Personal Responsibility, Personal Shame A Discourse Tracing of Individualism about Healthcare Costs
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Abstract
America’s individualistic culture is reflected in deeply held beliefs about how people should manage their health and their (lack of) money. In this essay, we trace the ideological discourse of individualism at macro and micro levels, explicating how macro-level discourses surrounding finances and health fulfill key functions of individualism: explanatory and evaluative as well as identity and prescriptive. For each function, we illustrate at the micro level how social adherence to discourses of individualism affects people, relationships, and communities. In particular, we argue, failure to live up to individualistic ideals fosters internalized shame and guilt and worsens mental, physical, and financial health. Grounded in critical rhetorical theory and drawing upon critical interpersonal and family communication and health communication approaches, we illustrate how individualistic discourse is circulated and taken up by people, constituting their identities and relationships. We also showcase the benefits of investigating exigent social issues from multidisciplinary vantage points.
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References
Abrams, Abigail. (2020, March 19). Total cost of her COVID-19 treatment: $34,927.43. Time. https://time.com/5806312/coronavirus-treatment-cost/
Adorno, Theodor A. (1954). How to look at television. The Quarterly of Film Radio and Television, 8(3), 213-235. https://www.jstor.org/stable/i251835
Afifi, Walid A., & Cornejo, Monica. (2020). #CommSoWEIRD: The question of sample representativeness in interpersonal communication research. In M. L. Doerfel & J. L. Gibbs (Eds.), Organizing inclusion: Moving diversity from demographics to communication processes (pp. 238-259). Routledge.
Aune, James A. (2001). Selling the free market: The rhetoric of economic correctness. Guilford Press.
Ball, Terence, & Dagger, Richard. (2004). Political ideologies and the democratic ideal (5th ed.). Pearson.
Becker, Gary. (1976). The economic approach to human behavior. University of Chicago Press.
Bevans, Margaret, & Sternberg, Esther M. (2012). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA, 307(4). 398-403. http://doi.org/fzx46w
Borrelli, Christopher. (2019, June 10). Reagan used her, the country hated her. Decades later, the Welfare Queen of Chicago refuses to go away. Chicago Tribune. https://www.chicagotribune.com/entertainment/ct-ent-welfare-queen-josh-levin-0610-story.html
Brashers, Dale E. (2001). Communication and uncertainty management. Journal of Communication, 51(3), 477–497. https://doi.org/10.1111/j.1460-2466.2001.tb02892.x
Brown, Kendall. (2017, June 29). The reality of being poor and sick in America. Medium. https://medium.com/the-new-leader/the-reality-of-being-poor-and-sick-in-america-b3636e8f4a0f
Centers for Disease Control and Prevention. (2020, May 4). Lifestyle risk factors. https://ephtracking.cdc.gov/showLifestyleRiskFactorsMain
Centers for Disease Control and Prevention. (2021, January 21). Health and economic cost of chronic diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm#ref1
Chevrette, Roberta. (2013). Outing heteronormativity in interpersonal and family communication: Feminist applications of queer theory “beyond the sexy streets.” Communication Theory, 23(2), 170-190. https://doi.org/10.1111/comt.12009
Cloud, Dana L. (1996). Hegemony or concordance? The rhetoric of tokenism in ‘Oprah’ Winfrey’s rags-to-riches biography. Critical Studies in Mass Communication, 13(2), 115-137. https://doi.org/10.1080/15295039609366967
Collins, Patricia H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. Routledge.
Consumer Financial Protection Bureau. (2014, December). Consumer credit reports: A study of medical and non-medical collections. https://files.consumerfinance.gov/f/201412_cfpb_reports_consumer-credit-medical-and-non-medical-collections.pdf
Cooper, David. (2018, June 15). One in nine U.S. workers are paid wages that can leave them in poverty, even when working full time. Economic Policy Institute. https://www.epi.org/publication/one-in-nine-u-s-workers-are-paid-wages-that-can-leave-them-in-poverty-even-when-working-full-time/
Corn, David. (2012, September 17). SECRET VIDEO: Romney tells millionaire donors what he REALLY thinks of Obama voters. Mother Jones. https://www.motherjones.com/politics/2012/09/secret-video-romney-private-fundraiser/
Covert, Bryce. (2017, September 21). Deadbeat democrats: How Bill Clinton set the stage for the GOP’s war on the poor. The New Republic. https://newrepublic.com/article/144544/deadbeat-democrats-bill-clinton-set-stage-gop-war-poor
Crenshaw, Kimberlee. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1541-1299. https://doi.org/1229039
Denzin, Norman K. (1970). The research act: A theoretical introduction to sociological methods. Aldine Publishing.
Dowd, Maureen. (1988, October 30). Bush, in Illinois, keeps up tough talk. The New York Times. https://www.nytimes.com/1988/10/30/us/bush-in-illinois-keeps-up-tough-talk.html
Duerringer, Christopher M. (2019). Rhetorical arbitrage: The rhetoric of the sharing economy. Communication Theory, 29(4), 383-400. https://doi.org/10.1093/ct/qtz005
Dutta-Bergman, Mohan J. (2005). Theory and practice in health communication campaigns: A critical interrogation. Health Communication, 18(2), 103-122. https://doi.org/10.1207/s15327027hc1802_1
Edelman, Peter. (1997, March 1). The worst thing Bill Clinton has done. The Atlantic. https://www.theatlantic.com/magazine/archive/1997/03/the-worst-thing-bill-clinton-has-done/376797/
Fottrell, Quentin. (2017, January 12). Majority of Americans are one medical emergency away from financial ruin. New York Post. https://nypost.com/2017/01/12/majority-of-americans-are-one-medical-emergency-away-from-financial-ruin/
Francis, Diane B. (2021). “Twitter is really therapeutic at times”: Examination of Black men’s Twitter conversations following hip-hop artist Kid Cudi’s depression disclosure. Health Communication, 36(4), 448-456. https://doi.org/10.1080/10410236.2019.1700436
Friedman, Milton. (1962). Capitalism and freedom. University of Chicago Press.
Giddens, Anthony. (1984). The constitution of society: Outline of the theory of structuration. University of California Press.
Habermas, Jürgen. (1991). The structural transformation of the public sphere: An inquiry into a category of bourgeois society (T. Burger & F. Lawrence, Trans.). MIT Press. (Original work published 1962)
Hall, Stuart. (1996). The problem of ideology. In D. Morley & K. H. Chen (Eds.), Stuart Hall: Critical dialogues in cultural studies (pp. 24-45). Routledge. (Original work published 1983)
Health Resources & Services Administration. (2021, June). COVID-19 claims reimbursement to healthcare providers and facilities for testing and treatment of the uninsured. https://www.hrsa.gov/CovidUninsuredClaim
Hoffman, Allison K. (2017, January 16). The unhealthy return of individual responsibility in health policy. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/01/16/the-unhealthy-return-to-individual-responsibility-in-health-policy/
Jarvis, Caitlyn M. (2021). Invitational rhetoric in epistemic practice: Invitational knowledge in infertility support groups. Rhetoric of Health & Medicine, 4(1), 1-32. https://doi.org/10.5744/rhm.2021.1002
Johnston, Emily R. (2020). Pathologizing the wounded?: Post-traumatic stress disorder in an era of gun violence. Rhetoric of Health & Medicine, 3(1), 1-33. https://doi.org/10.5744/rhm.2020.1001
Jones, Jeffrey M. (2019, May 30). Healthcare costs top financial problem for U.S. families. Gallup. https://news.gallup.com/poll/257906/healthcare-costs-top-financial-problem-families.aspx
Khullar, Dhruv. (2018, January 10). You’re sick. Whose fault is that? The New York Times. https://www.nytimes.com/2018/01/10/upshot/youre-sick-whose-fault-is-that.html
Kirk, Russell. (1993). Ten conservative principles (adapted from The Politics of Prudence). Russell Kirk Center. https://kirkcenter.org/conservatism/ten-conservative-principles/
Klein, Ezra. (2012, September 17). Romney’s theory of the ‘taker class,’ and why it matters. The Washington Post. https://www.washingtonpost.com/news/wonk/wp/2012/09/17/romneys-theory-of-the-taker-class-and-why-it-matters/
LeGreco, Marianne, & Tracy, Sarah J. (2009). Discourse tracing as qualitative practice. Qualitative Inquiry, 15(9), 1516-1543. https://doi.org/10.1177/1077800409343064
Locke, John. (1960). Locke’s Two Treatises of Civil Government (2nd edition, Peter Laslett. Ed.). Cambridge University Press. (Original work published in 1689).
Lupton, Deborah. (1994). Toward the development of critical health communication praxis. Health Communication, 6(1), 55-67. https://doi.org/10.1207/s15327027hc0601_4
Manning, Jimmie. (2014). A constitutive approach to interpersonal communication studies. Communication Studies, 65(4), 432-440. https://doi.org/10.1080/10510974.2014.927294
Marx, Karl. (1977). A contribution to the critique of political economy. Retrieved from https://www.marxists.org/archive/marx/works/1859/critique-pol-economy/preface.htm Progress Publishers. (Original work published 1859)
McGee, Michael C. (1990). Text, context, and the fragmentation of contemporary culture. Western Journal of Communication, 54(3), 274-289. https://doi.org/10.1080/10570319009374343
Meloncon, Lisa, & Scott, J. Blake. (2018). Manifesting a scholarly dwelling place in “RHM.” Rhetoric of Health & Medicine, 1(1-2), i-x. http://dx.doi.org/10.5744/rhm.2018.1001
Molloy, Cathryn, Scott, J. Blake, & Meloncon, Lisa. (2021). Ruminations on the long haul: Harnessing RHM’s hybridity. Rhetoric of Health & Medicine, 4(1), iii-ix. https://doi.org/10.5744/rhm/2021.1001
Moon, Michael. (1987). “The gentle boy from the dangerous classes:” Pederasty, domesticity, and capitalism in Horatio Alger. Representations, 19(2), 87-110. https://doi.org/10.2307/2928532
Moore, Julia. (2017). Where is the critical empirical interpersonal communication research? A roadmap for future inquiry into discourse and power. Communication Theory, 27(1), 1-20. https://doi.org/10.1111/comt.12107
Moore, Julia, & Manning, Jimmie. (2019). What counts as critical interpersonal and family communication research? A review of an emerging field of inquiry. Annals of the International Communication Association, 43(1), 40-57. https://doi.org/10.1080/23808985.2019.1570825
Murray, Christopher J. L., & Lopez, Alan D. (Eds.). (1996). The global burden of disease. Harvard University Press.
National Patient Advocate Foundation. (2014, August). Medical debt, medical bankruptcy, and the impact on patients. https://www.npaf.org/wp-content/uploads/2017/07/Medical-Debt-White-Paper.pdf
Packer, George. (2020, June 15). We are living in a failed state. The Atlantic. https://www.theatlantic.com/magazine/archive/2020/06/underlying-conditions/610261/
Pence, Michael. [@VP]. (2017, February 22). ObamaCare will be replaced with something that actually works—bringing freedom and individual responsibility back to American healthcare. [Tweet]. Twitter. https://twitter.com/vp/status/834493747836682241?lang=en
Perez, Lauren, Romo, Lynsey K., & Bell, Trevor. (2019). Communicatively exploring uncertainty management of parents of children with type 1 diabetes. Health Communication, 34(9), 949-957. https://doi.org/10.1080/10410236.2018.1446249
Pollard, Stephen. (2001, August 28). Stephen Pollard: Mr. Clinton’s ‘tough love’ welfare reform passes the test of time. The Independent. https://www.independent.co.uk/voices/commentators/stephen-pollard-mr-clintons-tough-love-welfare-reform-passes-the-test-of-time-9147195.html
Raju, Manu. (2009, December 14). Health bill sparks nanny state debate. Politico. https://www.politico.com/story/2009/12/health-bill-sparks-nanny-state-debate-030543
Romo, Lynsey K., Thompson, Charee M., & Ben-Israel, Patience. (2021). An examination of how people appraise and manage health-related financial uncertainty. Health Communication. Advance online publication. https://doi.org/10.1080/10410236.2021.1876813
Scott, J. Blake, & Meloncon, Lisa. (2019). Expansiveness in/through RHM. Rhetoric of Health & Medicine, 2(1), iii-x. https://doi.org/10.5744/rhm.2019.1000
Scott, J. Blake, & Meloncon, Lisa. (2019). RHM’s relations and relationships. Rhetoric of Health & Medicine, 2(4), iii-x. https://www.doi.org/10.5744/rhm.2019.1016
Shapiro, Isaac, Trisi, Danilo, & Chaudhry, Raheem. (2017, February 16). Poverty reduction programs help adults lacking college degrees the most. Center on Budget and Policy Priorities. https://www.cbpp.org/research/poverty-and-inequality/poverty-reduction-programs-help-adults-lacking-college-degrees-the
Sullivan, Peter. (2017, March 3). GOP rep: Some people ‘just don’t want healthcare.’ The Hill. https://thehill.com/policy/healthcare/322285-gop-lawmaker-some-people-just-dont-want-health-care
Suter, Elizabeth A. (2016). Introduction: Critical approaches to family communication research: Representation, critique, and praxis. Journal of Family Communication, 16(1), 1-18. https://doi.org/10.1080/15267431.2015.1111219
Teston, Christa, Gonzales, Laura, Bivens, Kristin M., & Whitney, Kelly. (2019). Surveying precarious publics. Rhetoric of Health & Medicine, 2(3), 321-351. https://www.doi.org/10.5744/rhm.2019.1015
The Dave Ramsey Show. (2019, April 24). 5 things that will make you wealthy. YouTube. https://www.youtube.com/watch?v=x9ueaxf75SU
Weiss, Richard. (1988). The American myth of success: From Horatio Alger to Norman Vincent Peale. University of Illinois Press.
West, Emily. (2014). Consumer subjectivity and U.S. healthcare reform. Health Communication, 29(3), 299-308. https://doi.org/10.1080/10410236.2012.753140
Whysel, Brett. (2018, June 27). 3 vicious cycles among financial, physical, and mental health. Forbes. https://www.forbes.com/sites/brettwhysel/2018/06/27/3-vicious-cycles/#2fd0ad8540d2
Williams, Raymond. (1983). Keywords: A vocabulary of culture and society (Rev. ed.). Oxford University Press.
Winfrey, Oprah. (1991, February 25). The Academy of Achievement Interview. Academy of Achievement. https://achievement.org/achiever/oprah-winfrey/#interview
Zoller, Heather M., & Kline, Kimberly N. (2008). Theoretical contributions of interpretive and critical research in health communication. Annals of the International Communication Association, 32(1), 89-135. https://doi.org/10.1080/23808985.2008.11679076