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10 Pathos in Support of Ethos: The Strategy of Personalization

10 Pathos in Support of Ethos: The Strategy of Personalization

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



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emotional and the moral, asking members of the House to look beyond

the cold logos of businesses into the individual eyes of the ailing, and to

empathize with their plight and respond to their needs. Reflecting a strategy of moralization, he states:

I want also to say to the Representatives in Congress, you have a special

duty to look beyond these arguments. I ask you instead to look into the eyes

of the sick child who needs care, to think of the face of the woman who’s

been told not only that her condition is malignant but not covered by her

insurance, to look at the bottom lines of the businesses driven to bankruptcy

by health care costs, to look at the “for sale” signs in front of the homes of

families who have lost everything because of their health care costs.53



Here Clinton is using pathos to bypass logos—not the logos of his healthcare reforms, but the logos of the healthcare industry and private insurers

whose profit priorities may weigh heavily upon Congressmen, and whose

preference for inertia and maintaining the current healthcare system can

easily win over Representatives afraid to take on the risks of change, even

if they are necessary. Here he is not invoking pathos in the context of a

reasoned moral argument as much as summoning images of vulnerability, suffering, and injustice, and empathically imagining an interaction

between the individuals experiencing such vulnerability and suffering and

Representatives in Congress. This act of empathic imagination ruptures

the chain of facts and logic than can conceivably rationalize a refusal to

embrace Clinton’s healthcare reforms and, without directly projecting

guilt, forces a confrontation of conscience.

Clinton continues to apply the strategy of personalization to evoke

pathos in the context of a series of individual injustices facing Americans

struggling to meet the costs of healthcare. He recounts:

I ask you to remember the kind of people I met over the last year and a half:

the elderly couple in New Hampshire that broke down and cried because of

their shame at having an empty refrigerator to pay for their drugs; a woman

who lost a $50,000 job that she used to support her six children because

her youngest child was so ill that she couldn’t keep health insurance, and

the only way to get care for the child was to get public assistance; a young

couple that had a sick child and could only get insurance from one of the

parents’ employers that was a nonprofit corporation with 20 employees, and

so they had to face the question of whether to let this poor person with a



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sick child go or raise the premiums of every employee in the firm by $200;

and on and on and on.54



One of the ways in which pathos has distinctive rhetorical power is a function of its relative incontestability. Whatever one thinks about Clinton’s

healthcare reforms, these individual experiences—as exemplars of what

is wrong with healthcare provision in the US—describe the tormented

emotions of individuals struggling to reconcile their healthcare needs

with their limited financial means, and do so in a way that, rather than

inviting dialogue and multiplicity of perspective, assert one overarching

claim: the sorrow and injustice which these individuals experience is a

result of the failure to reform healthcare. Emotions do not invite reasoned

argument and alternative viewpoints—they have intrinsic power and are

self-justifying simply by virtue of being felt and described. As such, they

are potent rhetorical tools which buttress reason and logos in support

of healthcare reform by making potential arguments against healthcare

reform unappealing by virtue of the emotional distress depicted of individuals who lack healthcare.

Clinton’s invocation of a child’s treatment in hospital and the way in

which the current healthcare system fails to reach many sick children in

need similarly creates a powerful expression of pathos in the service of

ethos. Discussing his visit to the Children’s Hospital in Washington, DC,

he states:

A nurse named Debbie Freiberg told us that she was in the cancer and bone

marrow unit. The other day a little boy asked her just to stay at his side during his chemotherapy. And she had to walk away from that child because

she had been instructed to go to yet another class to learn how to fill out

another form for something that didn’t have a lick to do with the health care

of the children she was helping. That is wrong, and we can stop it, and we

ought to do it.55



The juxtaposition that Clinton establishes between the image of a vulnerable and needy sick child and the dehumanizing and stifling bureaucracy

that results from the current system of health insurance in the US—which

prevents the child from receiving the support he needs during an anxietyprovoking treatment—provides an emotionally resonant image and individual narrative that buttresses the ethos of his speech.

There is one other way in which Clinton uses pathos to advance the ethos

of his speech, and that is with regard to advancing the value of bipartisanship.



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



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In this context, in contrast, he uses pathos to invite dialogue and constructive debate on healthcare reform implementation, and to affirm the moderate and malleable nature of his healthcare reforms which are open to the

perspectives of a broad cross-section of Americans, of all political persuasions, but which are uncompromising on the principle of universality.

6.10.1



Pathos and Bipartisanship



At the close of his speech, Clinton links pathos with the ethos of bipartisanship. To invoke positive feelings in association with his proposed

healthcare reforms, he emphasizes the bipartisan nature of the efforts to

reform healthcare and acknowledges that “we have differences of opinion,”56 but affirms that despite these differences, if we “look into our

heart,”57 Congress will find a way to address healthcare insecurity and

insufficiency. Using words such as “magical,” “moved,” and “proud,” he

generates a sense of patriotic shared mission and communitarian obligation in which whatever obstacles remain can be overcome because of unity

of purpose and transcendence of partisan division and political acrimony.

This is, of course, a highly idealized presentation of the political reality at

the timeindeed, his efforts failed in part because although the faỗade

of substantial agreement may have existed, it had rickety foundations and

there was no consensus on healthcare reform:

The proposal that I describe tonight borrows many of the principles and

ideas that have been embraced in plans introduced by both Republicans

and Democrats in this Congress. For the first time in this century, leaders of

both political parties have joined together around the principle of providing

universal comprehensive health care. It is a magic moment, and we must

seize it. I want to say to all of you, I have been deeply moved by the spirit

of this debate, by the openness of all people to new ideas and argument and

information. The American people would be proud to know that earlier

this week, when a health care university was held for members of Congress

just to try to give everybody the same amount of information, over 320

Republicans and Democrats signed up and showed up for two days just to

learn the basic facts of the complicated problem before us.58



Clinton’s depiction of the bipartisanship of healthcare reform efforts is

essential to maintain a rhetoric of urgency, moment, and even of inevitability and to link the political project of healthcare reform with a

more universalistic social imaginary that incorporates all Americans and



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transcends party politics. By referring to bipartisanship in a way which

makes it very hard for Republicans to back down from healthcare reform

efforts—because doing so would imply that they have spoiled the magic

and have failed to listen and respect the wishes of the American people

and the positive character of bispartisanship—he creates a rhetorical trap

whereby having set the terms of the debate any substantive objection to

his healthcare reforms becomes an act of destructiveness and disrespect

rather than one of potentially principled dissent.

Clinton goes on to make bipartisanship a necessary precondition for

the realization of an ethos of solidarity and care which he alludes to by

saying that “rising above these difficulties and our past differences to solve

this problem will go a long way toward defining who we are and who we

intend to be as a people in this difficult and challenging era.”59 Although

he does not describe bipartisanship as being necessarily constitutive of the

ethos he advocates—as we will see is central to Barack Obama’s rhetoric—

he nevertheless salutes sustained bipartisanship as a prerequisite for achieving public policy that reflects the ethos of communitarian solidarity which

he advocates. This necessitates transcending ideological division and coming together in support of his healthcare reforms, which he depicts as

being ideologically neutral, but infused with moral values of communitarian solidarity and care. This represents a sharp departure from the rhetoric

of Truman and Johnson, in which bipartisanship and political compromise

do not feature centrally because the prevailing social imaginary at the time

was more sympathetic to robustly liberal efforts to secure positive liberty

through government programs, and because of the strength of Johnson’s

Democratic congressional majority.

Having examined the rhetorical dimensions of ethos and pathos in the

speech, we will now examine how Clinton applies various rhetorical strategies to illustrate the logos of the speech which outlines how he envisions

fixing healthcare provision in the US and, in so doing, making a stillunachieved American social imaginary a new American social reality.



6.11



LOGOS: PROBLEMS AND PRINCIPLES



The core problems with American healthcare according to Clinton are as

follows:

• The high costs of healthcare and the risks of bankruptcy for those

without health insurance or insufficient health insurance.



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



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• Discrimination against individuals with pre-existing conditions by

insurers.

• 37 million Americans are uninsured. The majority are working,

but still do not receive health insurance. Tens of millions of other

Americans are underinsured; the quality of their insurance is precarious and weak and they are vulnerable to losing it.

• Rising medical bills that are forcing Americans to spend too much on

healthcare, far more than other nations, and undermining American

economic competitiveness as a result.

In addressing these problems, Clinton sets the parameters of the logos

of his speech by referring to six principles: security, simplicity, savings,

choice, quality, and responsibility. At the heart of the logos is the need for

a universal mandate whereby all Americans are required to be insured or

guaranteed subsidies or free insurance provided by the government if they

cannot afford it. He states: “Unless everybody is covered—and this is a

very important thing—unless everybody is covered, we will never be able

to fully put the brakes on health care inflation.”60 Reflecting on the current

insecurity regarding healthcare provision, he states that “our health care

is too uncertain and too expensive”61 and, regarding simplicity and savings, “too bureaucratic and too wasteful.”62 On the subject of quality and

responsibility, he states: “It has too much fraud and too much greed.”63

Having established the core principles that guide his logos and defined the

current problems which are preventing their actualization, he reaffirms the

ultimate overarching priority of his healthcare reform: healthcare security.

This is the paramount principle which reflects both the ethos and logos of

the reforms, and he argues that it can only be actualized with a government guarantee of universal health insurance: “We must make this our

most urgent priority, giving every American health security—health care

that can never be taken away, health care that is always there.”64

6.11.1



Logos and the Rhetorical Strategy of Personalization



The rhetorical strategy of personalization humanizes large, often abstract

matters of public policy relating to the six principles Clinton refers to and

conveys their urgency in a way to which audiences can relate. Indeed, in

references to Americans who represent a common or typical American

citizen—rather than one with a particularly high rank in government or

industry—this humanization is the major effect of personalization. But



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Clinton also uses personalization to call upon individuals with expertise

who share his convictions about healthcare reform. In so doing, by naming these individuals, he expands the circle of trusted authority and burnishes his own credentials.

So, for example, early in the speech, Clinton references his wife, Hillary,

as having conducted a wide-ranging program of research on healthcare

reform. In so doing, the Clintons become a synecdoche for the American

people, a conduit whereby small business owners, the underinsured and

the uninsured are all given voice. In the following passage, we see the

way in which speaking to individual Americans and learning about their

stories and experiences of healthcare takes central stage, and also epideictically demonstrates Clinton’s openness, intellectual and policy rigor, and

his desire to be inclusive of all Americans in the efforts to improve and

expand healthcare provision:

Over the last eight months, Hillary and those working with her have talked

to literally thousands of Americans to understand the strengths and the frailties of this system of ours. They met with over 1,100 health care organizations. They talked with doctors and nurses, pharmacists and drug company

representatives, hospital administrators, insurance company executives and

small and large business. They spoke with self-employed people. They talked

to people who had insurance and people who didn’t. They talked with union

members and older Americans and advocates for our children.65



Later in the speech, Clinton references the Surgeon General, marshalling

him as an individual in a position of authority to help support his case for

healthcare reform:

Now, nobody has to take my word for this. You can ask Dr. Koop. He’s

up here with us tonight, and I thank him for being here. Since he left his

distinguished tenure as our Surgeon General, he has spent an enormous

amount of time studying our health care system, how it operates, what’s

right and wrong with it. He says we could spend $200 billion every year,

more than 20 percent of the total budget, without sacrificing the high quality of American medicine.66



Illustrating the problems with waste and inefficiency in current healthcare

policy, Clinton depicts his recent visit to a hospital, where doctors spend

far too much time filling out papers rather than attending to the needs of

their patients. He notes that $2 million a year are spent at one hospital,



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



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Washington Children’s Hospital, by hospital administrators. He invokes a

doctor he spoke to during a visit to the hospital:

We met a very compelling doctor named Lillian Beard, a pediatrician, who

said that she didn’t get into her profession to spend hours and hours—

some doctors up to 25 hours a week—just filling out forms. She told us she

became a doctor to keep children well and to help save those who got sick.

We can relieve people like her of this burden.67



To illustrate just how significant this waste is, Clinton recounts that he was

told by hospital staff that if a system was in place that wouldn’t require

endless amounts of paperwork, each doctor on staff—and there are 200

of them—could see another 500 children a year, for a total of 10,000

more children receiving healthcare. These examples then, in addition to

humanizing by telling stories about individuals, also humanize by insisting

that healthcare reform will prioritize the individual welfare of Americans

which is now so compromised by a highly bureaucratized system which

constrains patient-centered care and depersonalizes the experience of

healthcare.

Finally, Clinton employs the strategy of personalization when he tells

the story of Kerry Kennedy:

Kerry Kennedy owns a small furniture store that employees seven people in

Titusville, Fla … over the last several years—again, like most small-business

owners—he’s seen his health care premium skyrocket, even in years when no

claims were made. And last year, he painfully discovered he could no longer

afford to provide coverage for all his workers because his insurance company

told him that two of his workers had become high risks because of their

advanced age. The problem was that those two people were his mother and

father, the people who founded the business and still worked in the store.68



By invoking a small business owner—an idealized category of middle-class

Americans and a glorified middle-class image of self-reliance and hard

work that conservatives typically champion to illustrate the problem of

health insurance discrimination and excessive costs, Clinton renders more

immediate and dramatic these larger injustices. Although he implicitly

addresses the healthcare injustices facing working-class and economically

disadvantaged Americans in this passage, its focus and primary concern

is not on them, but on their middle-class manager who employees them.

Employing a strategy of anticipatory and defensive rhetoric, he notes that



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organizations which have previously vociferously challenged universal

healthcare efforts in past years out of concern for potential detrimental

impact on small business owners now support the employer mandate at

the heart of the healthcare reforms: “The Chamber of Commerce has

said that [the need for an employer mandate] and they’re not in the business of hurting small business. The American Medical Association has said

that.”69 Thus, he invokes two of the most historically stalwart critics of

universal health insurance and one pillar of conservative power and policy—the Chamber of Commerce—in defense of his healthcare reforms to

assuage conservative critiques of them. We will now further examine how

he applies the strategy of appropriating conservative values in his healthcare reform rhetoric.

6.11.2 Logos and the Rhetorical Strategy of Appropriating

Conservative Values and Anticipatory and Defensive Rhetoric

to Convey Moderation: Clinton’s “Third Way”

In the previously discussed passage about the Washington Children’s

Hospital, Clinton uses the anti-bureaucratic trope that so dominates

conservative Republican rhetoric. In much of the logos of the speech,

he adopts conservative values and ideas in his arguments. In addressing

how to actualize the principle of savings, for example, he actively criticizes

government regulation while simultaneously insisting that it is necessary

in a mild form:

Rather than looking at price control or looking away as the price spiral continues, rather than using the heavy hand of Government to try to control

what’s happening or continuing to ignore what’s happening, we believe

there is a third way to achieve these savings.70



Clinton defines this third way, which balances liberal concerns with access

and affordability with conservative concerns with protecting the free market and maximizing choice and competition, as follows:

• By giving groups of consumer and small businesses the same market

bargaining power that large corporations and large groups of public

employees now have.

• By using the law to force healthcare plans to compete and by making

it illegal for them to profit by turning away the sick and the old or



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



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by providing excessive coverage for costly and medically unnecessary

procedures.

• By establishing strict limits on the prices of healthcare plans, so that

companies do not overcharge individuals and make healthcare prohibitively expensive.71

In order to depict these government regulations as being in the public interest rather than smothering free markets and business initiative,

Clinton offers the example of government regulation of airplanes to demonstrate the importance and broad acceptance of government regulation

of matters of public safety. He explains that it will be the government’s

responsibility to ensure that Americans receive quality healthcare:

Our proposal will create report cards on health plans, so that consumers

can choose the highest quality health care providers and reward them with

their business. At the same time, our plan will track quality indicators, so

that doctors can make better and smarter choices of the kind of care they

provide. We have evidence that more efficient delivery of health care doesn’t

decrease quality. In fact, it may enhance it.72



Clinton provides a combination of examples from the private and the public sector to illustrate the effectiveness of cost savings and how they can be

done in a way that improves healthcare rather than undermining it:

Ask the public employees in California, who’ve held their own premiums

down by adopting the same strategy that I want every American to be able

to adopt, bargaining within the limits of a strict budget. Ask Xerox, which

saved an estimated $1,000 per worker on their health insurance premium.

Ask the staff of the Mayo Clinic, who we all agree provides some of the

finest health care in the world. They are holding their cost increases to less

than half the national average. Ask the people of Hawaii, the only State that

covers virtually all of their citizens and has still been able to keep costs below

the national average.73



Although Clinton criticizes the current healthcare system for many of the

policies that stem from its lack of regulation, he maintains a careful balance between criticizing the current lack of government regulation and

cautiously calling for more regulation, while simultaneously applying conservative rhetoric that finds problems not primarily in the functioning of

the private sector, but in excess government regulation.



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This is a delicate rhetorical juggling act. In this sense, Clinton is calling

for a recalibration of the role of government and the private sector rather

than championing one and denouncing the other. This nuanced approach

enables him to advance his healthcare reforms in a way that is less likely to

meet the rejection of conservatives:

Under our proposal there would be one standard insurance form, not hundreds of them. We will simplify also—and we must—the Government’s rules

and regulations, because they are a big part of this problem. This is one of

those cases where the physician should heal thyself. We have to reinvent the

way we relate to the health care system, along with reinventing Government.

A doctor should not have to check with a bureaucrat in an office thousands

of miles away before ordering a simple blood test.74



The language Clinton employs here is typically conservative in its critique

of government and its tendency to over-regulate and expand authority

over areas that conservatives argue should be left to citizens and medical professionals to determine without government interference. But it

is also critical of markets, acknowledging that they can be inefficient and

wasteful, and that having a large number of private health insurers while

superficially seeming to increase patient choice in fact undermines healthcare quality and affordability because of the huge bureaucracies created to

process health insurance that distract from a focus on quality healthcare

delivery above all.

Another way in which Clinton’s rhetoric reflects the rhetorical strategy

of appropriation and defensive rhetoric is his insistence on the centrality of individual choice to his healthcare reforms. In so doing, he echoes

Truman, who similarly prioritized this principle and demonstrates a policy

continuity that is manifest in Obama’s healthcare reform rhetoric, where it

also features as a central component of his healthcare reform logos:

Americans believe they ought to be able to choose their own health care

plan and keep their own doctors. And I think all of us agree. Under any

plan we pass, they ought to have that right …75 We propose to give every

American a choice among high quality plans. You can stay with your current

doctor, join a network of doctors and hospitals, or join a health maintenance

organization. If you don’t like your plan, every year you’ll have a chance

to choose a new one. The choice will be left to the American citizen, the

worker, not the boss and certainly not some Government bureaucrat.76



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The last sentence evokes populist feelings in its championing of the

worker77—and especially in its explicit emphasis on the worker’s rights

as paramount and taking precedence to the authority of his or her superiors/managers at work and the government itself. This reflects a hybrid

synthetic argument which incorporates liberal skepticism of intentions of

corporate management and the profit bottom lines of business, and conservative skepticism of the competence and intentions of government and

its potential violations of citizens’ liberties.

6.11.3



How High Healthcare Costs Harm Other Government

Expenditure



As discussed earlier, Clinton does not directly link healthcare reform to a

vision of government—like Truman’s and Johnson’s—in which the primary responsibility of government is assuring citizen welfare in a holistic

way that realizes social and economic rights. However, he acknowledges

that because the government performs a wide range of roles needed to

maintain a functioning society, if healthcare costs are not kept under

control, they will undermine the capacity of government to meet other

social needs. His focus is on managing the economy efficiently and he

only obliquely addresses other social needs in the speech by emphasizing

that if healthcare costs are not restrained and the healthcare system is not

reformed, then American “living standards” will go down:

Rampant medical inflation is eating away at our wages, our savings, our

investment capital, our ability to create new jobs in the private sector, and

this public Treasury. Our competitiveness, our whole economy, the integrity of the way the Government works, and ultimately, our living standards

depend upon our ability to achieve savings without harming the quality of

health care.78



Clinton explains that until costs are brought down, workers will lose $655 a

year in income because of increasing healthcare premium costs, small businesses will be forced to drop health insurance coverage because they will

not be able to afford it, and American corporations will be at a disadvantage

when competing in global markets with corporations which do not need to

spend huge amounts of their own funds to cover their employees: “State

and local government will continue to cut back on everything from education to law enforcement to pay more and more for the same healthcare.”79



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