Julia Reed: "(In)valid Citizens: Patient Advocacy and Social Security in Gaullist France"

Beskrivning:

The French welfare state is often described as a more or less "conservative" and "Bismarckian" regime in comparison with liberal and social democratic welfare states. The social security scheme created in 1945 by the Provisional Government limited coverage to industrial and commercial employees, partially enacting the proposals of Pierre Laroque (1907-1997), the director of Social Security, whose aims for a more universalist program were frustrated by the occupational, fragmented, and mutualist character of existing social insurance programs. In the years following Liberation, a variety of groups and interests–industrialists, mutual aid societies, physicians’ groups, small business owners, Resistance reformers, and Gaullist nationalists–helped shape the public health, public assistance, social insurance, and familial policies of the postwar French welfare state. In this paper, I analyze another important historical actor in the formation of the postwar French welfare state: patient organizations in the earliest years of the social security administration in France. Drawing from the periodicals of two patient organizations, the Association Française des Diabétiques (AFD) and the Association des Paralysés et Rhumatisants de France (APF), I argue that we can see several important features of "patienthood" in the French welfare state as these patient communities adapted and were integrated into the welfare state apparatus. First, conditions took on new disease framings of being identified with, or between, the social security categories of long-term illness or infirmity, which were defined in relation to a reduction in labor capacity and the potential for regaining that capacity through rehabilitation. Second, patient communities developed new identities as sub-populations subject to study and management. Finally, the organizations drew on the French mutualist tradition of voluntary participation and representation that the architects of Social Security envisioned as a crucial instrument of its solidarist aims. Both organizations appealed to both a Fordist corporatism of sick and disabled persons as productive workers and to a nationalist ideal of restoring and perfecting the republic. This tension between the corporatist solidarism of productive workers and a nationalist program of reconstruction and welfare expansion characterized much of the formation of the postwar French welfare state. By comparing how the organizations responded to, and advocated for, the development of social security, I show how distinct patient communities positioned themselves as unfairly excluded from the republic in practice but also included in its ideal reformation, as well as how the postwar tension between corporatist and nationalist aims cut across different contexts of advocacy and state-building.