Political commentators tend to agree that during the first half of the present century, many western societies became ‘welfare states’, in which the State tried to ensure high levels of employment, economic progress, social security, health and housing through the use of the tax system and investments, through state planning and intervention in the economy, and through the development of an extended and bureaucratically staffed apparatus for social administration. From our perspective, however, this is less the birth of a new form of state than a new mode of government of the economic, social and personal lives of citizens. This mode of government, that we term ‘welfarism’, is constituted by a political rationality embodying certain principles and ideals, and is based upon a particular conception of the nature of society and its inhabitants. This welfarist rationality is linked to an array of mutually translatable programmes, technologies and devices ranging from tax regimes to social insurance, from management training to social casework, from employment exchanges to residential homes for the elderly.
We have discussed welfarism and the government of economic life elsewhere (Miller and Rose 1990b. See also Miller and Rose 1990c). Let us here consider welfarism and ‘social’ government. ‘Social’ does not refer in this instance to a given repertoire of social issues, but to a terrain brought into existence by government itself – the location of certain problems, the repository of specific hopes and fears, the target of programmes and the space traced out by a particular administrative machinery (Donzelot 1979a).13 The programmes of social government that proliferated in the nineteenth century involved complex alliances between private and professional agents – philanthropists, charitable organizations, medics, polemicists and others, and the state – formed around problems arising in a multitude of sites within the social body. From the latter half of the nineteenth century onwards, these programmes, and the schemes they gave rise to, were gradually linked up to the apparatus of the state. These connections were, no doubt, inspired by diverse aims and principles, but they appeared to offer the chance, or impose the obligation, for political authorities to calculate and calibrate social, economic and moral affairs and seek to govern them. Yet the state apparatus did not, could not, eliminate all other centres of power or decision, or reduce them to its creatures whether through the mechanisms of command and obedience or by subjecting everyone to perpetual surveillance and normalization. Welfarism is not so much a matter of the rise of an interventionist state as the assembling of diverse mechanisms and arguments through which political forces seek to secure social and economic objectives by linking up a plethora of networks with aspirations to know, programme and transform the social field.
Governing the networks of welfare
The English example illustrates three key features of welfarism. The first concerns the relations between political rationalities and the formation of networks of government. As a political rationality, welfarism is structured by the wish to encourage national growth and well being through the promotion of social responsibility and the mutuality of social risk. This rationality was articulated in a number of different ways. The Beveridge Report was framed in terms of a kind of contract between the state and its citizens, in which both parties had their needs and their duties (Beveridge 1942). The state would accept responsibility to attack the ‘five giants of Want, Disease, Idleness, Ignorance and Squalor’ through a nationalised health service, a commitment to full employment and a social insurance system which would prevent the social demoralization and other harmful effects of periods of want by redistributing income across the life cycle. In return, the citizen would respect his or her obligations to be thrifty, industrious, and socially responsible. The Labour Party, on the other hand, articulated this rationality in terms of the just and equal treatment for each and for all, to be realized by planned, rationalised and universal state dispensation of security, health, housing and education (Morgan 1984; Craig 1975).
The rationality of welfarism was programmatically elaborated in relation to a range of specific problematizations: the declining birthrate; delinquency and anti-social behaviour; the problem family; the social consequences of ill health and the advantages conferred by a healthy population; and the integration of citizens into the community. These were not novel problems, but in the post-war period they were to be problematized by a multitude of official and unofficial experts and, crucially, were to be governed in new ways. The key innovations of welfarism lay in the attempts to link the fiscal, calculative and bureaucratic capacities of the apparatus of the state to the government of social life. The social devices of the pre-war period consisted of a tangle of machinery for the surveillance and regulation of the social, familial and personal conduct of the problematic sectors of the population. The personnel, procedures, techniques and calculations that made up these devices were attached to specific locales and organizations: the courts, the reformatories, the schools and the clinics. Welfarism sought to articulate these varied elements into a network and to direct them in the light of centralised calculations as to resources, services and needs.
However, welfare was not a coherent mechanism that would enable the unfolding of a central plan. The networks were assembled from diverse and often antagonistic components, from warring Whitehall departments to peripheral and ad hoc agencies (Bulpitt 1986: 24). This was no ‘state apparatus’, but a composition of fragile and mobile relationships and dependencies making diverse attempts to link the aspirations of authorities with the lives of individuals. Assembling and maintaining such networks entailed struggles, alliances and competitions between different groups for resources, recognition and power. The problem posed for the next thirty years, for those aspiring to form a ‘centre’ from which the welfare apparatus could be governed, was one of regulating those who claimed discretionary powers because of their professional or bureaucratic expertise.
The example of health illustrates these difficulties of welfarism as a technology of rule.14 How was one to make administrable the multitude of hourly and daily individual decisions by physicians, consultants, general practitioners, nurses, dentists, pharmacists and others? Each of these agents claimed and practised their rights to make decisions not on the basis of an externally imposed plan, or according to criteria reaching them from elsewhere, but according to professional codes, training, habit, moral allegiances, and institutional demands. The problem was one of connecting them instead to the calculations and deliberations of other authorities.
Between the Ministry of Health and the practitioners of the cure during the 1950s, a complex administrative structure was assembled. In the hospital sector alone this comprised 14 Regional Hospital Boards, 36 Boards of Governance for Teaching Hospitals and some 380 Hospital Management Committees. To govern this system in a ‘rational and effective’ manner as envisaged in the 1944 White Paper posed a problem of information: even the most basic information about the number and distribution of doctors was lacking at the periphery let alone the centre. This ‘lack’ was to be the start of a massive attempt to transform the activities of healers into figures that would make medicine calculable. The initial form of problematization was financial for the new technology displaced earlier ways of relating medical care to money. A series of studies lamented the limited information possessed by the Ministry on the financial administration of hospitals, the absence of costing yardsticks to judge the relative efficiency or extravagance of administration of various hospitals, and hence the invidious alternatives of accepting the plans of medical agents wholesale as submitted without amendment, or applying overall cuts in a more or less indiscriminate manner (see Jones 1950, quoted in Klein 1983: 48–9).
Diverse programmes sought to transform the health apparatus into a calculable universe in which entities and activities would be mapped, enumerated, translated into information, transmitted to a centre, accumulated, compared, evaluated, and programmed. The duties of each actor and locale would be relayed back to them down the network in the form of norms, standards and constraints. The problems of calculability were to be raised again and again over the next thirty years, and in relation to differing political rationalities and programmes. But in the 1950s, Ministry of Health policy making was more or less limited to operating by exhortatory circular – an average of 120 a year throughout the 1950s – and political exhortations can be ignored. For the medical profession established the NHS as a medical enclosure. Medics drew on a profound optimism concerning the ability of medical science to alleviate illness and promote health, in a variety of tactics that succeeded both in shaping the ‘policy agenda’ concerning health and in placing certain issues out of bounds for non-professionals (Klein 1983: 27). Further, medics came to dominate the administrative networks of health, forming a medico-administrative bloc that appeared resistant to all attempts to make it calculable in a nonmedical vocabulary.
By the 1960s, the technological questions of how the machinery of health was to be governed were re-posed within a more general shift of governmental rationalities. The notion that efficiency and rationality could be achieved through mechanisms of planning crossed the boundaries of economic and social policy and the bounds of political party. The Plowden Report of 1961 called for the use of public expenditure control as a means to stable long-term planning, with greater emphasis on the ‘wider application of mathematical techniques, statistics and accountancy’ (Chancellor of the Exchequer 1961, quoted in Klein 1983: 65). A range of new techniques were invented by which civil servants and administrators might calculate and hence control public expenditure: the Public Expenditure Survey Committee (PESO), the use of cost benefit analysis, of PPB (Planning, Programming, Budgeting) and PAR (Programme Analysis Review). And official documents like the Fulton Report envisaged these as gaining their hold upon the machinery of government through their inculcation into a professional corps of administrative experts, specialists both in techniques of management and those of numeracy (Committee of the Civil Service 1968).
Management, mathematics and monetarisation were to tame the wild excesses of a governmental complex in danger of running out of control. The Ministry of Health set up its Advisory Committee for Management Efficiency in 1959 and expenditure on ‘hospital efficiency studies’ rose from £18,000 in 1963–4 to £250,000 in 1966–7. Health economists invented themselves and installed themselves in the Ministry of Health and outside it, articulating a new vocabulary for defining problems and programming solutions (Office of Health Economics 1967). Yet for some fifteen years these new mechanisms for central planning according to rational criteria appeared destined to fail.
It was in the 1970s that the medico-administrative enclosure of health was to be breached. Politicians and planners began to speak of the insatiability of the demand for medical services and hence the need to impose some politically acceptable limits upon national provision. The very success of medics in promoting high-tech medicine had vastly increased the cost of treatment. Sociologists and demographers issued dire predictions about the consequences of the aging population and increases in life expectancy for demands on the health apparatus. Further, the medical monopoly over the internal working of the health apparatus began to fragment. General practitioners and consultants began to stake rival claims for dominance. New actors proliferated in the health networks – nurses, physios, occupational therapists – and began to organize themselves into ‘professional’ forces, claiming special skills based upon their own esoteric knowledge and training, demanding a say in the administration of health, contesting assumptions of the superiority of medical expertise. Ancillary workers became increasingly unionised and pressed for better wages. The conflicts between rational planning and expert powers became more evident. As the health apparatus threatened to become ungovernable, a new form of rational expertise, grounded in the discourse of health economics, began to provide resources for those who wished to challenge the prerogatives of doctors. New devices began to be developed for evaluating the costs and benefits of different treatments and decisions, rendering them amenable to non-clinical judgments made neither by doctors nor by local politicians, but by managers (Ashmore, Mulkay and Pinch 1989).
Further, the health consumer was transformed, partly by developments in medical thought itself, from a passive patient, gratefully receiving the ministrations of the medics, to a person who was to be actively engaged in the administration of health if the treatment was to be effective and prevention assured. The patient was now to voice his or her experiences in the consulting room if diagnosis was to be accurate and remedies effective. The patient was also to be actively enrolled in the government of health, educated and persuaded to exercise a continual informed scrutiny of the health consequences of diet, lifestyle and work. And patients, reciprocally, were to organize and represent themselves in the struggles over health. By 1979, 230 organizations for patients and disabled people could be listed in a directory, providing forums for sufferers of particular conditions and their relatives, pressing for increased resources for problems ranging from migraine to kidney transplants, demanding their say in decisions concerning everything from the place of birth to the management of death. Out of this concatenation of programmes, strategies and resistances, a new ‘neo-liberal’ mode of government of health was to take shape.
Welfare and responsible citizenship
Welfarism embodies a particular conception of the relation between the citizen and the public powers. As the ‘contractual’ language of Beveridge's programme indicates, welfarism is a ‘responsibilizing’ mode of government. Social insurance, which Beveridge made the centrepiece of his report, will serve to illustrate this (Rose 1980).15 Insurance fundamentally transforms the mechanisms that bind the citizen into the social order. A certain measure of individual security is provided against loss or interruption of earnings through sickness, unemployment, injury, disablement, widowhood or retirement. Yet simultaneously the subjects of these dangers are constituted as the locus of social responsibility and located within a nexus of social risk.
Prior to insurance, perhaps the principal socially regulated relationship was between the employer and the employee. The technology of insurance not only entails the direct intervention of the state as third party into the contract of employment, it articulates this relation within a different but complementary contract between the insured individual and society, introducing a relation of mutual obligation in which both parties have their rights and their duties. Programmes of insurance did not merely aspire to the prevention of hardship and want. They also sought to reduce the social and political consequences of economic events such as unemployment by ensuring that, whether working or not, individuals were in effect employees of society. Within the political rationality of welfarism, insurance constituted individuals as citizens bound into a system of solidarity and mutual inter-dependency. Insurantial technology did not compose a mechanism where premiums were adjusted to risk or contributions were accumulated in order to provide for future benefits. Rather, the vocabulary of insurance and the technique of contribution were chosen in the belief that this would constitute the insured citizen in a definite moral form: payment would qualify an individual to receive benefits, would draw the distinction between earned and unearned benefits, and teach the lessons of contractual obligation, thrift and responsibility.
Welfarism and the technicisation of politics
The system of social insurance embodied definite politico-ethical aspirations. However, it had the paradoxical effect of expelling certain issues and problems from the political to the technical domain. This illustrates a third key feature of welfarism: the role accorded to expertise. By incorporating expertise into a centrally directed network, welfarism facilitates the creation of domains in which political decisions are dominated by technical calculations.
In most European societies, sickness and insurance funds were developed by voluntary associations, trade unions, political parties and religious groups. They had an immediate ‘political’ form, in that they allowed for some participation by the insured in decisions over the administration of these benefits, provided a base for workers' organizations, served as a resource for the creation of collective identities and the mobilization of members for such issues as elections and strikes. Such issues can be ‘de-politicized’ in two ways: either by re-locating them as ‘private’ matters to be resolved by individual market transactions, or by transforming them into technical, professional or administrative matters to be resolved by the application of rational knowledge and professional expertise in relation to objective and apparently neutral criteria (Starr and Immergut 1987).
Even such a perceptive commentator as T. H. Marshall was to write of social insurance, that ‘This new sophistication was a scientific not a political phenomenon . . . applying techniques, which were of universal validity, to problems that were an intrinsic part of modern industrial society’ (Marshall 1975: 69). Yet as Jaques Donzelot suggests, one of the most important results of insurance is the de-dramatisation of social conflicts, through
eliding the questions of assigning responsibility for the origin of ‘social evils’ and shifting the issue to the different technical options regarding variations in different parameters required to ‘optimise’ employment, wages, allowances etc. (Donzelot 1979b: 81)
And, at the same time, insurance creates a form of passive solidarity amongst its recipients, de-emphasising both their active engagement in collective mechanisms of providing for hard times such as trade unions or friendly societies and their individual striving for self-protection through savings. Insurance is certainly a ‘technical’ option, but it is a technology that redraws the social domain and simultaneously readjusts the territory of the political on the one hand – struggles, contestations, repressions – and the economic on the other – wage labour, the role of the market, subsistence and poverty.
If the contemporary ‘crisis’ of welfare as a rationality of government arose, in part, out of the difficulties engendered by the technologies that sought to operationalise it, the possibility of supplanting welfare by a new rationality of government arose out of the proliferation of a range of other, more indirect means, for regulating the activities of private agents. This entailed the implantation of technologies of calculation and the development of various techniques for attaching actual or psychological rewards to certain decisions and making others financially or culturally less attractive. Government was to be vested in the entrepreneurial activities of producers of goods and suppliers of services, the expertise of managers equipped with new modes of calculation, the operation of a market that would align the activities of producers and providers with the choices of consumers, actively seeking to maximise their ‘lifestyles’ and their ‘quality of life’.