Bill Bradley
Address on health care, Los Angeles Valley College
28 September 1999
Source: Official campaign website for Bill Bradley
Note: This is the text as prepared for delivery. It may differ slightly from the speech as delivered. My commentary follows the text. I have added some comments within the text enclosed in [ ]. For further definitions of terms of rhetoric used in the comments, see Sliva Rhetoricae.
Our health is in many ways the most intimate part of our being -- our most precious possession. When you talk about health and healthcare, everyone has a story to tell. Some have happy endings, some are tragic. I have listened to so many of them over the years. Here is one of mine. [Opens like a Freshman essay--a series of over-generalized statements leading to a personal narrative.]
My father's health was the family's number-one priority when I was growing up in Crystal City, Missouri. He lived with constant pain. He had calcified arthritis of the lower spine. He could not walk much further than the two blocks from our house to his office. I never saw him drive a car, throw a ball or tie his shoes.
I think about my father when I think about health care. [Nice touch, but it would have been nicer without the first paragraph.] And I think about all those other stories I've listened to along the road, of how illness can shape a life, and haunt it with the fear of losing everything to physical and emotional and financial catastrophe. How illness can create a prison [metaphor] of pain and disability and fear. And that's why one of the basic promises I make to the American people is health care for all Americans. [A specific promise.]
My father was a lucky man; he had helping hands to guide him out of that prison, and as a small-town banker he had the money to assure first-rate care. He deserved it, this hard-working and productive middle-class man. He had to quit school at 16 when his own father died of cancer. He worked his way up in our hometown bank from a job he called "shining pennies" to be the major shareholder. He created his own future, but he never lost his empathy for others. He was very proud that during the Great Depression he never foreclosed on a single homeowner. [Ethos: Is Bradley apologizing for his father's ability to pay for care or is he associating himself with his father's apparent compassion?]
I think about my father when I think about health care because I believe that every American deserves what my father got -- the helping hands to a productive life, whether they are the hands of family members or the hands of that extended family of all Americans, helping each other. You can call that extended family government if you like, but government is, after all, just us -- the people. [Notice the switch: his father's helping hands were paid for my his own toil, but today's helping hands will be paid for by today's "extended family"--also known as government. I would argue this is skirting dangerously close to a false analogy.]
My father's life showed me that through self-reliance, discipline and determination, a person can overcome virtually any obstacle, achieve any goal. But I can also imagine forces beyond your control that can overwhelm you. I saw that at home, too. And in traveling across America for so many years I've seen it in a lot of other homes, as well. [This paragraph is essential to cover the narrative as presented so far.]
This is why I know that health care -- two wonderful words that have been beaten into a phrase as unappealing as the crinkly paper on a doctor's examining table -- goes far beyond even such critical issues as curing or controlling disease, of research projects and prevention programs, of insurance coverage; we need to start thinking of those two words -- health care -- as the shiny pennies of America's future, the foundation of our lives, as individuals, as families, as communities and as a nation. [By using "shiny pennies" in this context, Bradley is turning his father's experience into a metaphor for national action.]
Health care -- as appealing and intrinsic to our lives as a well baby's gurgle and a worker's muscle and a grandparent's smile. Health care is about assuring middle-class working people that they will not be locked into jobs they hate because of their insurance coverage, or economically ruined by catastrophic illness.
Health care is about assuring all Americans that their race or sex or class or address will not be the determining factor in whether they have a chance for a healthy start in life. Healthcare is about strengthening America, by strengthening each one of us -- one person at a time.
In Iowa recently I talked with a man who described symptoms that implied colon cancer. "What does your doctor say," I asked.
"I haven't gone to one," he said. "I don't have any health insurance to pay for it." [A contrast to his father's experience. The narrative force leads the audience to want for this man what Bradley's father had.]
When we talk about the 45 million uninsured Americans, we are not talking about the indolent or the negligent, we're talking about people you and I know. We're talking about the waiters and waitresses who bring our meals; we're talking about home care workers who sit with our aging parents; we're talking about the taxi-drivers, gas station attendants and department store clerks. We are talking about Americans who get up every day, do a full day's work, but who know that if they get sick or hurt, they have no back-up. These are our neighbors. In fact, they could easily be you tomorrow; and they may already be you today.
It is not right that uninsured Americans face illness alone. [This simple assertion carries more persuasive weight because it follows a strong narrative argument.]
It's not right to force them to choose between proper healthcare and bankruptcy. It's not right that Americans should lose the insurance coverage that gives their children adequate healthcare just because they're caught in corporate downsizing. It's not right that just because you work for a small business or are starting one of your own you must live in fear that some medical emergency might undo everything you've worked for. Nor is it right that kings and dictators can come to this country to get the best medical care in the world, while Americans two blocks away may not be able to afford any care at all. [Anaphora]
Health care is not a luxury. Americans have the right to life, liberty, and the pursuit of happiness. [Invoking cultural code words.] But Thomas Jefferson, who proclaimed those rights in our Declaration of Independence also said, "Without health, there is no happiness." [Invoking a culture hero.] We can't abolish sickness or deny mortality. But we can help care for the sick and ease the pain of the dying and ensure that children have a healthy start in life. We can commit ourselves to the proposition that when it comes to health care, everyone will have the American Dream -- at last.
When we talk about healthcare in this country, we often talk about it as if it were an end in itself. We forget that it is really a means to an end -- and the end is the best possible health for Americans.
Good health, like education, is in all our interests. It has measureless benefits for all of us. It allows us to get up in the morning and go to work with a feeling of hope, not dread. Parents with good health can look after their children. Healthy communities are places where neighbors look after their neighbors. Good health begets good health.
In many ways, America has the best, most advanced medicine in the world. Our doctors and nurses are peerless; our hospitals matchless; our technology unequaled. [Parallel structure reinforces the point.]Breakthroughs in genetic engineering in the next decade could dramatically extend life expectancy.
With all our skill and technology and innovative treatment, why aren't Americans the healthiest people in the world? Why don't we have the best health care system in the world? [Rhetorical questions.]
I am here today to tell you -- we are going to have the best health care system in the world. [A specific promise.]
Good health is a blessing; it is not a right. But good health care is a right. And it is up to us to ensure that right to every American.
First, we will do so by making certain that all children are insured.
Second, by giving adults a real choice of affordable health insurance plans.
Third, by expanding the concept of health care to include the idea of good health and by attacking the myriad of non-medical factors which determine health.
I am talking about a health care system that doesn't just swoop in during an emergency. I am talking about a system that emphasizes prevention and early intervention, a system that uses our scientific advances for the many who can benefit, rather than the few who can afford them. I'm talking about giving the joy of medicine back to doctors and nurses who see a decline in quality, and feel a sense of loss in a system that often erodes their professionalism and makes them feel they cannot do right by their patients. I am talking about healthcare that goes out to people where they live their lives -- in their communities, in their schools, in their businesses, their places of worship - not healthcare that waits for people to show up when they have no other place to go. I am talking about a system of public health that truly ministers to the physical and mental health of the public. [Anaphora] Throughout our history, leaders from both parties have looked upon the health of our citizens as a national responsibility. Over two hundred years ago, Congress established the Marine Hospital Service, offering care to seamen who contributed a small yearly premium. A century later, Teddy Roosevelt's Progressive Party called for a system of social insurance that would protect people against sickness and the ravages of old age. During the Depression, Franklin Roosevelt called for nationally supported health insurance, something his successor, Harry Truman, fought for after the war.
Almost forty years ago, John Kennedy, while campaigning for the presidency, saw that one out of two elderly Americans were living in the kind of poverty that prevented them from getting even the bare minimum of healthcare. Lyndon B. Johnson picked up the reins [Cliché] of reform and created Medicare, the most successful medical program in our history. Richard Nixon passed the HMO act of 1972.
In 1994, President Clinton sought to provide health insurance for all Americans. That attempt failed. But the problems that called forth that effort have not disappeared. And it is time to try again -- but in a different way. [This listing of various presidents, and their promoting of healthcare, creates another narrative movement that easily leads to the idea that a President Bradley will complete the historically inevitable.]
The lessons learned from the experience of the past, and the stories people have told me along the road are valuable guides today.
Americans do not want a health care system controlled from the center by a massive bureaucracy.
Americans do not want a health care system that seems indifferent to quality.
Americans do not want to be denied their right to choose their doctors or the direction of their treatment. [Notice that this anaphora does not reinforce the point of the preceding narrative. Instead, it continues the build-up to the promise of a Bradley presidency.]
In 1986 everyone told me tax reform could never be achieved because there were too many opposing interests. I listened to all those interests, and eventually I understood their concerns. A short while later, the common ground we established turned into the tax reform that everyone said was unachievable. Improving our healthcare system will require a similar process.
Before sending a program to Congress, we will consult the concerns and ideas of all participants in the enterprise of American health. We will address their objections and draw upon their experience, knowing that no one has all the answers. And, above all, we will listen to prospective patients. The contours of this proposal will change as the voices of others are heard. It should be viewed as a starting point, not a final plan. I know that making healthcare available to all will not be easy. But the difficulty is a challenge, not a reason to avoid engagement. [At the crucial moment of this argument, Bradley switches to "we."]
The riddle of the ancient oracle at Delphi was, "What goes on four legs at dawn, two legs at noon, and three legs at sunset?" The answer, of course, is all of us. We crawl at birth, we walk as adults, and sometimes we use a cane as we age.
The proposal I will offer today deals with Americans at these three critical stages of life: at dawn, at noon, and at sunset.
I am suggesting a different approach to health care -- one for each stage of life -- from infancy to old age. For as we know, the problems at each stage are different, and solutions must fit the problems.
Let's begin with -- healthcare for children. There is no more serious indictment of a society than that it lets its children languish in pain or illness. Yet in the midst of our great prosperity, there are 11 million children who go without medical care because their parents cannot afford it.
No devotion to the principle of personal responsibility allows us to blame the child whose parents cannot provide medical care. Even the harshest calculus of costs and benefits teaches that by diminishing the present lives of our children, we are dimming the future prospects of the nation. It is not just a metaphor to say that our children are our future. It is the literal truth. [Metaphors state a figurative truth. But notice Bradley denies the metaphor by using it: children are not the future; the future is the future. His linguistic mistake serves to reinforce the "truth" of the original metaphor and make it appear he is straight talking.] They are the citizens, the workers, the dreamers of America's tomorrow.
Nearly 35 years ago, we made that kind of commitment to our senior citizens when we enacted Medicare. That commitment was simple: healthcare for the elderly was a national responsibility.
Now we need to make a similar commitment to our children. That commitment is also simple: no child in this country will be without health insurance. Because our children are our national future, their healthcare must be a federal responsibility. And to those who say we can't afford to do this, I answer: We can't afford not to.
I propose that we enroll every child in a health insurance program from the moment of birth. Enrollment will be the responsibility of the parent. Just as proud new parents must fill out a birth certificate and a social security card before leaving the hospital, these parents must also enroll their new child in a health care plan.
I don't think this is onerous or difficult. In most states, we can't drive a new car home from an auto dealership without signing up for insurance. Should we have a lesser requirement for the most valuable and cherished addition to our lives? [Rhetorical question]
Under this proposal parents would be able to choose the form of protection they want for their children by keeping the insurance coverage they already have, or by joining one of the private insurance plans for children that will be developed through the healthcare system that serves all federal employees.
Since we require insurance for every child, we must make it possible for every family to afford it. I suggest we do so through refundable tax credits for the poor and middle class and by excluding premium payments from income for all Americans. The reason we help all parents, is because all children are important to the future.
For Americans between the ages of 19 and 64, I propose to make it easier for them to find insurance and to purchase it. For those who are now insured and satisfied with their plans, nothing should change. But not all Americans are so lucky. Many small employers cannot afford health insurance for themselves or their employees. Many people, who were once employees, find themselves classified as independent contractors without health benefits. Others can't pay the cost of insurance, even though they're above the federal poverty line.
For these uninsured adults, I suggest we make insurance more accessible by allowing them to enroll in one of the many private plans now available only to members of Congress and other federal employees.
Those who can't afford a plan will be helped by a refundable tax credit, scaled to income, and all citizens will be able to exclude insurance premium costs from their federal taxes. Whether they join a new plan or decide to stay with what they now have, this simply extends to all individuals those tax benefits which are part of the employment-based system.
With this approach, healthcare will become portable, which means you will be able to take it from job to job, from city to city. You won't have to stay in a job you don't want in order to guarantee your health insurance.
No matter what plan you choose, it should come with a Patients Bill of Rights and a Consumer Right to Know provision. And if you don't like your insurance company, you can fire them, and you don't have to worry about them firing you.
Just as we must fortify our future by helping the youngest among us, we must honor our past by keeping our commitments to our oldest citizens. We have already done so through Medicare, the most successful public health insurance program in American history. But we need to make this program better by expanding it to include costs of prescription drugs, with generic drugs being the first choice of medication whenever possible.
In addition we should encourage the elderly, through Medicare payments, to join health plans that will not only provide healthcare but allow them to remain independent in their homes. This will reduce the economic and psychological burden on family members, eliminate the costs of institutional care, and give our older citizens the opportunity to spend their remaining years among the people and places they know and love, and among those who know and love them.
Healthcare is something we get from professionals. But caring for your health is something we must all do for ourselves as individuals and communities. If the first rule of medicine is to do no harm, the first rule of health is to care for yourself. Good health is not just about recovering from an illness, it is the knowledge and the practice that prevents that illness from occurring in the first place.
Let's be realistic. You can't smoke two packs a day for thirty years and be surprised by lung cancer. Seat belts and helmets, proper nutrition, safe sexual practices and exercise must be the responsibility of individuals. But we can all help each other in meeting our responsibilities.
When it comes to the needs of our communities, one size does not fit all, but the goal will be the same: to promote a healthy lifestyle.
The public health system will be about a shared responsibility -- helping people take care of themselves. For health is not just about being alive, it is about being well.
This life stage proposal will allow the three parts of our society to do what they do best. The private sector will do what it does best -- provide healthcare insurance for Americans. Community organizations and communities will do what they do best - help build the strong networks locally to provide good health for Americans. And government will do what it has a fundamental responsibility to do -- protect the well being of its citizens.
That's the proposal.
I believe it is irresponsible to commit to new programs without also laying the costs before the public so that we can decide together how to pay for them. The healthcare specialists I have consulted estimate that my proposals will cost $35 - $45 billion for children and adults, $10 billion for drug benefits for the elderly, $6.5 billion for tax exclusions, $2 billion for public health initiatives. That is a great deal of money, but a campaign proposal without a price tag is just another politician's promise. [Even with a price tag it is a politician's promise. Nothing about stating the price ensures the program's passage.]
With the imaginative use of new technologies, we are already finding new cost savings within the system. We must step out of the old box that says either we raise taxes or cut benefits in order to control costs. Instead, we need to think most creatively about how to use our resources. Understand that of the roughly $1 trillion spent on healthcare in 1998, $250 billion are related to the delivery of unnecessary care, redundant tests, and the excessive administrative costs. Imagine a world where the Internet replaces all the filing cabinets and paper forms.
Imagine a world where the cost of retrieving information is near zero.
Imagine a world where doctors have good data, and make decisions that are both economically prudent and clinically valuable.
Imagine the future -- where health care costs will be much lower.
In 1996, hospitals and doctors spent $30-$50 billion trying to get paid and insurance companies spent another $30-$50 billion trying not to pay. Many doctors are spending 2 to 3 hours a day on the phone, looking for approval to provide care, explaining a decision, or inquiring about reimbursement. It is ridiculous to spend so much time and money on personnel and equipment just to stay on top of all the different insurance requirements. Common sense and technology can change this.
Together, this waste and these administrative costs all add up to around $300 billion. Our program would cost between $50 and $65 billion to make sure 95% of all Americans have health insurance.
We can get this right.
I think of healthcare as a good investment -- in our productivity and our growth. But I do not justify it as only an investment. I ask for it as a fulfillment of the nation's responsibility to its people; in the belief that in this country of such great power and unexampled wealth, no citizens should be denied the chance to seek help for illness -- not as long as we have help to give.
I've talked in this campaign about the importance of government doing a few big things well. When it comes to America's health, this is not the time to be timid. It requires bold action and a national commitment, from the President on down, to make certain that every American has what should be a basic birthright. It is about who we are as a people and a nation, and what we can become. [Bradley is becoming repetitive.]
During the Great Depression, when the people of my home town in Missouri were anxious about the health of the banking system, my father -- the small town banker -- would stack up piles of cash in the bank's glass window to reassure the people of the town that the bank had protected their deposits. We must reassure people today that healthcare will be there for them when they need it. And like my father, who never foreclosed on a mortgage during the depression, I want to assure Americans that their dreams of a better life for themselves and their children will not be foreclosed simply because they can't afford healthcare. That is my common sense dream for the America of the new millennium. It can happen. [Bringing the narrative full circle.]
Abraham Lincoln taught us that "the legitimate object of government is to do for a community of people whatever they need to have done, but cannot do at all, or cannot so well do, for themselves in their separate and individual capacities." Care for health is a legitimate and a necessary task for the government which has been designed to serve the people. By undertaking this task we have the opportunity to strike down barriers to that "pursuit of happiness" which is the unalienable right of every human being.
When Thomas Jefferson wrote those words into the Declaration of Independence, neither he nor those who gathered with him in that Pennsylvania summer could envision that their handful of sparse and isolated colonies would become the repository of almost unimaginable power and wealth. Yet no change in our circumstances has altered one phrase of those enduring principles, nor relieved us of the obligation they impose. Time has only expanded our capacity to protect those rights to which they dedicated a newborn nation. What we can now do, we should do now, [Anastrophe] so that we, like those [who] came before, can extend and enlarge the content of American liberty.
The logic of narrative: Bill Bradley's strength as a speaker is his ability to weave narrative throughout his speeches. For a reminder of this, notice how he used a narrative of his own life in Crystal City, Missouri in his campaign kick-off address. In that analysis, I wrote about the power of narrative and claimed: "Narrative does not appear to be an argument, so listeners/readers may have their critical consciousness disarmed by the story." This characteristic of the persuasive appeal of narrative I like to call the logic of narrative. As the story unfolds it appears to have a life or direction of its own independent of the speaker (who appears to merely be telling a story). But, often, stories come with imbedded morals. I could even argue that the best stories--the most interesting ones--have morals. The moral is the pay-off at the end of the narrative line; it is the point to the plot.
In a very real sense, the life of the elder Mr. Bradley is not a story. It's a life. It happened the way it happened. His life, or bits of it, become a story in the telling. And the story teller--Bill Bradley in this case--chooses those parts of it that create a narrative line that lead to a moral. It is in the plot that we find the logic of narrative.
The logic of narrative makes it difficult to object, to find a crack in the argument to pry open. But Bradley wastes his narrative power in this case by delivering a speech far longer than necessary to make his point and outline his plan. He nearly ruins it at the beginning with a clumsy introduction. He introduces a subplot about other presidents and their achievements in healthcare. Toward the end, he drops the father narrative in favor of the oracle analogy and redundant assertions about what it means to be healthy, caring, and cared for. By the time he brings the first narrative full circle we've forgotten about his father (the real power behind this speech) and have begun to focus on the specifics of his plan. Had he worked the specifics of his plan into the warp and woof of the narrative he would not have given doubters as many cracks to pry open. In a sense, his narrative structure is too complicated to be a speech. It better suits the genre of personal essay
Am I suggesting that being specific about policy is a poor rhetorical strategy? Not necessarily. But, if a politician intends to be specific (be attackable), that politician then must carefully package those specifics in ways appeals that persuade. Bradley's choice of narrative was a good one (and will continue to be a good one for him), but his execution this time was poor.
Return to: Presidential Campaign Rhetoric 2000