The Influence of Words as Determinants of U.S. International and Domestic Health Policy: Part I

Article excerpt

-[Mr. Deasy] . . . We are a generous people, but we must also be just.

-I fear those big words, Stephen said, which make us so unhappy.

-Nestor chapter of James Joyce's Ulysses

A WAY OF viewing U.S. international and domestic health policy is to consider the power of words to fuel whatever actions are proposed and subsequently implemented. Words form the building blocks of stories and according to Robert Reich, who served as secretary of Labor in the Clinton Administration, there are four essential American narratives. Two are about hope, and two are about fear. Hope stories appear as a pair, the Triumphant Individual and the Benevolent Community, while fear stories may be divided into the Mob at the Gates and the Rot at the Top.

Political parties compete to fill the four mental boxes of the electorate with such tales. Major shifts in governance-in party alignments and political views-have been precipitated by one political party or the other becoming more skilled at telling stories along these dimensions. In more modern times, beginning with the Roosevelt Administration in 1932, Democrats told the stories that had the most appeal to Americans. Since Ronald Reagan first was elected in 1980, however, the Republican version has worked to the considerable advantage of that party.

Hope Stories

Reich contends that over the course of American history, it has been customary for inhabitants of the United States to portray it as an hospitable environment for the proverbial little guy to become a Triumphant Individual who can prosper materially through hard work, a willingness to take risks, and possession of a strong belief in one's self. Depending on its policies, the government may be in a position to play a constructive role in enabling personal success to be achieved.

Several examples can be found of the Benovelent Community. In frontier days, individuals helped build each other's homes and barns. In a more contemporary vein, the nation is heavily dotted with a vast array of useful activities being performed by volunteers in libraries, and fire stations and in the provision of emergency medical services.

Fear Stories

The Mob at the Gates has taken many forms over the decades. Early settlers battled Indians. Immigrants willing to work for lower wages and low-paid workers abroad have been and continue to be seen as threatening. Evil empires and axes, along with terrorists, represent more contemporary perceived dangers.

The Rot at the Top began with the British monarchy that had to be overthrown in order to establish an independent American nation. Since then, industrial trusts, Wall Street barons, big government, and cultural elites have offered a veritable bargain basement of things to worry about and serve as objects of scorn.

Reich contends that George Bush was reelected in 2004 because the policies of John Kerry, his opponent, lacked context and meaning. In short, the President had more meaningful stories to tell.

Absent a clear narrative about the Mob, the Rot, the Benevolent, and the Triumphant, his (John Kerry) policies were just . . . policies. As such, they were no match for Bush's convictions about what Americans should do-no match, in other words, for Bush's recasting of the Mob at the Gates as vicious terrorists that had to be killed or would kill us (and against whom, he said, Kerry could not be trusted to use force); of the Triumphant Individual as people free to pursue individual wealth (whom Kerry would smother with taxes); of the Benevolent Community as a collection of religious people with heart (of whom Kerry was contemptuous); and of the Rot at the Top as an arrogant cultural elite (of which Kerry himself was a member).1

In the stories that they told, James Joyce and other great artists over the centuries have attempted to address two essential aspects of the human condition: the loneliness of the soul and the heart in conflict with itself. …