UNIVERSIDAD COMPLUTENSE DE MADRID FACULTAD DE FILOLOGÍA Departamento de Filología Inglesa II (Literatura de los Países de Lengua Inglesa) TESIS DOCTORAL The rhetoric of American exceptionalism in Obama's speeches on health care reform La retórica del excepcionalismo americano en los discursos de Obama sobre la reforma sanitaria MEMORIA PARA OPTAR AL GRADO DE DOCTOR PRESENTADA POR Carmen Serrano Lanzuela Director Dámaso López García Madrid, 2014 © Carmen Serrano Lanzuela, 2014 UNIVERSIDAD COMPLUTENSE DE MADRID FACULTAD DE FILOLOGÍA Departamento de Filología Inglesa II (Literatura de los Países de Lengua Inglesa) LA RETÓRICA DEL EXCEPCIONALISMO AMERICANO EN LOS DISCURSOS DE OBAMA SOBRE LA REFORMA SANITARIA MEMORIA PARA OPTAR AL GRADO DE DOCTOR, MENCIÓN EUROPEA PRESENTADA POR Carmen Serrano Lanzuela Bajo la dirección del doctor Dámaso López García Madrid, 2013 UNIVERSIDAD COMPLUTENSE DE MADRID FACULTY OF PHILOLOGY English Department II (Literature) THE RHETORIC OF AMERICAN EXCEPTIONALISM IN OBAMA'S SPEECHES ON HEALTH CARE REFORM LA RETÓRICA DEL EXCEPCIONALISMO AMERICANO EN LOS DISCURSOS DE OBAMA SOBRE LA REFORMA SANITARIA EUROPEAN DOCTORAL THESIS Submitted By Carmen Serrano Lanzuela Supervised By Dr. Dámaso López García Madrid, 2013 Carmina Serrano Lanzuela, 2013. Acknowledgements I would like to acknowledge many people for their invaluable support and assistance. I am grateful to my supervisor, Professor Dámaso López García. I will always be endebted to him for his kindness, continual encouragement, wise and cunning advice and very timely and witty sense of humour. I would also like to extend thanks to Professor Glyn Hambrook (University of Wolverhampton) and Professor Iwan Morgan (Institute for the Study of the Americas at University College London) for their support and guidance during the research. Thanks are due to Professor Nigel Bowles (Rothermere American Centre at the University of Oxford), Mr. Paul Sullivan (Senate House, University of London), Ms. Tony Fine (Fordham University), Ms. Mariah Strauch-Nelson (Georgetown University) and Steven Hobbs (British Library) for the help and assistance they provided. Notwithstanding all the above support for this project, any errors and/or omissions are solely my own. Contents Acknowledgements .............................................................................................. 3 Acronyms and Abbreviations ............................................................................ 7 Introduction .......................................................................................................... 11 0.1 American Exceptionalism and Health Care ....................................... 11 0.2 Objectives ......................................................................................... 14 0.3 Methodology and Sources................................................................. 16 0.3.1 Methodology ............................................................................... 16 0.3.2 Sources – Research Materials Used ........................................... 18 0.3.2.1 Primary Sources ...................................................................... 19 0.3.2.2 Secondary Sources .................................................................. 23 0.4 Structure and Content ....................................................................... 24 0.5 Theoretical Background .................................................................... 26 0.6 Cultural Studies ................................................................................. 30 1 What is American Exceptionalism? ........................................................... 35 1.1 Introduction ....................................................................................... 35 1.2 Development of the Concept ............................................................. 36 1.3 American Creed ................................................................................ 41 1.4 Obama’s Speeches and American Exceptionalism ........................... 45 1.5 Conclusion ........................................................................................ 47 2 Health Care in the United States ................................................................. 49 2.1 Introduction: Purpose of Description ................................................. 49 2.2 Number of Uninsured Americans ...................................................... 50 2.3 Negative Impact of Lack of Health Insurance on Public Health ......... 52 2.4 High Price of Health care .................................................................. 54 2.5 How Does the U.S. Compare to Other Countries? ............................ 55 2.5.1 Life Expectancy........................................................................... 55 2.5.2 Level of Child Mortality - Under-5 (per 1,000 live births) ............. 56 2.5.3 Health Care Spending ................................................................. 57 2.6 Conclusion: Poor Job ........................................................................ 58 i 3 The Need to Reform ........................................................................................ 60 3.1 Introduction ....................................................................................... 61 3.2 Is There a Real Need for Reform? Assessment of the American Health Care System ............................................................................. 61 3.2.1 Reform is Necessary ................................................................... 61 3.2.2 Reform is Not Necessary ............................................................ 75 3.3 Reforming .......................................................................................... 76 3.4 Universal Coverage ........................................................................... 79 3.4.1 Failed Past Attempts to Attain Universal Coverage .................... 80 3.4.2 Why Have Past Attempts Failed? ............................................... 86 3.5. Conclusion ....................................................................................... 90 4 Theoretical Background for Reform .......................................................... 91 4.1 Introduction ....................................................................................... 91 4.2 Socialized Medicine and the Welfare State ....................................... 92 4.2.1 Concept ...................................................................................... 92 4.2.2 Socialized Medicine and the PPACA .......................................... 96 4.3 Moral Imperative – Utilitarianism – Craft Ethics ............................... 100 4.3.1 Need for Reform Based on Facts.............................................. 101 4.3.2 Need for Reform Based on Ethics............................................. 102 4.3.3 Moral Imperative and the PPACA ............................................. 106 4.3.3.1 Importance ............................................................................. 106 4.3.3.2 Utilitarian Strategy .................................................................. 107 4.3.3.3 Craft Ethics ............................................................................ 109 4.4 Conclusion - Scholars Ponder ......................................................... 110 5 Government Role in Providing Health Care ........................................... 112 5.1 Introduction ..................................................................................... 113 5.2 Measuring Government ................................................................... 113 5.2.1 Social Procurement ................................................................... 114 5.2.2 Proportion of Economy Subject to Regulation .......................... 115 5.3 Failure of National Health Insurance ............................................... 116 5.4 National Health Care and American Exceptionalism ....................... 120 5.4.1 Philosophical and Political Reasons ......................................... 123 5.4.2 Federalism – Structure of the U.S. State and its Institutions ..... 126 ii 5.4.3 Antistatist Political Culture ........................................................ 128 5.4.4 Absence of a Working-Class Movement nor Labour-Based Political Party ..................................................................................... 130 5.4.5 Racial Politics of the South ....................................................... 132 5.4.6 Special Interests to Keep Health a Private Endeavour ............. 133 5.5 Superstatutes Save the Day… ........................................................ 138 5.6 Conclusion ...................................................................................... 140 6 Reform comes with the PPACA ................................................................. 141 6.1 Introduction ..................................................................................... 142 6.2 The Context: Economic Recession ................................................. 142 6.3 Legislative Hurdles .......................................................................... 146 6.4 Reactions When PPACA Was Passed. The Outcome. ................... 160 6.4.1 Praise of the PPACA ................................................................. 160 6.4.2 Criticism of the PPACA ............................................................. 163 6.5 Implementation of the PPACA ........................................................