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2 The Working Class and Economically Disadvantaged: Increasing Invisibility

2 The Working Class and Economically Disadvantaged: Increasing Invisibility

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BILL CLINTON’S SEPTEMBER 22, 1993 ADDRESS ON HEALTHCARE REFORM...



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thinly veiled critiques of economically disadvantaged Americans who—

since the Reagan era—were depicted as lacking the desire to act responsibly, maintain a job, and be self-sufficient. His emphasis on the middle

class was closely linked with his appropriation of conservative rhetoric of

limited government and with a politics of compromise. As Jon Herbert

writes:

The decline of the liberal order … was particularly important in shaping the

rhetorical challenge for Clinton … He undoubtedly embraced the challenge

of subsuming the established liberal-conservative dichotomy in pursuit of

new forms of centrist legitimacy for his leadership.13



Clinton’s identification with the middle class was explicit, central to his

presidential campaigning and presidential rhetoric, and a subject he commented upon repeatedly to reinforce popular perception that he understood, represented, and indeed came from the middle class. When he

accepted the Democratic nomination, he said:

I am a product of the middle-class, and when I am president, you will be

forgotten no more … In the name of all those who do the work and pay the

taxes, raise the kids, and play by the rules, in the name of the hard-working

Americans who make up the forgotten middle class, I proudly accept your

nomination for President of the United States.14



In Clinton’s rhetoric, the ‘middle class’ was not just an economic and

social category, but a potent signifier that reflected a particular romantic

American ideal of the ‘everyman’/‘everywoman’ who respects the law and

contributes to society, as discussed in Chap. 3.

Clinton ultimately named his welfare reform which received Republican

support the “Personal Responsibility and Work Opportunity Reconciliation

Act”15—insinuating that the primary problem the economically disadvantaged faced in the US was not a lack of quality education, adequately

remunerated jobs, and discrimination in the provision of government

social services, as Johnson had argued, but their own defects of character

and effort.16 Welfare reform as Clinton pursued it gave his “third way”

philosophy of government some credibility for conservatives. Though it

did not go nearly as far as many conservatives desired, in both rhetoric and

policy, it reflected many of their key concerns and broke decisively with

both the rhetoric and policy of Johnson.



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6.3



CLINTON’S “THIRD WAY”



As President, Clinton portrayed himself as a centrist who advanced a

“third way,”17 which was neither conservative nor liberal, but somewhere

between the two: above all, not only politically moderate, but also nonideological, concerned with maximizing positive outcomes at minimal

cost and without an ideological commitment either to comprehensive

and generous state-centered welfare programs or a drastically truncated

welfare state with few social safety nets inspired by the principles of limited government. The American judge Richard Posner characterizes the

“third way” in an American context as follows, building on the writings

of political scientist Stephen Skowronek and defining it as a “pragmatic

centrism”:

Obama resembles Presidents such as Nixon and Clinton in the following

respect. They are what the political scientist Stephen Skowronek calls practitioners of “third way” politics (Tony Blair was another), who undermine

the opposition by borrowing policies from it in an effort to seize the middle

and with it to achieve political dominance.18



As Clinton articulates in his speech, his policies stem from pragmatic concern with the ways in which globalization necessitates changes in how

government relates to citizens and enables them to be competitive in a

global economy that demands new levels of education, skills, and infrastructure to sustain economic growth. It also places an emphasis on individual citizen responsibility and effort, and seeks to reduce dependency

on government, a key component of his welfare reforms, which we will

discuss below.

Clinton’s “third way” philosophy of governance often tilted further

toward conservative concerns with limited government, low taxes, and

minimizing government expenditure rather than liberal concerns with

egalitarianism and social and economic justice.19 Many of the arguments

he makes in his healthcare reform speech reflect concerns with economic

efficiency and growth. British sociologist Anthony Giddens articulated a

definition of the “third way,” which was more concerned with egalitarianism, social justice, and positive liberty than the one that Clinton would

ultimately adopt in his policies and that Posner and Skowronek use to

characterize the “third way” in the US.  Indeed, the term and concept

as Giddens defines it applies more to Tony Blair and British politics than

to Clinton and American politics, despite Blair being in part inspired by



BILL CLINTON’S SEPTEMBER 22, 1993 ADDRESS ON HEALTHCARE REFORM...



183



Clinton’s own revising of liberal-left politics in a pragmatic, centrist, compromising vein.

In the case of Clinton’s healthcare reforms, the “third way” reflected

the politically moderate policy core of the reforms: a universal guarantee

of health insurance with quality and cost controls based on government

regulation (reflecting liberal values), while maximizing the freedom of private healthcare insurers to continue to provide healthcare insurance on a

for-profit basis, and maximizing consumer choice to pick amongst a wide

range of health insurance plans (reflecting conservative values). Thus, his

healthcare reforms and his speech advance a liberal goal of universal health

insurance via moderately conservative means. Before we turn to his healthcare reform address, we will consider the political character of his healthcare reform efforts and will examine several possible causes of their failure.



6.4



CLINTON’S HEALTHCARE REFORMS: POLICY

HISTORY AND CAUSES OF REFORM FAILURE



Clinton’s20 efforts to create universal health insurance in 1993 and 1994

were the most focused and advanced since those of Richard Nixon and

Truman, although there were various health reform bills before Congress

when Clinton attempted to pass his reforms.21 The Clinton proposal called

for managed competition with federal budget controls under an employermandated plan.22

The discursive strategy conservatives used to defeat Clinton’s legislation nested comfortably with the dominant conservative discourse of

“socialized medicine” as the bogeyman of American politics and society,

threatening the civil liberties of Americans, their freedom to pick health

insurance (or freedom to abstain from being insured), and allegedly bringing down the quality of care for all Americans. As with prior conservative

efforts to defeat universal health insurance legislation during the Truman

era, the rhetoric employed was emotive, impressionistic, short on facts and

analysis, and high on innuendo, fear-mongering, and misrepresentation.23

Although the bulk of the energy and resources devoted to its rejection came from conservative Republicans and businesses fearful of revenue

loss, Democrats also played a role in the defeat of the legislation:

The health insurance industry committed tens of millions of dollars to … TV

ads, which began denouncing the “Hillarycare” plan months before it was

completed. The hospital industry, the drug industry, and many physicians’



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N. SCHIMMEL



groups joined the insurers in opposition. Business support began to crumble. Organized labor, angry at the Clinton White House because of the

NAFTA free-trade agreement, was lukewarm at best. Liberal backing was

tepid, because the compromise plan the Clintons came up with fell short of

the single-payer universal-coverage plan that the left had expected from a

Democratic president.24



After 12 years of Republican control of the White House, and Reagan’s

consistently anti-government rhetoric, the Democrats faced a public and

political culture that was almost intrinsically skeptical of the government,

its value, efficacy, and capacity to promote genuine positive social change:25

the Clinton proposals come at a juncture when government is held in general disrepute. Taxes are not the only issue … more so are the public’s worries about governmental effectiveness. Many Americans believe, or are quite

ready to be convinced, that governmental “bureaucracies” bungle everything they touch.26



Public attitude surveys since the 1950s showed an almost continuous drop

in faith in the competence and integrity of government and in its trustworthiness. In 1958, over 70 percent of Americans expressed trust in “the

government in Washington to do what is right” always or most of the

time. The figure kept declining to a low of roughly 25 percent in 1980.

By 1992, it was even lower at 22 percent and, by 1994, it had dipped to

20 percent.27

Cognizant of these tendencies, part of Clinton’s rhetorical strategy was

to downplay the role of government in the healthcare plan. For example,

he was sensitive to public skepticism of government. Campaign posters advocating his Health Security Act listed three options: Government

Insurance, Guaranteed Private Insurance, and No Guarantee of Coverage.

“Guaranteed Private Insurance” was placed the middle in bold, seeking

to focus on the private component of his universal health insurance plan

rather than invoking the government role in its implementation.28 But such

rhetorical shifts were not enough to allay the public’s anxieties about the

government’s ability to implement universal health insurance reform fairly

and successfully, especially given the intensity of conservative attacks on the

very notion of the government having any role to play in healthcare reform.

Clinton and the Democrats had an uphill battle to face given the political,

cultural, and media climate—but there was nothing inevitable about their

failure to pass healthcare reform. The urgency to pass universal insurance



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