A Just Framing of Healthcare Reform: Distributive Justice Norms and the Success/Failure of Healthcare Reform in America

In 2010 President Obama did the politically unthinkable: he passed healthcare reform that has the effect of providing healthcare to all Americans. What makes this feat so impressive is that other presidents (Franklin Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon, and Bill Clinton) all tried and failed in their efforts. Why did Obama succeed and these other presidents fail? Using agenda setting and issue framing theories, this study explores how each of these presidents framed their healthcare reform efforts. In particular, this study focuses on how each president framed reform in terms of distributive justice and the four principles of allocation (equality, merit, need, and efficiency) available to them. Content coding major policy addresses of each president in order to generate frequency distributions, the analysis presented here demonstrates that President Obama was successful because he framed healthcare reform in terms consistent with the American public\u27s distributive justice preferences. Unlike previous presidents who attempted to combine the principles of need and equality, President Obama combines need and efficiency in a policy frame that not only captures the preferences of the American public, but undermines the argument of his political opposition. The analysis and argument advanced here speak to the power of marrying language and politics in the rhetorical presidency and the ability of presidents to pursue political change. Future efforts in healthcare policy development created by the Trump administration and subsequent presidential administrations should attempt to follow President Obama\u27s lead in creating policies that accord with Americans\u27 understanding of distributive justice