Think Piece

Neoliberal Dogma? Revisiting Foucault on Social Security, Healthcare, and Autonomy (Pt. II of II)

by guest contributor Luca Provenzano

Earlier, I discussed claims that the French philosopher Michel Foucault anticipated or deployed neoliberal dogmas about social security in an interview in 1983. I now consider Foucault’s assertions about health and healthcare in the same interview. I further assess how the allegations that he deployed “neoliberal dogmas” might relate to the contradictions of contemporary knowledge production.

In the 1983 interview, Foucault indeed proposed that “health” was not a right (cf. Zamora, Critiquer Foucault, 103). But not as a conclusion to “neoliberal” reasoning: the main argument was that it was obscurantist to “secure” by juridical right a state of biological and psychological fact. In other words, Foucault considered that a state as fragile as “health” could not be secured by legislation.

It is clear that there is hardly sense in speaking of a “right to health.” Health, good health, cannot come from a right. Good and bad health, regardless of the unsophisticated or subtle criteria that we use, are facts: facts of health and of consciousness (Foucault, Dits et écrits, vol. 4., 376).

A plausible intellectual genealogy would not include neoliberalism so much as the thought of Foucault’s former mentor Georges Canguilhem, a historian of medicine, philosopher, and medical practitioner:

Biological normalities have no guarantee other than their fact, unless one gives them a metaphysical foundation, which nothing forbids us from seeing only as a consecration of that fact…health is not at all an economic exigency to be asserted within a legislative framework [i.e., in the “right to health”]; it is a spontaneous unity of the conditions for the exercise of life.  This exercise, on which all other exercises are founded, founds for them and restricts, as they also do, the risk of failure, a risk from which the individual cannot be protected by any statute of socially normalized life (Canguilhem, Writings on Medicine, 61-62, italics mine; cf. 65; 83fn34 gives the original publication).

In this perspective, it is a juridical illusion to believe that right secures what cannot be reasonably guaranteed—health. (Consider Foucault’s own deteriorating health due to an incurable illness, then barely understood, from which no juridical statute could protect him.) But Foucault thought that society could posit rights to specific working conditions and accident compensation: “Nevertheless, we can have the right to conditions of work that do not significantly augment the risks of illness or of various disabilities. We can have the right to reparations, to care, and to sanctions when a health accident originates in one fashion or another from the responsibility of an authority figure.”(Foucault, Dits et écrits, vol. 4, 376). Foucault also thought that the law could establish the right of access to healthcare (les moyens de santé) and pointed out the problems of realizing equal access (ibid., 377). For Foucault, law could secure healthcare and health insurance but not health.

In Foucault’s opinion, if the demand for health were susceptible to grow indefinitely, it would be impossible for society to completely satisfy that demand. However, rather than offer a severe critique of healthcare expenditures, Foucault judged the contemporary rate of growth of those expenditures unsustainable: “it will be in any case impossible to let expenses under this column [i.e., health] grow at the rhythm of these past years” (ibid., 378). He argued that French society would inevitably make decisions concerning how to allocate its resources and limiting coverage for certain conditions, and that these issues needed to be publicly confronted—not determined by automatism or fiat (ibid., 378). These statements mediated both common themes about finitude from inter- and post-war French philosophy and the impact of the immediate conjuncture: on the one hand, the onset of austerity policies under Mitterrand, on the other, his own illness. The motifs of human frailty in the face of insurmountable limitations pointed towards broader societal conditions and Foucault’s own bodily decline (he concluded the interview by meditating on his own potential death).

Foucault made three major points in this 1983 interview. First, it was imperative that social provisions should produce autonomy and limit normativity in their mechanisms of access; second, social provisions would have to be adjusted to finite resources; third, the French needed to invent new practices and conceptual frameworks to address these issues.  As far as I can tell, his points had slight positive relation to the notions that the market should become the sole force for the rational distribution of societal resources or that the state should merely regulate the market and provide security and order.

Why then the allegations? In my view, the notion that Foucault deployed “neoliberal dogma” regarding social security and healthcare in this interview is prisoner to a methodology quite indifferent to the larger networks of statements in which he articulated his claims. To be sure, this method affords marvelous talking points that have been used in the latest debate such as ‘Foucault rejected the right to health’ or ‘Foucault stated that social security had perverse effects’: if you take language-fragments out of their game, you might find damning material. Yet if it is certainly possible that further evidence from the Foucault archives at the BNF will show that he positively endorsed aspects of neoliberalism, the latest case is no stronger than the one five years ago.

Finally, the most outspoken critics of Foucault in this affair do not ask about the conditions of emergence of their own critique or the difference between those conditions and the ones faced by Foucault. Knowing the future successes of neoliberalism, they project today’s conditions of thought as a norm for their source material. One symptom of this is a dismissal of Foucault’s questions and problems that never bothers to ask why the “correct” questions were not available to him at that moment. Yet regardless of whether his thought is a valuable resource for us, Foucault was not necessarily our contemporary, something both critics and defenders often struggle to accept. The need for historical reflexivity in this debate is more acute than ever.

I thank Stefanos Geroulanos for pointing out the connection to Canguilhem.

Luca Provenzano is a second year doctoral student at Columbia University. He is currently working on Louis Althusser, May 1968, and the concept of ideology.

Think Piece

Neoliberal Dogma? Revisiting Foucault on Social Security, Healthcare, and Autonomy (Pt. I of II)

by guest contributor Luca Provenzano

Was Michel Foucault “seduced” by neoliberalism? Daniel Zamora and other scholars voice this allegation in Critiquer Foucault: Les années 1980 et la tentation néolibérale (English translation forthcoming). Last month, an interview with Zamora (translated from the French) and a later essay resonated among Foucault readers (See post by Stuart Elden). A vibrant debate also reignited last week at An und für sich (usefully curated here).

In my take, the accusations (often hyperinflated online, most strikingly here) disclose more about the production of knowledge under neoliberal conditions than they reveal about Foucault. To set up this argument for my forthcoming second post, I look to a 1983 interview about French Sécurité sociale and healthcare rights (the speakers were Michel Foucault and Robert Bono, the general secretary of the CFDT French trade union). The interview is “Un système fini face à une démande infinie” in Foucault, Dits et écrits IV (English translations are my own). For two reasons, this seems as good place as any to criticize the seduction claims: first, its brevity; second, the essentially “normative” mode pursued by Foucault. I consider only whether Foucault’s discussion of social security substantially reproduced “neoliberal” dogma about the dependent poor or the negative economic effects of social provisions. Far from serving as an active contributor to the destruction of social security, I believe Foucault attempted to re-envision it so as to reduce its limitations. (NB: French Sécurité sociale has a more extensive meaning than our “social security” and denotes the ensemble of social provisions for workers).

Let’s work through the interview. Foucault concluded his first statements about social security thus:

Finally, Sécurité sociale, whatever its positive effects, has also had ‘perverse effects’: the growing rigidity of some mechanisms and situations of dependency. This is inherent to the functional mechanisms of the institution [dispositif]: on the one hand, we give people greater security and, on the other, we increase their dependency. Rather, we should be able to expect our social security to grant each person their autonomy in relation to dangers and situations that would subordinate or subject them (Foucault, 368).

Foucault later qualified this statement:

There really is a positive demand for a [social] security that opens the route to richer, more numerous, more diverse and more supple relations to the self and to its milieu, all the same assuring to everyone a real autonomy. This is a new fact that should weigh upon contemporary conceptions when it comes to social protection (Foucault, ibid).

From the start, Foucault bracketed but acknowledged the positive effects of French social security. His inquiry concerned the more ambiguous effects of the contemporary system on personal autonomy, but Foucault apparently thought that social security and autonomy were potentially compatible. In my interpretation, he implicitly denied the claim that situations of mounting dependency were necessities of any social security; rather dependency inhered in the “functional mechanisms” of the contemporary system. Foucault further prodded his interlocutors to consider a renovation of these structures: “Shouldn’t we rather try to conceive of a system of social coverage that would take into account the demand for autonomy that we are talking about in such a fashion that these famous effects of placement into dependency [mise en dependence] would almost totally disappear?” (ibid., 370)

Notably, Foucault categorized the two sorts of “dependency” reinforced or produced by post-war French welfarism as “placement into dependency through integration” and “placement into dependency through marginalization or exclusion” (ibid., 369). “Dependency through integration” originated in the distribution of social aid through certain “normal” institutions like the family, the workplace, or the geographic region. “Dependency through marginalization” originated in exclusion from aid or marginalization from aid by the same administrative mechanisms. “Our systems of social coverage impose a determinate mode of life to which it subjects individuals and any person or any group,” he wrote, “that, for one reason or another, does not want or cannot integrate to this mode of life finds himself marginalized by the very play of the institutions” (ibid., 372). This is a critique of contemporary conditions of access to social provisions.

In my view, it was not a “neoliberal” critique in the sense that it was not at all about the purported negative macroeconomic effects of socialized coverage or how social provisions supposedly encouraged unproductive behavior among recipient populations. Foucault also took seriously the notion that non-access to coverage could be a source of “dependency” or heteronomy. His comments complimented the CFDT proposal to renounce “the absurd juridicism” of a French social aid system that discriminated against “marginals” through a bureaucratic firewall and to decentralize social welfare institutions in order to make them more accessible. Foucault envisioned not the destruction of social security but the move towards a system that would prove more agnostic towards the modes of life of its recipients: “the objective of an optimal social coverage conjugated to a maximum of independence is very clear” (ibid).

In short, Foucault asked: “what are the limits to autonomy posed by the way our social democracy administers and adjudicates claims to aid?” The critique of the mechanisms of access to social security fit Foucault’s contemporary philosophical inquiries into how systems enforced professions of identity; he wanted to investigate how the state validated dominant identities and modes of life via the distribution of aid and how to limit that effect. Foucault thought that the state should establish new forms of access to Sécurité sociale that were less contingent on the adherence of aid recipients to “normal” social categories insofar as these procedures tended to force individuals to identify as “X,” and in turn reinforced dominant institutions. The problem of social security reform for Foucault was “how to act so that the person would no longer be a ‘subject’ in the sense of l’assujettissement…” (ibid., 373) – a subject subjected to prevailing societal norms. In my view, the link to neoliberalism is at best a retrospective illusion.

Luca Provenzano is a second year doctoral student at Columbia University. He is currently working on Louis Althusser, May 1968, and the concept of ideology.