Narrative, Identity, and the News Media in the 2009-2010 Health Care Reform Controversy




Logan, Theresa M.

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This study engaged in a narrative analysis of the 2009-2010 U.S. health care reform controversy from a conflict analysis and resolution perspective grounded in social identity theory. Four sets of artifacts produced during the controversy were analyzed using a narrative framework, including online content from both pro-reform and anti-reform interest groups, news coverage from newspaper, radio and cable television media outlets, and letters to newspaper editors written by members of the public. Analysis of the interest groups’ documents revealed two distinct narratives framed by 1) different estimations of the nation’s health care problems and 2) competing beliefs about the appropriate roles for the federal government and the free market in addressing those problems. Pro-reform groups defined the Patient Protection and Affordable Care Act (ACA) as a pragmatic response to both fiscal and moral imperatives to repair the broken and unsustainable health care system which they believe violates many Americans’ basic human right to access quality, affordable health care. Anti-reform groups defined the controversy as another battle in the ongoing war to protect individual liberty from government expansion and inappropriate interventions in private markets. The narrative structure of the letters to the editor suggested that morality and values are likely more important than calculations of rational self-interest in the public’s formation of opinions on health care reform. The news media’s coverage was dominated by a ‘sportscaster’ frame, which frequently used sports analogies to describe the political process and focused narrowly on the strategies and maneuvers of political players, thereby marginalizing other stakeholders and failing to identify the central importance of values in the controversy. While no consistent patterns of bias were identified in coverage from the more ‘liberal’ news outlets, some evidence of bias in favor of the anti-reform narrative was found among the ‘conservative’ news sources owned by Rupert Murdoch. Finally, it was observed that melodrama—the framing of conflict as a battle between righteous heroes and evil villains to save or harm innocent victims—appears to be the dominant conflict frame across the political spectrum. However, those promoting the liberal pro-reform narrative exhibited a slightly better understanding of the complex structural and psychological sources, processes and dynamics of intergroup conflict than those promoting the conservative anti-reform narrative.



Health care reform, Media effects, Narrative analysis, Conflict analysis, Social identity theory, Letters to the editor