# FOUCAULT /// Foucault and Healthcare: A Biopolitical Problem

I am in complete disagreement with American libertarian politicians like Ron Paul and his son, Senator of Kentucky Rand Paul as far as interior policies are concerned. However, one needs to acknowledge the consistency of their political system, a sort of anarchist free-market in which supposedly social justice comes from the self-regulation of the system. This kind of thinking leads, of course, to the conservation of the current American healthcare system that nevertheless constitutes the most blatant example of capitalism’s indifference for any form of social justice. To be just, the libertarian pure capitalist system should make all human ‘start from scratch’ with egalitarian conditions of life, a sort of capitalist kibbutz in which children would be separated from their parents at their birth to be given the fair chance to take their place in the meritocracy. It goes without saying that such structure would not be to the Libertarians’ taste and therefore their system fails in consistency only when they want it to appear as just. The current American healthcare system that treats extremely differently the wealthy and the poor and that provides life-long debts, is what we could call a crime against society as a new legal definition.

It would be too simple however to state that countries like Canada, Japan or the European Union have found a perfect healthcare system. In this regard, it is interesting to look at the 1983 conversation entitled “The Risks of Security” (“Un système fini face à une demande infinie” in its original French version) in which Michel Foucault answers the questions of Robert Bono, general secretary of the union CFDT (Democratic French Confederations of the Workers) that was part of the Administration Council of the French social security back then. It is incidentally interesting to see that in the early 1980’s in France during the beginning of the first left president François Mitterand, a conversation about an important topic like healthcare between one of the main representatives of the country’s unions and a philosopher like Foucault could occur. It is also to Foucault’s credit in this conversation not to remain in the abstraction of a disincarnated philosophy but, on the contrary, to speak of problems concretely and even proposing a few ideas to the risk of loosing credibility.

Foucault admits that it is illusory to think of a healthcare that would cover the entire needs of individuals in terms of health. The modern era did not limit itself to distinguish the healthy from the unhealthy, but rather developed (bio)politics that makes each individual aware of the non perfection of her/his health. “[T]here was a growth in the demand for health, which demonstrates that the need for health (at least as far as it is felt) has no internal principle of limitation.” The impossibility of a perfect health implies the impossibility of an absolute healthcare both at the material and economic level. There is therefore a norm that has to be considered to evaluate what can be covered and what cannot. Again, it is Foucault’s credit to admit it and he pragmatically encourages that the immanence that is proper to the norm be as much seek and respected as possible:

When I speak of arbitration and normativity, I do not have in mind a sort of committee of wise men who can proclaim each year: “Given the circumstances and state of our finances, such a risk will be covered and such another will not.” I picture, in a more global sense, something like a cloud of decisions arranging themselves around an axis that would roughly define the retained norm. It remains to be seen how to ensure that this normative axis is as representative as possible of a certain state of consciousness of the people—that is, of the nature of their demand and of that which can be the object of consent on their part. I believe that results of arbitration should be the effect of a kind of ethical consensus, so that the individual can recognize himself in the decisions made and in the values behind the decisions. It is under this condition that the decisions will be acceptable, even if someone protests and rebels. (Michel Foucault, “The Risks of Security,” in Power: Essential works of Michel Foucault edited by Paul Rabinow, New York: The New Press, 2000. 378)

The problem that healthcare thus represents, reveals the problem of the norm. The role of politics in regards of it is to maintain as much as possible the immanence of the norm through minimal transcendental power. The norm is through what power is applied in a biopolitical regime and the correspondence of the problem of healthcare to the one of the norm should in no way be considered as an illegitimacy of the healthcare system itself. The latter is not a philanthropic ‘gift’ from the government to its subjects, it is fully part of the biopolitical mechanisms that tie together society’s function with the life of its participants. This argument is pointed out by Foucault himself in the same conversation:

Today a problem of limits intervenes. What is at stake is no longer the equal access of all to security but, rather, the infinite access of each to a certain number of possible benefits. We tell people: “You cannot consume indefinitely.” And when the authorities claim, “You no longer have a right to that,” or “You will no longer be covered for such operations,” or yet again, “You will pay a part of the hospital fees,” or in the extreme case, “It would be useless to prolong your life by three months, we are going to let you die”—then the individual begins to question the nature of his relationship to the state and starts to feel his dependency on institutions whose power of decision he had heretofore misapprehended.

[…]

An apparatus made to assure the security of people in the domain of health has thus reached the point in its development at which it will be necessary to decide that such an illness, such a suffering, will no longer benefit from any coverage—a point at which even life, in certain cases, will no longer enjoy any protection. And that poses a political and moral problem somewhat related, observing due proportion, to the question of the right of the state to ask an individual to die in a war. (Michel Foucault, “The Risks of Security,” in Power: Essential works of Michel Foucault edited by Paul Rabinow, New York: The New Press, 2000. 367-375)