18.1: The Classroom Lecture and Activity

Different Types of Essay Structures

SLO-Employ a voice, style, and tone appropriate to the topic selected and the rhetorical situation  -Direct an argument or explanation to the designated audience  -Establish a clear framework of essay and paragraph organization appropriate to the writing task and the thesis  -Employ rhetorical strategies consistent with the purpose of the writing task  

Overview

Before you pick a structure for your research essay, you have to decide what your main purpose is going to be. Do you want to explore or argue? Knowing this will help you figure out where your thesis will appear in the essay. Also, while there are different topics of argument that you can choose as well as different structures and organization, all research essays should include the following elements.

1. A point, a claim, a thesis, and one main thing you are trying to say. Bruce Ballenger calls this  S.O.F.T. This means Say One Frickin' Thing. The gist is that even though your essay has different ideas, there should be one specific point you are trying to get across to the reader.

2. A review or discussion with what has already been said about the topic. This is where you 'say back' or engage in conversation with current experts in the field.

The Conversation

Each essay should have a section where you put your sources into conversation with each other. This can be tricky if you haven't done this before, but hopefully, this template will explain it a bit more.

EXPERTS

In order to engage in conversation, you should have several sources from experts that offer different perspectives to answering your research question. When you put them into conversation with each other, this means you will draw connections to each of them by comparing and contrasting or adding information.

Conversation Example \(\PageIndex{1}\)

Expert A's perspective is that generally, "___________". While another social perspective looks at it as ________.

Interestingly enough, this idea is supported by Dr. _______ who says ______. On the other hand, sociologist _    disagrees and thinks ________.

 

In other words, it is your job as the researcher to make connections as if these people were in contact with other. One way to imagine it would be to pretend that they were on a panel and you are the facilitator.

3. Specific Information: This is all the data, sources, evidence, studies, and research that you find.

4. You should have a method of reasoning. You want to consider all the writing strategies available to you that would best fit the rhetorical situation of your essay. This includes using narrative, compare and contrast, argument, evaluation, definition, dialogue, description, and analysis.

The structure of your essay deals mostly with where you want to present your thesis and what type of tone you want to use.

Organization is how you order your paragraphs and sections. This can be from most important to least important or vice versa. If your research essay has distinct sections, each section might have paragraphs that are ordered differently. For instance, if you have a background or historical section, it would be organized chronologically; on other hand, the paragraphs that directly support your thesis would be ordered in the same way they are presented in the thesis. Below are two structural ideas that you can use that show the reader that you have explored the topic. If your main purpose is to argue your point now that you have done your research, there are a couple of suggestions that you can use. Ultimately, you should choose a structure that helps the reader understand your purpose. It always comes back to the rhetorical situation. Reflecting on the rhetorical situation you want to create with your research essay will help you choose a structure that's right for you.

Considering audience is also important. In Chapter 3 of Writing Persuasive Research Essays or Open Letters from Designing Arguments, they explain it this way.

Writing to Persuade Skeptical or Resistant Audiences

Writing for audiences already in agreement with you is a relatively easy task: you can rely on one-sided arguments, choose research that your audience already expects and respects, and easily accommodate the beliefs and values of your readers or listeners. In many ways, you are not actually arguing but stoking your audience’s enthusiasm for the issue and your position.

However, if you are thrown into a rhetorical situation in which you have to consider skeptical or resistant audiences, you’ll need to contend with many significant rhetorical constraints. To start off with, you need to grapple with the various perspectives on the issue (multisided argumentation); understand your audience’s positions, beliefs, and values; consider research that counters your position and find ways to respond to that information; shape your ethos to make you a more trustworthy and sympathetic writer for your readers; find moments of common ground and compromise; and imagine ways to use pathos-based appeals to reach your readers.

The difficulty of addressing skeptical and resistant audiences can be found in popular adages or sayings. If we are “preaching to the choir” in one-side arguments (with audiences that are in accord with our positions), what are the similar sayings for dialogical arguments?

A few have negative connotations of the audience: “Casting pearls to swine” (imagining your arguments as “pearls” and your audience as “swine” may not be the best way to plan for persuading them); similarly, “Talking to a fence post” and “Banging your head against a wall” may depict opposing audiences in ways that are not useful for you. “Leading a horse to water” is a good possibility, as it shows that good persuasion is similar to good teaching. “Winning hearts and minds,” meanwhile, summarizes pathos- and logos-based persuasive strategies. All of these phrases make clear, though, that persuading a resistant audience is more difficult than addressing an audience who already agrees with you.

Depending upon the level of resistance of your audience, you may decide that persuasive strategies will not be useful. For especially hostile audiences, you can only hope to make them more open for persuasion in the future. Therefore, instead of offering an argument that they will immediately reject, you might use a dialogical or invitational approach: you pose questions, tell stories, and try to get them to reflect on their own values and beliefs and to at least better understand alternative viewpoints, even if they don’t agree with them.

And, here’s some bad news. According to Ezra Klein in Why We’re Polarized (2020), Americans are getting more and more entrenched in their own views and becoming more unwilling to listen to views and opinions that are different from their own. Consequently, the rhetorical strategies are extremely important for you to consider. Learning how to communicate across difference is a crucial skill, not only in college, but in the workplace and in society more broadly. (Marzluf)

You might also want to start thinking about your essay as having sections depending on the requirements of your particular assignment. If you're mainly used to writing 6-7 paragraphs in an essay, a 8-10 page or longer essay may seem daunting. To tackle a research essay project, put your paragraphs into sections. Label these sections as reminders to what you are trying to achieve in that particular section. Later, in the final draft stage, if your assignment does not call for sections, you can delete the section headings

Delayed-Thesis Structure: This structure invites the writer and reader to a deeper understanding of the issue.

Introduction	Establish the problem under discussion and the occasion that makes the issue timely (kairos) Engage the audience in the problem
Discussion	Explore the problem from multiple perspectives, showing the validity of different perspectives. Invite the audience to join with you in considering different perspectives. Show how you are wrestling with the problem. For a good portion of the argument, keep the problem open, building some suspense.
Delayed Thesis and Support	Present your thesis-claim toward the end of the essay Support the thesis with several reasons and a brief discussion that may build on points presented earlier.
Conclusion	Leave the audience thinking about the problem and your position.

Rogerian Communication (Dialogue): This type of structure is more open and your thesis is more of a suggestion.

Introduction	Address the audience and identify the problem that  you and audience want to solve. Try to establish a friendly or cordial relationship with the audience. Possibly indicate information that shows your familiarity with the audience.
Summary of the Audience's Views	Summarize the audience's views in a fair and neutral way that the audience would accept.  Show that you understand the audiences positions. Also, show an understanding of, and respect for the audiences values and beliefs; the goal of this 'saying back' is to summarize these views in a way that will be entirely acceptable to the audience.
Common Ground	Identify common ground you share with your audience. Demonstrate your growth through empathic consideration of views that you would otherwise find threatening or unwelcome Show understanding of the audience's views by playing the believing game and by extending them to other situations through new examples. Show how your views have been enlarged by empathic listening to the audience's ideas.
Contribution of New Points [Thesis]	Respectfully propose your own way of looking at this issue Through respectful and inquiring tone, encourage the audience to listen and work with you to solve the problem.
Conclusion	Possibly propose a synthesis of the two positions, discuss how both parties gain from a bigger vision or invite the audience to ongoing negotiation.

 

Classroom Activity

Read the student sample and discuss how the delayed thesis approach helped the essay to be more persuasive to a resistance audience. Discuss with your group and the class. If you think using a different structure would have been better, explain.

Yusuf Ciftci wrote this persuasive research essay in Caitlin Hymans’ ENGL 200 class. Ciftci’s audience is legislative leadership in states that have not expanded to Medicaid

Healthcare Equity and Social Justice

The ideals of the American Revolution were founded on the concept of unalienable rights, described as “life, liberty, and the pursuit of happiness” in the Declaration of Independence. The inclusion of an endowed right to life is rather interesting. What constitutes the right to life? How can the government ensure a right to life among constituents? These difficult questions have dominated political discourse surrounding American healthcare since the early 20th century. In recent decades, rising healthcare costs, barriers to healthcare access, and deteriorating health outcomes among the general population have threatened this fundamental right to life. In response, legislative reforms have focused on mending inequalities within the American healthcare system. Most notably, the Affordable Care Act (ACA), colloquially known as Obamacare, significantly altered the structure of American healthcare in the past decade. A critical, yet controversial, component of the ACA focused on increasing healthcare coverage through Medicaid expansion, the premier federal safety net for socioeconomically disadvantaged individuals.

To explore why some legislators oppose Medicaid expansion, I will initially analyze the short-term fiscal impact of Medicaid expansion, barriers to healthcare delivery, and limitations on patient autonomy. Following this analysis, I will explore research on health outcomes, long-term health expenditures, and healthcare delivery reforms in Medicaid to understand the positive impacts of expansionary policies.

Many legislators who oppose Medicaid expansion are concerned about inefficiencies in Medicaid, directing attention to high tax rates and excessive spending throughout the years to maintain the program. Bryce Ward, a researcher on health economics with a Ph.D. from Harvard University, states that the median cost of Medicaid expansion for each state is approximately $100 million each year. Moreover, the federal government only covers the cost of expansion for the first three years of implementation, followed by incremental increases in state responsibility for the cost of expansion in successive years (2020). The substantial cost of Medicaid expansion, at $100 million each year, is concerning for legislators who are tasked with allocating limited funds to improve their communities. As a result, legislators may view opposing such large amounts of government spending as an appealing prospect to garner support among constituents.

Additionally, some are worried about the fiscal burden of Medicaid expansion on states after the three-year grace period. Given legislative term limits and recurrent election cycles, there is limited political incentive to undertake such a burdensome expansion in the view of some policymakers. Instead, legislators may focus on policies that are more likely to provide tangible short-term benefits to their communities. Rising tax rates introduce another dimension of complexity on the issue of Medicaid expansion. Ward (2020) states that “several states have explicitly raised taxes and fees to cover their share of Medicaid expansion.” Therefore, legislators who value limited government interference may be unwilling to adopt government-subsidized healthcare coverage and leverage their opposition to high tax-rates for constituent support. The fiscal impact of Medicaid expansion is a challenge that must be addressed if the ACA is to succeed in its goal of increasing access to healthcare.

Opponents of Medicaid expansion are also worried that expanding Medicaid may not improve short-term health outcomes because of barriers to healthcare delivery. Gordon et al. (2018), a group of health policy professors in leading medical schools across the nation, explored this endogenous relationship between healthcare delivery and health outcomes. According to their study, relatively low Medicaid reimbursement rates and the “administrative burden of navigating a state-run insurance program” led to historically low provider participation rates in 2018. Physicians are confronted with several barriers that prevent them from providing care for those in need. These include both bureaucratic restrictions on scope of practice and insurance companies requiring prior authorization for treatments. Moreover, providers interviewed as part of the study explicitly stated that inadequate investment placed a strain on providers and was not feasible in the short-term (Gordon et al., 2018). Thus, legislators may believe that Medicaid expansion negatively impacts healthcare workers who are reluctant to undertake the additional administrative burden of Medicaid expansion without adequate compensation.

On the other hand, such policies introduce an additional barrier to healthcare delivery and reinforce detrimental health outcomes among at-risk communities. One pediatrician specifically addressed barriers to mental healthcare, stating that “They [patients] have very poor access…[to] mental health services. The mental health services they do have, on paper don’t seem to solve the problems” (Gordon et al., 2018). Barriers to healthcare delivery place an undue burden on physicians, ultimately reflecting on patients in the form of disparate health outcomes. Presumably, a majority of legislators are concerned with public service and improving the lives of their constituents. As a result, some legislators may be hesitant to endorse Medicaid expansion without fundamental changes in healthcare delivery.

Finally, some legislative opponents of Medicaid expansion argue that the policy limits patient autonomy, the intrinsic right of patients to decide on medical care. In 2012, the Supreme Court reached a landmark decision ruling that critical parts of the ACA, including the Medicaid expansion mandate, were constitutional (National Federation of Independent Business v. Sebelius, 2012). However, on the question of whether Congress exceeded its power in withdrawing federal funds for states refusing to expand Medicaid, the Supreme Court ruled that “the Medicaid expansion provisions were unconstitutionally coercive as written.” Therefore, the federal government exceeded its power in leveraging federal funds to incentivize Medicaid expansion. This apparent overreach of power by the federal government may be worrying for some legislators who oppose Medicaid expansion. Among policymakers who value individual autonomy, the prospect of the federal government dictating medical care and coercing individuals to enroll in government-subsidized health coverage is likely to elicit strong opposition. As a result, legislators may appeal to constituents by publicly opposing “coercive”

Medicaid expansion mandates and appearing to advocate for the common citizen in the face of government overreach. I understand why some legislators may oppose Medicaid expansion as a mandate of the ACA because of its fiscal burden on constituents, inefficient healthcare delivery, and constraints on patient autonomy. However, I respectfully disagree with these arguments for several reasons. I believe that Medicaid expansion will decrease long-term healthcare costs, incentivize the development of efficient healthcare delivery models, and ultimately increase patient autonomy by resulting in a healthier population. Medicaid expansion will lead to improved long-term health outcomes, effectively reducing healthcare costs and compensating for short-term costs. In his article “The Long-term Health Impacts of Medicaid and CHIP,” Owen Thompson, a professor of health economics, longitudinally tracked health outcomes among children benefitting from Medicaid coverage. The study suggests that “an additional year of public health insurance eligibility during childhood… substantially reduces health limitations, chronic conditions and asthma prevalence while improving self-rated health” (2017). The results indicate that healthcare coverage in early childhood translates to improved health outcomes and lower rates of chronic illness in adulthood. Essentially, Medicaid expansion serves to improve the health and lives of children. These long-term impacts may serve as an incentive for legislators who value intrinsic concepts like “the American Dream” and equality of opportunity. Essentially, children will have the opportunity to succeed and contribute to society as healthy individuals without experiencing burdensome health disparities. By endorsing Medicaid expansion, legislators will position themselves as advocates for future generations and demonstrate their investment in the long-term success of the communities they represent, an appealing prospect for any policymaker across the country.

Conversely, improved long-term health outcomes will reduce the fiscal burden of disease on individuals and the healthcare system, lowering healthcare costs as a result. The Centers for Disease Control, the leading public health institute in the nation, reports that treatment costs for individuals with chronic conditions constitute roughly 90% of all healthcare expenditures in the United States. Moreover, approximately 42% of the general population is diagnosed with a chronic condition (Buttorff, Ruder, and Bauman, 2017). Given that the United States spends $3.5 trillion on healthcare each year, chronic conditions represent a tremendous financial burden on patients, providers, and taxpayers alike. Additionally, the annual cost of Medicaid expansion is estimated at 100 million each year, a significantly smaller amount compared to the healthcare cost of treating chronic illness (Ward, 2020). As established by Thompson (2017), Medicaid expansion is correlated with improved long-term health outcomes and reduced rates of chronic disease. Therefore, reduced healthcare expenditures to treat chronic illness in the long-term will offset the short-term fiscal impact of Medicaid expansion on constituents. Once again, endorsing Medicaid expansion allows legislators to entrench themselves as advocates concerned with long-term success in communities they represent. Moreover, legislators concerned about the fiscal impact of Medicaid may view the long-term payoffs in the form of improved health outcomes and reduced expenditures as appealing factors.

Medicaid expansion has also benefited from flexibility at the state level, where different states have implemented various programs to improve Medicaid. States are commonly referred to as laboratories of democracy, as they often practice innovative or controversial programs before such policies are implemented on a federal level. Medicaid expansion is no exception to this trend. The State Innovation Models Initiative, sponsored by the Centers for Medicare and Medicaid Services (CMS), offers grants for states to implement innovative healthcare delivery models. For example, Maine and Minnesota have utilized these grants to implement the Patient-Centered Medical Homes (PCMH) primary care model for Medicaid recipients. This innovative healthcare delivery model coordinates patient care among providers, including primary care physicians, specialty providers, and long-term care specialists, among others (Van Vleet and Paradise, 2014).

Moreover, the PCMH model incorporates community and personalized wellness coaching into healthcare. According to a longitudinal study on the effect of PCMH on health outcomes, researchers found that patients receiving care under this coordinated care model had lower mortality rates, decreased rates of chronic illness, and lower numbers of visits to the emergency room (Jackson et al., 2013). These key indicators of long-term patient health outcomes may be encouraging for legislators who desire to improve the lives of their constituents and communities. Considering that the PCMH is one aspect of flexibility in healthcare delivery, there exists tremendous potential to implement other innovative models of healthcare delivery and improve healthcare outcomes across the nation through Medicaid expansion.

Another key provision of Medicaid integrates social determinants of health (SDOH) into healthcare, ultimately leading to reduced healthcare disparities and increased patient autonomy. The SDOH are commonly defined as socioeconomic and environmental factors that influence individual health. These include income, education, housing, and transportation (Alderwick and Gottlieb, 2019). According to a study by Braveman and Gottlieb (2014), socioeconomic status “follows a stepwise gradient pattern, with health improving incrementally as social position rises.” Moreover, this same study reported that “the number of U.S. deaths in 2000 attributable to low education, racial segregation, and low social support was comparable with the number of deaths attributable to myocardial infarction, cerebrovascular disease, and lung cancer, respectively.” The SDOH are a significant systemic barrier to healthcare access and negatively impact health outcomes among individuals.

Furthermore, these determinants limit patient autonomy, as patients are forced to choose between healthcare and essential expenses like food and rent. Thus, individuals are not afforded the right to choose medical care for themselves simply because they are unable to access healthcare. Provisions of Medicaid expansion integrate programs targeting SDOH inequalities with healthcare delivery, demonstrating tremendous potential to alleviate these systemic barriers to patient autonomy. This is an appealing prospect for legislators who value patient autonomy and desire to portray themselves as advocates of limited government interference.

Like many issues that impose significant challenges on the status quo, Medicaid expansion remains a controversial issue among legislators across the nation. There are legitimate concerns with the fiscal impact of Medicaid expansion, inefficient models of healthcare delivery, and possible limitations on patient autonomy among legislators who oppose Medicaid expansion. Nonetheless, I believe that the beneficial impacts of Medicaid expansion warrant its consideration as a tool to reduce healthcare disparities in the American healthcare system. Expansionary policies can achieve this goal by decreasing long-term health expenditures, incentivizing flexibility to develop efficient healthcare delivery models, and ultimately increasing patient autonomy. These outcomes represent important progress toward achieving the Declaration of Independence’s ideals of “right to life, liberty, and the pursuit of happiness.”

References

Alderwick, H., & Gottlieb, L. M. (2019). Meanings and misunderstandings: A social determinants of health lexicon for health care systems. The Milbank Quarterly, 97(2), 407.

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports (Washington, D.C.: 1974), 129 Suppl 2(Suppl2), 19–31. https://doi.org/10.1177/00333549141291S206.

Buttorff, C., Ruder, T., and Bauman, M. (2017). Multiple chronic conditions in the United States, pp. 1-33. Santa Monica, CA: Rand.

Crumley, D., Lloyd, J., Pucciarello, M., & Stapelfeld, B. (2018). Addressing social determinants of health via Medicaid managed care contracts and section 1115 demonstrations. Center for Health Care Strategies. https://www. chcs. org/media/Addressing-SDOH-Medicaid-Contracts-1115-Demonstrations-121118. pdf.

Gordon, S. H., Gadbois, E. A., Shield, R. R., Vivier, P. M., Ndumele, C. D., & Trivedi, A. N. (2018). Qualitative perspectives of primary care providers who treat Medicaid managed care patients. BMC Health Services Research, 18(1), 728.

Health and Economic Costs of Chronic Diseases. (2020, September 15). Retrieved November 05, 2020, from https://www.cdc.gov/chronicdisease/a...osts/index.htm

Jackson, G. L., Powers, B. J., Chatterjee, R., Prvu Bettger, J., Kemper, A. R., Hasselblad, V., ... &

Gray, R. (2013). The patient-centered medical home: a systematic review. Annals of Internal Medicine, 158(3), 169-178.

Nat. Fedn. of Indep. Business v. Sebelius, 132 S. Ct. 2566, 567 U.S. 519, 183 L. Ed. 2d 450 (2012).

Thompson, O. (2017). The long-term health impacts of Medicaid and CHIP. Journal of Healt Economics, 51, 26-40.

Van Vleet, A., & Paradise, J. (2014). The state innovation models (SIM) program: an overview. Kaiser Family Foundation.

Ward, B. (2020). The impact of Medicaid expansion on states’ budgets. The Commonwealth Fund.

Citations and Licenses: Marzluf, Phillip, "Designing Arguments for Academic, Public, and Professional Audiences" (2021). NPP eBooks. 40.
https://newprairiepress.org/ebooks/40

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