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June 11, 2009
The history of the Australian welfare system, like that of the British, has always been one of grudging, paternalistic and sometimes punitive forms of social protection. In New Labour, the market state, and the end of welfare in New Formations Jonathan Rutherford argues that welfare reform under Blairite New Labour in the UK meant the transformation of the old style nation state into a new kind of 'enabling' market state.
Instead of providing social protection, the market state offers 'opportunities' and 'choice' to 'customers', who in return must shoulder a greater degree of responsibility for their individual predicament. Rutherford says that:
The system is not in crisis, and this is not the motivation for the proposed changes. New Labour's politics of welfare reform has subordinated concern for the sick and disabled to the creation of a new kind of market state: claimants will become customers exercising their free rational choice, government services will be outsourced to the private sector, and the welfare system will become a new source of revenue, profitability and economic growth.
The goal was the transformation of the welfare system. The cultural meaning of illness would be redefined; growing numbers of claimants would be declared capable of work and 'motivated' into jobs. A new work ethic would transform welfare recipients into entrepreneurs helping themselves out of poverty and into self-reliance. So this Blairite form of social democracy does not try to separate itself from a neoliberal model, as it buys into "free market fundamentalism" in its response to end a culture of welfare dependency.
The underlying argument is an interpretation of the bio-psychosocial model of health, which argues that ithe old biomedical model of illness, which has dominated health care for the past century, cannot fully explain many forms of illness.' This old model assumes a causal relation between disease and illness, and fails to take into account how cultural attitudes and psychological and social factors shape illness behaviour. In other words it allows someone to report symptoms of illness, and for society to accept him or her as sick, without their having a pathology.
The interpretation is that disease is the only objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour - all the things people say and do that express and communicate their feelings of being unwell. The degree of illness behaviour is dependent not upon an underlying pathology but on 'individual attitudes and beliefs', as well as 'the social context and culture in which it occurs. Personal choice plays an important part in the genesis or maintenance of illness.
The solution is not to cure the sick, but to transform the culture of welfare and tackle the 'personal and social/occupational factors [that] aggravate and perpetuate incapacity'. Adopting this model will lead to a 'fundamental transformation in the way society deals with sickness and disabilities'. The goal and outcome of treatment is work: 'work itself is therapeutic, aids recovery and is the best form of rehabilitation'.
Tough the social and cultural dimensions of illness are acknolwedged, this interpretation fails to consider that these and other structural and economic forces might be the dynamic causes of genuine ill health. Instead the problem of illness is located in the individual, whose beliefs and behaviour then become the focus of moral judgment and action. The solution is to change people's behaviour by transforming the language and culture of welfare, and by using sanctions as a 'motivational tool' to prise people out of their sick role. The 'sick role' as an explanation for a person's actions and attitudes makes the individual who is incapacitated responsible for what are socially produced problems.
The workfare system that is taking shape is turning the logic of welfare onto its head. It is no longer a system that seeks to help people who are sick or disabled; instead it is increasingly asking them how they can help us. Tony Blair called it 'mutual responsibility'.
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