Mediating Citizenship through the Lens of Consumerism: Frames in the American Medicare Reform Debates of 2003–2004

Abstract

Abstract:Access to health care is an issue that challenges the imagined boundary between being a 'consumer' and being a 'citizen'. This is especially true in the United States where marketbased solutions to providing health care have historically been favored over care organized through government. In the recent debate over how to organize prescription drug coverage for seniors in the United States, stakeholders quoted in the press were more likely to position health care as a consumer issue rather than as an issue of basic rights that accompany citizenship. As scholars such as Lizabeth Cohen (2003) have illustrated, being a 'consumer' is not necessarily a depoliticizing stance. Organizing around consumer rights can be effective in changing policy and bringing people together politically. However, discourse that remains within a consumer rights frame can also reinforce the terms of debate laid out by interested corporations and government. This paper looks at the 'consumer' and 'citizenship' frames in the 2003-2004 debate about prescription drug coverage for seniors in print and television news compared to those promoted by institutional sources. Proponents of the bill sold it on the basis of individualized consumer choice, implicitly collapsing the power of individual choices in both consumerism and citizenship. Compared to their institutional sources, the news media more often highlighted collective models of power and occasionally even resisted the frame of individualized consumerism promoted by supporters of the bill.

The “Luntzification” of the U.S. Health Care Debate

“…Patients' Bill of Rights debate. West's (2006) study of Medicare reform news coverage, as previously noted, tallied specific word counts related to: citizen, consumer, and patient.…”

“…The examination of word choice in health care public policy debates is well established. West (2006) looked at the Medicare prescription drug coverage debate in [2003][2004], specifically the terminology used by both news media and institutional sources such as the American Medical Association, President George W. Bush, and the American Association of Retired People. She concluded that the word choice reflected more of a consumer than citizen model, especially among the institutional sources.…”

Consumer Subjectivity and U.S. Health Care Reform

“…A strand of this critical work addresses the commodification of health care, and the transformation of health care users into consumers (Lupton, 1994;West, 2006;Zoller, 2008). A key insight is that while consumerism connotes choice and empowerment, it is also a tool of discipline (de Souza, 2011;Lupton, 1995;Rose, 2007).…”

Biocommunicability

“…7 In wealthy nations at least, the question is now less one of separating ill and healthy populations than the government of life itself, the intense capitalization of our efforts to maximize our corporeal existence, present and future, especially as it unfolds at the level of the molecule. 8 If biopolitics shapes definitions and practices of citizenship, gender, race, sexuality, pleasure, and danger, how does this modeling capacity jump scale from laboratories and hospitals and forge broad social and political effects?…”