Victims of Health‐Care Reform: Hirschman's Rhetoric of Reaction in the Shadow of Federalism

Abstract

This paper harnesses the Narrative Policy Framework's articulation of characters as vital components of policy narratives to enhance the analytical traction of Albert O. Hirschman's typology of reactionary and progressive rhetoric. Using content analysis of transcripts containing policy narratives presented in federal legislative, executive, and judicial venues, this paper presents an analysis of the rhetorical use of victims as surrogates for an underlying conflict over fundamental values of liberty and equity in debates surrounding the Affordable Care Act (ACA) in the United States. This research finds that Hirschman's rhetorical typology continues to be useful in analyzing the development of the welfare state, while benefitting from its pairing with the NPF's focus on the characters which occupy policy narratives. Victims are strategically deployed in policy narratives around the ACA. Reactionary rhetoric had a statistically significant association with the value of liberty and portraying state and local governments as victims of federal overreach. Progressive rhetoric had a strong and statistically significant association with the invocation of family as victim whereas those using reactionary rhetoric type more often employed government as victim. These differences in the types of victims can be understood as reflecting a conflict between the values of equity and liberty in federal relations undergirding the U.S. health‐care system, shifting control of state‐level government, and as differences between the political makeup of the Democratic and Republican parties.

Advancing the Narrative Policy Framework? The Musings of a Potentially Unreliable Narrator

“…In another meso‐level NPF analysis, Smith‐Walter () uses a mixed‐method approach relying primarily on content analysis to examine policy narratives regarding the Affordable Care Act (ACA) within multiple institutional venues including the Senate, the White House Health Care Summit, and oral arguments from the Supreme Court. Theoretically, this addition to the special edition integrates Albert O. Hirschman's typology of rhetoric with the NPF to examine the strategic deployment of ACA policy narratives.…”

“…However, we also find studies being applied to other policy areas. In this issue, Merry () examines firearm policy, Smith‐Walter () analyzes health care policy narratives related to the ACA, McBeth and Lybecker () explore sanctuary cities, and McMorris et al () examine Measure 97, a ballot initiative. Outside of this issue, there is evidence that the NPF continues to broaden its policy area reach.…”

“…When the NPF began, it was largely based on the content analyses of what were termed “public consumption” documents (McBeth et al, ), or those documents made readily available by interest groups, the media, and policy advocates. Some of the data used in this issue show the NPF to be applicable far beyond public consumption documents (and the tendency to associate such analyses strictly with how they interact with public opinion), including in major governmental venues such as the United States Congress, Supreme Court, and the executive branch (McBeth & Lybecker, ; Smith‐Walter, ). The NPF also appears to be tapping some emerging data sources, including Merry's () use of Facebook posts and McBeth and Lybecker's () use of Google Trends.…”

“…Research in this special issue exemplifies that aim. Lawlor and Crow () incorporate the concept of risk; Smith‐Walter (), Albert O. Hirschman's rhetoric of reaction (1991); Kirkpatrick and Stoutenborough (), third‐party effects; and, McMorris et al () and Zanocco et al () invoke what has now almost become a staple belief system approach within the NPF, Cultural Theory (e.g., Thompson, Ellis, & Wildavsky, ), to name but a few of the integrative theoretical contributions of this issue. Here, I take license and highlight two general contributions.…”

“…Merry () defines framing broadly as simply the portrayal of a policy problem. Gottlieb et al (), McMorris et al (), and Smith‐Walter () all appear to use the term casually, without providing a clear definition. My intent here is not to impugn these works as sloppy or careless, as all do seem to appropriately apply the framing concept, given the context in which they invoke it.…”