied these discussions, were all shunted aside, and as a result so was the country’s attention to these things. As the debate progressed following

Clinton’s initial address, “the Clinton plan,” instead of being associated with issues that served to best unify the American people, quickly became associated with the divisive issue of its own economic viability.

This situation was devastating for Clinton, as the cogency of his argument depended on the concept of security transcending concerns about cost. Following his speech, he consistently attempted to stress these favorable issues, even as he simultaneously had to defend himself against criticisms of his specific economic claims.

One of his final attempts at salvaging the direction of the conversation, which was also

15 Robert Pear’s article, referenced above, is a perfect example of the dissection of Clinton’s plan that in fact borrowed Clinton’s own structure. The headline alone: “Experts’ Grades: ‘A’ in Security, ‘C’ in Simplicity, ‘D+’ in Savings,” tells the whole story. 69

one of the last concerted efforts to rekindle the public’s support of his plan, summed up – unfortunately for Clinton – the negative trajectory of his proposal. Organized by the pro-

Clinton plan group Families USA, the “Health Security Express” bus caravan endeavored to crisscross the country rousing support for the President’s proposal. At each stop, riders recounted stories of average people who were experiencing – or had experienced – great misery under the current health care system. As Lisa Disch explains, these bus tours were

“modeled after the bus tours of the Wellstone and Clinton elections, and probably also

[were] designed to recall the Freedom Rides of 1964” (25). Everywhere they went, these bus riders tried to redirect the course of the health care debate by highlighting tragic stories that all powerfully emphasized the link between community responsibility (and, thus, collectivity) and health care issues. In so doing, they were reiterating the themes central to the persuasive power of Clinton’s speech.

By stressing these dramatic personalized examples of the health care system gone wrong, the bus campaign was attempting to refocus the discourse surrounding the

President’s plan by means of the humanitarian screen and, correspondingly, to direct the focus away from discourse which made use of the economic screen, which by this time was predominant in almost all discussion of “the Clinton Plan” in the media.

Unfortunately, however, the attempt was largely a failure. A bus tour might have been effective during past elections, when candidates needed to travel across a state to make campaign speeches, but in this case there was no apparent reason for the tours, which made their existence as a publicity stunt painfully obvious. The hoped-for comparison to the sixties-era Freedom Rides was even more tenuous; as Disch puts it: “The Freedom

Riders challenged the segregation policies of Southern bus stations by violating them; bus

riding, by contrast, had no immediate connection to health care delivery except that the buses, like the system, kept breaking down.” These tours drew “meager crowds and attract[ed] little media coverage,” and, importantly, “failed to advance the public debate over health care” (25). The failure of this last-ditch effort, among other things, illustrates that though Clinton and his supporters understood that the humanitarian terministic screen was one of their most powerful rhetorical weapons, and therefore attempted to use it to structure the conversation following Clinton’s speech, the opposing economic screen, in just a few short months, had despite their efforts become irreversibly entrenched as the discursive basis for public conversation. The preponderance of this screen meant that the public eventually came to think, as well as speak, about the plan in terms that were inherently divisive, thus irreparably dissolving the fundamental unity on the issue that Clinton had needed so badly to maintain.

An examination of the press coverage of “average” people’s reaction to the speech bears out the notion that the success of Clinton’s appeal rested on his ability to foreground the humanitarian terministic screen, and to occlude the economic screen. For example, the September 24 edition of The Washington Post ran an article detailing the reactions of “a small sampling of Middle America,” which was composed of residents of a Cincinnati suburb ranging in age from their teens to their forties. Despite stating that

“initial public reaction to the President’s health care proposals was cautiously favorable,” the article documents several group members’ negative reactions to the economic ramifications of Clinton’s proposal: “Nearly all those around the table,” the author of the article writes, “wondered how much they would have to pay under Clinton's plan. ‘He says it's not going to be a 'major' cost?’ [one of the interviewees] said. ‘But what is this

figure going to be?’” (Broder and Morin). Throughout the article, as in this example, the group members’ objections were overwhelmingly phrased in terms of economics. More importantly, however, the article illustrates that the salience of the oppositional drama, which foregrounded the vast economic burden Clinton’s plan would impose, was in part dependent on Clinton’s own assertions about the plan’s cost. This respondent’s skeptical comment mimics many of the objections to the plan presented by the opposition, in that it responds directly to Clinton’s own claims. This rhetorical structuring not only undercuts

Clinton’s credibility by discrediting ideas that he himself had voiced, more importantly, it obfuscates the fact that these objections were fundamentally immaterial to Clinton’s primary argument, which in fact revolved around the security of health care, not the cost.

The Post article isn’t all about the negative reactions of these average people, however. There are at least two group members named (out of a total of 12) who are enthusiastic supporters of the plan. While it is understandable, as has been shown, that many who are part of this supposedly-average group would refer to its cost (since Clinton himself puts this issue on the table), it is noteworthy that the two most enthusiastic supporters of the proposal – and ostensibly the two who were most convinced by

Clinton’s speech – both mention its collectivity as the primary reason for their support.

For instance, despite being the same person quoted in the article (and in the above paragraph) questioning the cost of the proposal, Carol Templeton makes it clear that she is “for [the plan] 100 percent.” Her reasoning? Despite always having “fantastic insurance” herself, she believes that “this is something from which everyone will benefit.

If everybody's willing to pull together, I think he could pull this off." The other strong supporter, Tracy Hedleten, said that she had “always thought of health insurance as a

problem for other people, not herself. But after listening to Clinton and the comments at the table, she said, ‘He's right. We do have to do something’" (Broder and Morin). More than anything else, this article underscores the fact that Clinton’s two separate themes – which utilize two separate terministic screens – can have radically different effects on the dispositions of his audience members. Here, as the reactions of this impromptu focus- group illustrate, the convincing aspects of Clinton’s address are not those that deal with its cost-feasibility, but rather those that deal with the collective nature of the plan’s benefits, and with the idea that America is a cohesive community – in short, those aspects of the plan stressed early on in his speech, and which make extensive use of the humanitarian screen.

* * * * *

In crafting their own dramatic version of the health care situation facing

Americans in 1993, Clinton’s opponents made every effort to avoid any suggestion that health care itself is a right, and instead attempted, through use of the economic screen, to define it as a product, and thus as a finite, exhaustible resource. The problem, then, with health care, as (re)defined by groups opposed to the Clinton plan, was not that it was unavailable to those who could not afford it, but rather that there would not be enough to go around if Clinton’s proposal was enacted. This argument underlay the entire drama of the opposition, who posited that if Clinton’s health care plan was passed, catastrophic

consequences would result – including both the large-scale “rationing” of health care and the cessation of “life-saving” drug research.16

Just as did Clinton’s drama, the drama of his opponents conforms to a “narrative

arpeggio,” which makes the use of designated scapegoats necessary to its overall

persuasiveness. As mentioned earlier, the opposition’s sharp delineation of the “haves”

and “have-nots” of health care, combined with the portrayal of health care as a product,

facilitated the rhetorical designation of the “have-nots” as scapegoats, who, so went the

logic, were in fact taking health care away from those who had the means to purchase it.

In contrast to Clinton’s own dramatic portrayal of the health care system, in which the

insurance companies were the designated scapegoats and those without access to health

care were the victims, in the drama of his opponents, these victims became the

scapegoats. Thus Clinton’s opponents cleverly turned the tables on the perception of the

uninsured, emphasizing that they had only themselves to blame for their dire situations,

and that their failure to earn enough to purchase health insurance could not be the fault of

those who had it.

The narrative arpeggio of both dramas, then, made clear the route by which the

audience could achieve “transcendence.” For Clinton, following this route entailed

supporting his bill to ensure its enactment into law. Since his bill would (supposedly)

sacrifice the insurance companies, his audience’s guilt would be expiated, leading to

catharsis, and, thus, transcendence. For the opponents of his plan, on the other hand, the

16 For the former, see as one of a myriad possible examples Kirk Johnson’s article from the September 24 edition of The New York Times, in which he quotes the national medical director for Cigna Healthcare, Dr. W. Allen Schaffer, reacting to the President’s speech with the assertion that “the R-word, rationing, didn’t come up” despite the fact that it was “a big part of the proposal.” For the latter, see for example the February 16 issue of The Wall Street Journal, which ran three side-by-side editorials written by three medical industry insiders, each entitled: “Killing Drug Research Kills People” (Kleinke; Kogan; Loarie). 74

path to transcendence took the opposite route; by not supporting Clinton’s bill, Clinton’s audience would help prevent its passage, with the resulting denial of health care to the scapegoated lower classes tantamount to the all-important cathartic “sacrifice.”17

This particular designation of scapegoats was reflected in many of the reactions in the media following the President’s proposal. In an editorial for The Wall Street Journal on September 24, Paul A. Gigot, while channeling the political sentiment of many on the far-right, embraces the framework of the oppositional drama, suggesting that those without health insurance are somehow inherently averse to helping themselves.

Significantly, also, is the fact that Gigot argues within the discursive boundaries set by

Clinton himself by latching on to the theme of “responsibility” – one of the six “guiding stars” of Clinton’s proposal. In his piece, Gigot complains that “for all of Mr. Clinton's talk of personal ‘responsibility,’ an 80% employer mandate lets people shirk it.”

Suggested in Gigot’s logic here is the idea that health care, ultimately, is something that people should have to pay for themselves, and not be able to “shirk.” The implicit assumption in this logic, then, is that those who would get something for nothing from the government are in fact undeserving of these services; they aren’t paying for what they’re getting, ergo, they’re “shirking” their responsibility – the same responsibility,

Gigot claims, that Clinton in his speech made clear was so important. Gigot’s logic here clearly affirms the oppositional drama, and, as well, is derived from the economic terministic screen. His view of health care, cut and dry, is that it is anything but a “right”; indeed, Gigot dismissively refers to the plan as one more “entitlement that puts another

14% of the economy under the sway of government, and thus of politicians.” On the

17 In this case, the denial of health care served as a very real form of sacrificing these scapegoats; considering the hardship and misery that a lack of access to health care often led to, such a willful denial could easily be seen as a (somewhat) non-lethal form of human sacrifice. 75

contrary, Gigot believes that health care is something that should be earned by hard work, and thus dislikes the very idea of anyone “shirking” their responsibility to pay for it. For

Gigot, the way to obtain something like health care, in short, is to buy it, just like one would buy a gallon of milk at the grocery store. There is something inherently distasteful, then, in the underclass’ acceptance of this sort of largesse, and his underlying unwillingness to see these people as sympathetic victims directly enables their scapegoating, which, while not suggested overtly by Gigot, is clear in the subtext of his article.

Gigot, though, only represents the tip of the rhetorical iceberg in this regard; other editorial reactions in the press go much further in their unabashed scapegoating:

One of the reasons our health care system is so strained is because of the cost of taking care of people who can't or won't care for themselves – the mildly ill who use expensive emergency rooms instead of economical family practitioners' offices, high-risk mothers and babies in high-cost intensive care instead of affordable neonatal and well-baby clinics. Remember, too, that while many are uninsured, some 85 percent of us do have health coverage. Many if not most Americans have access to health care that is arguably the best in the world. (“Health Reform Security Blanket”; emphasis mine)

This passage is a prime example of the way the oppositional rhetoric worked to divide the public through the creation of scapegoats. First of all, the author refers to people who

“won’t” care for themselves, and thus are presumably unlike the rest of “us,” and subsequently juxtaposes – and therefore associates – them with people who “can’t” care for themselves. Combined with the assertion that most people do have health insurance

(“85 percent of us,” that is), this story paints an efficacious picture of everything that is supposedly wrong with the system: it portrays one social group, which lumps together the incompetent as well as the indigent, whose members are largely responsible for their own

situation (and, therefore, could change it if they wanted to enough), in opposition to a second group, which includes all of “us,” whose high standard of health care is threatened by the reckless habits of the first group. This argument, as, in a subtler fashion, does Gigot’s, harbors the unstated claim that those without health care are somehow deserving of their condition, and that it would be both foolish and harmful for those with health care to just give it to them for free. Not giving health care to this scapegoated underclass, then, within the dramatic framework espoused in this article, is a perfectly acceptable solution to the problems of the current system. And, since this denial is a form of sacrificing these scapegoats, it is also the final step on the path to transcendence.

Throughout the debate, this suggestion of the necessity of societal division into the “haves” and “have-nots” of health care lurked behind all the claims of “rationing” that were so prevalent in the oppositional discourse. The threat of rationing, in fact, existed as a powerful counterargument to Clinton’s plan, and thus was repeated often in the rhetoric of Clinton’s opponents, and, correspondingly, in the press. These claims, instead of focusing on the notion that health care should be a priority, and that universal coverage should be achieved at any cost (much like the way other governmental priorities, though monstrously expensive, are funded unquestioningly), suggested that health care is inevitably finite, which meant that any attempt to make it universally available would necessarily involve a reduction in the total amount available to each “consumer.” Along with the invocation of the underclass as scapegoats, this concept, which was a clear result of the use of the economic terministic screen, was constantly repeated in the press in the months following Clinton’s initial address. This repetition effectively foregrounded the

notion of Americans as individualized adversaries competing for a limited amount of health care, and correspondingly devalued the opposite notion, that Americans were a part of a collective community who all looked out for one another, and thus should all support what was best for the community as a whole. In short, this repetition of the oppositional drama inhibited the identification of Clinton’s audience with one another, and, thus, severely damaged the consensus his address had initially created.

Ramifications

At the point when Clinton makes his speech, there were about 41 million uninsured individuals in the U.S. (Laham 218). Since Clinton’s main persuasive goal, however, was identification, and since many in his audience were only at risk of losing their health insurance coverage, Clinton had to significantly underplay the division between those who had no current coverage and those who might not have it in the future. This is why he defines his first principle not simply as “coverage,” but as

“security” of coverage, which is a concept that would appeal to his entire audience, and, as well, would obfuscate any potentially divisive conflicts of interest within the group.

Put another way, as the cogency of Clinton’s proposal was dependent upon the degree to which he could unite his audience, creating division by reminding them of their differences would not have been conducive to his persuasive strategy. Since, on the other hand, reminding Americans of their differences was exactly the strategy of his opponents, it was catastrophic for Clinton to invoke, as he did in later sections of his speech, phrases such as “since they get the care but they don’t pay, who does pay? All the rest of us,” and

“why should the rest of us pick up the tab when a guy who doesn’t think he needs

insurance or says he can’t afford it gets in an accident” (par. 49, 68; emphasis mine).

Clinton, in these passages, was practically making his opponents’ arguments for them; at the very least, by speaking in these terms Clinton was embracing phrasing that suggested the drama of his opponents, and, thus, bestowed a sense of importance on those issues that were soon brought up in criticisms of his plan.

In the larger context of Clinton’s argument, divisive phrases like these were inexplicable, as it was almost inevitable that they would aggravate internecine divisions amongst those of different income brackets. As Holloway writes, following Clinton’s initial address, the unification of his target audience quickly broke down:

What started out as a public mandate for change soon disintegrated along politically partisan lines (Democrat versus Republican, state versus federal control) and according to individual circumstances: the young versus senior citizens, employed versus unemployed, those trying to preserve the health care they enjoyed versus those without adequate health care, and on and on. (176)

This passage, then, is a telling one, illustrating that a key feature which emerged in the debate was exactly the one that hurt Clinton the most: the fracturing of the body politic.

By embracing, in part, the argumentative framework of his opponents, Clinton not only diluted the strength of his central message, he allowed valuable press coverage to become centered on distracting debates over his plan that were nevertheless conducted within the rhetorical boundaries he himself had drawn. As Clinton’s opponents quickly latched on to the economic/numeric aspects of his address (which foregrounded, of course, these opponents’ preferred terministic screen), these aspects became magnified even more in the press, and eventually crowded out the other features of the debate.

Because of this, far less coverage was devoted to such issues as security and collectivity, which would have been filtered through the humanitarian terministic screen, and,

therefore, would have been helpful to Clinton’s cause. Making this rhetorical situation even worse for Clinton was the concerted effort by interest groups, who spent huge sums of money on negative advertising campaigns, the mere coverage of which further slanted press coverage against Clinton. The combination, then, of a muddled original message, which allowed the reactions to Clinton’s address to largely foreground its contestable economic claims, and the preponderance of this oppositional rhetoric, which led to a corresponding preponderance of press coverage that reflected the drama – and terministic screen – of Clinton’s opponents, was a lethal one for the durability of Clinton’s persuasiveness.

Far from establishing a lasting unity amongst his audience, then, by arguing in terms used by his opponents Clinton actually sowed the seeds of disunity in his address.

Not only did his preferred terministic screen, in the weeks and months after his initial speech, practically vanish from public discourse surrounding his plan, his drama, which appealed to the common identity of his audience as Americans facing the frightening possibility of their health insurance being taken away, was distorted beyond recognition.

As re-defined in the drama of his opponents, the “enemy” was in fact the victims of

Clinton’s drama, who were cast as undeserving leeches on the system itself, who threatened the quality of care for the good, hard-working Americans. Divided along economic lines, Clinton’s audience thus was effectively turned against his plan, which, without their support, had little chance of being enacted. Ultimately, while Clinton did achieve, as borne out in polls following his speech, an impressive degree of initial success, he created a situation in which his strongest arguments – prominent throughout the first half of his speech – were quickly relegated to the background in the public

sphere, yet at the same time, those arguments that his opponents were most comfortable with, and which give them the greatest advantage, were able to overwhelm the conversation.

Conclusion

The Message and the Media

Bill Clinton’s speech to the nation on September 22, 1993, in which he made the case for the institution of universal health care, was, primarily, an attempt to tap into a strong undercurrent of public support for universal coverage that transcends economics.

This is not to say that Americans’ support for universal health care, in general, is completely unrelated to considerations of its cost, but rather that a major part of the desire for universal coverage is grounded in the idea that health care is a human right, and should be available to all. This beneficent desire to help one’s fellow human being is a deeply rooted one, and, importantly, is distinctly separate from mundane economic concerns. Within his address, then, Clinton specifically invoked his audience’s underlying sense of anger with a health care system that denies such a fundamental right to other members of their community by vividly depicting specific injustices and tragic circumstances that were unavoidable consequences of such a monetarily-driven – and, thus, inhumanitarian – system. By painting this sympathetic picture of the victims of the system, Clinton made a powerful case for his plan, and in so doing created a specific drama, which portrayed a new paradigm of health care that was in fact defined by humanitarian issues.

Upon staking his claim to a sound health care system that had been born as a reaction to the gross injustices perpetrated by the existing one, Clinton could (and, I would argue, should) have stopped there – simply circled the wagons and let his opponents’ attacks come, hoping that the credibility he had established by proving his

noble intentions would carry him through the debate with public support for the plan intact. Of course, this is not what happened. In his speech, Clinton practically was his own devil’s advocate, laying out cost figures and planting naysayers that were both unnecessary and counterproductive: “Some will be asked to pay more,” Clinton cautioned, for example (par. 77); “Let’s not kid ourselves, it’s not that simple,” he warned in another section (par. 66); “There can’t be any something for nothing, and we have to demonstrate that to people. This is not a free system,” he pointedly declared, following this a few sentences later with the assertion that “there cannot be any such thing as a free ride. We have to pay for it. We have to pay for it” (par. 67, 69). When

Clinton stopped talking about the pressing, noble, transcendent need for a health care system that put people above profit, he really stopped talking about it. The tenor of

Clinton’s discourse in these economically-centered sections of his address went about as far away rhetorically as was possible from the arguments that supported the precedence of humanitarian issues, and, in shifting the focus of his argument, Clinton also turned away from his primary persuasive message that predominated in the initial sections of his address.

What became an issue in Clinton’s speech, then, was the consistency of the basis of his appeal, and, correspondingly, the consistency of his drama itself. Clinton in the first half of his speech seemed to fully embrace a clear and compelling drama that was derived, fundamentally, from the humanitarian terministic screen, and was replete with clear scapegoats, sympathetic victims, and a well-defined route to transcendence.

However, in later sections of his address, Clinton’s extended justifications of the economics of his plan, as well as his baffling insistence on asserting that cost was an

important aspect of his plan (“We have to pay for it. We have to pay for it”), constituted a de facto rejection of this previously established humanitarian drama, and an embrace of the drama of his opponents.18 In fact, Clinton’s repeated insistence on the soundness of

his “numbers,” exemplified by statements such as: “I believe our numbers are good and

achievable,” and “we gave these numbers to actuaries from major accounting firms and

major Fortune 500 companies who have no stake in this other than to see that our efforts

succeed” (par. 76), practically constitute an outright challenge to his opponents to come

after him on the economics of his plan. And, considering later admissions by the

architect-in-chief of his plan, Ira Magaziner, which made clear that Clinton’s cost-

estimates were effectively indefensible, this hyper-confidence was apparently unwarranted. Clinton’s opponents, of course, took up his challenge wholeheartedly – and

why not, since it meant that they would not have to acknowledge the basis of Clinton’s

compelling primary drama. As a result of Clinton’s inconsistency precipitated by his

insistence on arguing over the cost of his proposal, the lengthy debate following his

speech that took place in the public sphere, which should have been a battle between the

two competing dramas, became a battle fought exclusively within the parameters of the

drama of Clinton’s opponents.

18 Interestingly, many of these specific economic justifications and contextualizations that were so crucial to the weakening of Clinton’s address were added in after the first draft was prepared. While it was widely reported that the wrong speech had initially been loaded into Clinton’s teleprompter, forcing him to deliver the first few minutes of his address from memory, these deviations, which are evident when comparing the “as delivered” and “as prepared” versions of the speech, are pervasive throughout the address. These new passages, which are typified by phrases such as: “Yes, it will cost some more in the beginning,” and “I think we can save money in this system if we simplify it” (par. 32, 39; see also: Clinton “as prepared,” par. 33, 39), almost exclusively reference economic aspects of Clinton’s plan. While no definite conclusions can be drawn from the presence of these last-minute inclusions, it is reasonable to assume that their initial absence is evidence that Clinton’s original strategy was, in fact, to more exclusively present his plan in terms of its humanitarian elements. 84

Overall, the fact that Clinton allowed the debate subsequent to his address to center on economics was highly damaging to public support of his plan. By failing to strongly establish the features of his own drama in his initial speech, Clinton lost his best opportunity to decisively shape his audience’s perception of the health care system, and thus of his proposal. This is not to say, however, that Clinton did not make a concerted effort to rhetorically reinforce the humanitarian basis of his own drama following his initial address. Many of his speeches subsequent to the debate continued, in fact, to stress these issues. In his weekly radio address of October 30, Clinton asked: “Who are these people caught in this broken system?”, citing numerous individual stories, such as the

“working mother with a sick child that had to buy her own insurance and who, every month, must ask herself, ‘Do I pay the rent or the medical bills’ (Clinton, qtd. in Disch

21). In his State of the Union address in January of 1994, as another example, Clinton pointedly reasserts this humanitarian framework, telling stories of suffering victims of the system, such as “Richard Anderson of Reno Nevada, [who] lost his job and, with it, his health insurance. Two weeks later, his wife, Judy, suffered a cerebral aneurysm.” The

Andersons, Clinton dramatically reveals, after being “literally forced into bankruptcy” by their health bills, wrote to Hillary Clinton, and pleaded for health reform: “‘Mrs.

Clinton,’” Anderson wrote, “‘no one in the United States of America should have to lose everything they've worked for all their lives because they were unfortunate enough to become ill’” (pars. 45-47). In these speeches, Clinton reminds Americans of their membership in the collective community of “the United States of America,” and makes clear that it is a foundational principle of this community for people to look out for one another, and thus to prevent the suffering of these victims. Clinton’s rhetoric,

characterized by passages like: “You know, my fellow Americans, this is really a test for all of us,” is fundamentally inclusive, reemphasizing the identification that was so crucial to the efficacy of his humanitarian drama (“State of the Union,” par. 66). Clinton’s plan, then, with its guarantee of access to health care, would be a manifestation of this collectivity that Clinton implies is the essence of American identity.

Despite this and other attempts to re-center the debate around humanitarian issues, though, Clinton’s power to influence public discourse after his initial speech had ended was extremely limited. From the moment Clinton uttered the last words of his oration on

September 22, 1993, any real power to control the debate, or, actually, to control the public’s perception of the debate, fell into the collective hands of the press.

That the media have a formative influence on the public’s sense of political issues has been well-documented in communications scholarship in recent years. One aspect of this influence particularly relevant to the health care debate is referred to as “agenda- setting.” As described in a recent issue of the Journal of Communication by Scheufele and Tewksbury, agenda-setting “refers to the idea that there is a strong correlation between the emphasis that mass media place on certain issues (e.g., based on relative placement or amount of coverage) and the importance attributed to these issues by mass audiences” (11). In other words, according to this widely-accepted theory, the media sets the “agenda” for public discourse. While this does not mean that the public’s opinions are themselves directly influenced by media coverage, it does suggest that the choice of issues the public forms opinions about, and thus considers important to broader policy questions, is subject to press influence; as Bernard Cohen puts it in The Press and

Foreign Policy: “The press may not be successful much of the time in telling people what

to think, but it is stunningly successful in telling its readers what to think about” (13). So, while the press may not have been able to influence the public’s degree of support for

Clinton’s health care plan, by portraying an inextricable link between the plan itself and its “cost,” the media was able to draw the public’s attention to this issue.

Correspondingly, because of the dearth of coverage of “security,” the prominence of this aspect of the Clinton plan was severely diminished in public discourse. Overall, then, because of the agenda-setting power of the press, the public’s filtering of the health care debate was more likely to be done through the economic screen than the more unifying humanitarian screen.

Stories in the Times and The Washington Post were especially influential in setting the agenda for the debate following Clinton’s speech. First of all, as McCombs

Einsiedel and Weaver assert, “the leadership role of The New York Times in American journalism – what we would term its agenda-setting power – is widely known” (44; emphasis in original). Second of all, geographically, both the Times and the Post are located in what are often considered the preeminent “power centers of this country” (49).

For example, as Elizabeth Kolbert reports, those who ran advertisements both for and against Clinton’s health care plan focused their attention on locations where they could best “amplify their influence,” making sure their ads were seen by those who would

“shape the debate” (A20). New York and Washington D.C. were the logical choices in this respect, since these places were “where editors and reporters who decide the news live[d]” (West, Heith and Goodwin 43).

As has been extensively documented, an “important influence on the media agenda, and thus indirectly on the public agenda, is the work of various interest groups”

(McCombs, Einsiedel and Weaver 98). During the health care debate, groups opposed to

Clinton’s plan vastly outspent Clinton’s supporters; the issue in fact “unleashed a tidal wave of interest-group spending” as a variety of companies stood to lose a fortune if the plan was implemented, and thus were logically justified spending their money to prevent an even greater loss of it. Over the course of the debate, on advertising alone, the

Pharmaceutical Research and Manufacturers Association (who would have lost big because of price caps in the plan) spent $20 million dollars, the Health Insurance

Association of America, which represented small and medium-sized health insurance companies (the insurance companies who stood to lose the most under Clinton’s plan) spent $14 million, and the Republican National Committee spent $1.1 million; even the

Christian Coalition, headed by the markedly conservative televangelist Pat Robertson, spent $1.4 million dollars on advertisements against the plan (West, Heith and Goodwin

41-44). Overall, as Nicholas Laham notes, “the health care industry spent more money to influence the outcome of the debate on medical reform than interest groups have on any other issue in American history” (59).

Many polls at the time showed that these ad campaigns in themselves did not have a clearly defined effect on public attitudes; West Heith and Goodwin’s study, in fact, revealed that “there was no association between seeing ads and feeling there would be a substantial tax increase [for example] under the Clinton program, but a significant relationship emerged between that impression and seeing the news.” They conclude that

“elite views could have been altered by a public relations campaign, but there is little evidence documenting a substantial impact on the public at large beyond increased knowledge about the president’s program, at least among the national sample we

examined” (54, 57; emphasis mine). In other words, the ad campaigns did not influence the general public as much as news coverage of the campaigns did, so, by targeting their advertisements at areas where “those who decide the news live,” interest groups were able to considerably influence their own news coverage, and, thus, help set the “agenda” for discussion of the plan in the public sphere. The interest groups, as well as the advertising agencies they had hired, knew this, and had planned accordingly; Ben

Goddard bragged that his agency “worked the press corps very hard. We had a press conference every time a new ad was released. We had an editorial board program, we wrote op-ed pieces, we hit the talk shows all across the country. It was a combination which built press interest” (qtd. in West, Heith and Goodwin 48). Clearly, the strategy of

Clinton’s opponents was geared toward influencing the debate by shaping the conversation in the press, emphasizing the discursive framework (and, thus, the drama) that was most conducive to dividing the public. Given the money spent by these groups, it is clear that this framework, which filtered the conversation through the economic screen and thus fomented social divisiveness, was predominant.

The Triumph of the Status Quo

No matter what principles of analysis are used to dissect the failure of Bill

Clinton’s attempt to institute universal health care, what jumps out is the astonishingly rapid evaporation of public support for the plan. As Bert A. Rockman sums up this amazing turn:

When Clinton introduced his proposal (without there actually being legislation at hand), support for it ran about two to one in its favor, approximately 60 to 30 percent. But in a matter of two months, support for it decreased by 20 percent and

opposition gained by 20 percent, producing more persons opposed to the Clinton plan than in favor of it. (401)

Overall, I would argue that this precipitous drop in support for Clinton’s plan was a result of the triumph of the drama of Clinton’s opponents in the minds of the public, a primary cause of which was the preponderance of press coverage which reflected the terms, and adopted the point of view, of this oppositional drama. This rhetorical one-sidedness in the press, though, was made possible by the Clinton’s wavering presentation of his own drama. The dichotomous nature of his speech not only weakened its persuasiveness, but as well gave his opponents the opportunity to ignore the rhetorical underpinnings of his humanitarian drama, while simultaneously couching the iterations of their own drama as responses to economic challenges that Clinton himself had issued.

This resulting dominance of the drama of Clinton’s opponents was crucial to the solidarity of the public. By effectively “directing the attention,” as Burke would put it, away from the humanitarian aspects of health care, and toward the economic ones, the divisive outlook that was concomitant to the rhetorical paradigm espoused by this oppositional drama became the outlook of the public in regard to health care itself. While the desire for universal coverage, rooted in an impulse to help one’s fellow human beings, was not extinguished, the economic issues that were foregrounded in the oppositional drama, in effect, were placed in front of these humanitarian impulses. In an interesting twist, Rockman notes that

by July 1994, while support for Clinton’s proposal (now only one of several being considered in Congress) had decreased to less than 40 percent, support for the principle of universal health care coverage, depending on the wording of the polling questions, varied from 60 to 80 percent support. (401)

As evidenced, Clinton’s audience – the American people – still were concerned with their fellow citizens’ access to coverage. Because of the influence of the ascendant oppositional drama, though, their conception of the health care system was colored by the perception that humanitarian issues were by necessity contingent upon cost considerations. This, of course, was only a matter of perception, and it had been up to

Clinton to change this view of the health care system, to allow this pre-existing desire for the collective benefit to the community to be seen as the paramount issue in health care discussions. Once cost became a determinative issue in the minds of Clinton’s audience members, however, the economic details of the plan started to matter, and, considering the complexity of the proposal, these details quickly overwhelmed the conversation

(clocking in at 1,342 pages, the text of Clinton’s plan was referred to as a “policy

‘Godzilla’” by Congressman Tom Foley [Holloway 171]). Essentially, the typically labyrinthine financing of government programs such as health care, if considered as a primary criterion for discussion of the plan, has the potential to quickly obfuscate the underlying purpose for the program in the first place – which in this case was the guarantee of universal access to health care for all Americans.

Put simply, Americans’ support for universal health care is dependent upon the rhetorical paradigm within which the health care system is perceived. Clinton’s rhetorical task, then, was to firmly establish a conception of health care that would enable his audience to consider the humanitarian issues involved with his plan’s implementation as paramount. To do this, Clinton delineated a specific drama, which adhered to the dramas described in the theories of Kenneth Burke. As Burke maintains, the motivational power of these dramas is dependent on the cogent establishment of certain elements – such as

suffering victims and sacrificial scapegoats – which provide an audience with a clear route to the transcendence of a “discordant note” in their society. For Clinton, these elements were indeed present in his drama, however, they were not presented clearly enough – he didn’t provide a clear destruction of his scapegoats, and, later in the speech, he in fact seemed to embrace the framework of a divergent drama altogether. Clinton’s opponents, on the other hand, suffered from no such weaknesses. Their drama, conveyed repeatedly in the weeks and months following Clinton’s initial address, was sharply focused, and offered a clear and complete path to transcendence, effected by the destruction of new, clearly-targeted scapegoats.

The dominance of the opponents’ drama in the press, then, which was a result of the confluence of several factors – Clinton’s weak original message, his corresponding initiation of economic debates that were conducted exclusively in the terms of this oppositional drama, and, perhaps most importantly, the vast amount of money and effort the opposition put into advertisements, op-ed pieces, public appearances and press conferences – enabled their message to exert a decisive influence on the minds of the public. The paradigm promoted by the oppositional drama (which, of course, was a reaffirmation of the paradigm in existence), completely negated the need for Clinton’s entire proposal. In fact, within this version of reality, Clinton’s Health Security Act became a danger to American society. Instead of the notion that universal health care would pull up the most disadvantaged members of society by providing them with a way to access preventative care – and, thus, enabling them to reduce their overall use of the system – the oppositional drama posited that average Americans would sink down closer to the level of the uninsured, having less access to a lesser quality of care. This

frightening notion, which was a direct ramification of the idea that health care was a product, was highly formative of the public’s perception of health care, and, thus, of

Clinton’s plan. No more was it a noble establishment of an essential human right under the law; now, it was a reckless waste of money that the country could ill afford.19

Clinton’s failure to effectively establish his own drama, within which he made the case for health care independent of these monetary concerns, and, correspondingly, his failure to effectively establish a lasting identification amongst his audience that would have secured their continuing support, meant that the fundamental divisiveness engendered by the oppositional drama easily clouded out the public unity on the issue that was necessary for the enactment of this momentous piece of legislation.

Not only, though, was public opinion turned against what came to be known as

“the Clinton plan,” the fundamental divisions in society that were exposed during this debate continue to be used to undermine any attempt at instituting comprehensive public health access. In general, in fact, the “us versus them” mentality that surfaces in debates over public policy conducted in the public sphere, which casts the underprivileged as

leeches on the social body, is, ultimately, a mentality defined by economic concerns and

not humanitarian ones, and thus a continuation of this ongoing debate. While there is no

clear answer to the question of how much influence economic concerns should have in

the creation of public policy, including but not limited to health care, what is clear from

an examination of the health care debate of 1993-1994 is that the public’s support of

policy strategies is radically dependent upon the rhetorical paradigm of reality that is

19 Of course this dramatically-rendered argument ignored the fact that there was a defensible case to be made that universal health care would actually save money, by curbing the wasteful access patterns of the uninsured (catching illnesses earlier), and as well by pooling the economic risk so that it was more evenly distributed across income brackets. These individual arguments, though, while sound, are immaterial to the notions of collectivity and human rights that Clinton rightly attempted to tap into in his rhetoric. 93

adopted in the public sphere. If, as Burke writes, “different frameworks of interpretation will lead to different conclusions as to what reality is” (Permanence and Change 35), the dramas used by rhetors on either side of an issue, then, are part of an attempt to impose tendentious interpretive “frameworks” on an audience, which, if successful, would compel them to see reality from one of many possible points of view.

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