Success and Failure of Health Care Reform in the United States: Strategic FraminginPresidentialSpeechesand Media Samplesat Three Critical Juncturesfrom 1960-2013

Dissertation in Political Science

Mentoring team:
First supervisor: Prof. Dr. Christian Lammert
Second supervisor: Prof. Robert Entman PhD
Third supervisor: Prof. Dr. Eric Champagne

Health care reform in the United States has been a contentious and politically polarizing process, both fraught with political failure but also defined by key successes. This dissertation analyzes three health care initiatives under the Johnson, Clinton, and Obama administrations through a framing analysis that includes both speech and media samples. These particular administrations have been selected for analysis as they constitute the periods when Medicare∕Medicaid, the Health Security Act, and the Affordable Care Act (ACA) respectively were debated at the federal level, and the periods allow for a pre- and post-analysis of each policy’s passage or failure. There is a necessity of precise definitions and distinctions between frames and discourse. As such, this research identifies and categorizes different types of frames used in elite discourse at three critical historical junctures in health care development in the U.S. Six major public discourses surrounding health care are outlined: economic, rights, individualist, community, state, and federal problematizations of health care. These public discourses are transformed into frames through both a deductive and inductive coding process in MAXQDA 18, where different framing patterns are observed from 1962-1966, 1990-1994 and 2009-2013.

The frames used during these time periods reflect the social, political, and economic contexts of health care bill reform. Frames used in presidential discourse constitute an important aspect of the health care reform in a democratic and legislative process, as they are forces that help explain the frames in media texts. Framing helps us to understand not only how acts passed or failed; they also take into account the contexts in which they were proposed. This dissertation groups the main discourses and their transformation into frames through a coding process. The analysis shows a large amount of positive framing of the federal government in the 1960s in connection with framing of the elderly in both media and speech samples. The 1990s juncture shows strong economic framing and negative framing of the U.S. in Clinton’s speeches on health care reform, in contrast to the media samples. The mixed economic/rights frame was identified in the Obama’s speeches, but not the media samples. These frames provide insight into the messages relayed by political elites to influence the electorate and the general public, and illustrates how framing of health care goes beyond the binary of market and rights frames.

Health care reform in the United States has been a contentious and politically polarizing process, both fraught with political failure but also defined by key successes. This dissertation analyzes three health care initiatives under the Johnson, Clinton, and Obama administrations through a framing analysis that includes both speech and media samples. These particular administrations have been selected for analysis as they constitute the periods when Medicare∕Medicaid, the Health Security Act, and the Affordable Care Act (ACA) respectively were debated at the federal level, and the periods allow for a pre- and post-analysis of each policy’s passage or failure. There is a necessity of precise definitions and distinctions between frames and discourse. As such, this research identifies and categorizes different types of frames used in elite discourse at three critical historical junctures in health care development in the U.S. Six major public discourses surrounding health care are outlined: economic, rights, individualist, community, state, and federal problematizations of health care. These public discourses are transformed into frames through both a deductive and inductive coding process in MAXQDA 18, where different framing patterns are observed from 1962-1966, 1990-1994 and 2009-2013.

The frames used during these time periods reflect the social, political, and economic contexts of health care bill reform. Frames used in presidential discourse constitute an important aspect of the health care reform in a democratic and legislative process, as they are forces that help explain the frames in media texts. Framing helps us to understand not only how acts passed or failed; they also take into account the contexts in which they were proposed. This dissertation groups the main discourses and their transformation into frames through a coding process. The analysis shows a large amount of positive framing of the federal government in the 1960s in connection with framing of the elderly in both media and speech samples. The 1990s juncture shows strong economic framing and negative framing of the U.S. in Clinton’s speeches on health care reform, in contrast to the media samples. The mixed economic/rights frame was identified in the Obama’s speeches, but not the media samples. These frames provide insight into the messages relayed by political elites to influence the electorate and the general public, and illustrates how framing of health care goes beyond the binary of market and rights frames.