Debating health care: Rhetorical theory and the discourse of public policy-making

This dissertation uses a historical study of the national health insurance debates that have occurred in the United State since 1934 as a basis for developing an adaptation of classical rhetorical theory able to support a study of the policy-formation processes at work in bureaucratic mass democracy. The first chapter points out important conceptual gaps between the theorizations of deliberative discourse traditionally associated with classical rhetoric and the real-world processes of policy-level debate and suggests modifications of the notions of audience and rhetorical situation to help close that gap. In particular, it argues that, for the study of policy-level debate, rhetorical theory should adjust its focus to recognize the larger conversation, rather than the individual text, as the unit of analysis.; The next two chapters illustrate just such an approach, providing an extended study of the origins and early progress of the debate through an examination of crisis points in the fight for national health care--the New Deal, the Truman Health Plan, and the establishment of Medicare--and developing along the way adaptations of the notions of speaking agent, kairos, and exigence that enhance the ability of those traditional concepts to account for the argumentative strategies characteristic of contemporary political debate.; Chapter four shows hows the argumentative strategies used by the Reagan Administration inhibited health care debate during the early 1980s and then how the increasing economic pressures brought health care reform back to the forefront of the public agenda. To account for the emergence of a "health care crisis" during the Bush Administration, it develops an adaptation of Perelman's notion of presence that helps to explain how issues "breach the horizon of public awareness" under certain circumstances. Finally, it uses the concept of kairos developed in earlier chapters to account for the defeat of Clinton's Health Security Act in the face of what appeared to be certain victory.