The political control of medical diagnoses - welfare retrenchment through demedicalization

TY - CONF

T1 - The political control of medical diagnoses - welfare retrenchment through demedicalization

AU - Møller, Marie Østergaard

AU - Larsen, Lars Thorup

PY - 2012/9/2

Y1 - 2012/9/2

N2 - It is notoriously difficult to legitimize cutbacks in already existing welfare rights, but it somehow requires a redefinition of what falls within the limits of public responsibility. In Denmark, a universal welfare state, reforms have sought to regain political control over medical diagnoses and how they give access to wel- fare benefits. Since there is wide popular support for universal health and social insurance, retrenchment can be legitimized by problematizing the target group or by changing the perception of the problem from a medical illness into something, which is merely a personal interest or ‘need’. The paper compares two cases where retrenchment reforms have reframed medical conditions as personal preferences. First, access to fertility treatment has recently been cut off in the Danish health care system, because infertility is polit- ically reframed as putting their own interest ahead of the child. The second case concerns how doctors and medical aspects have been excluded from evaluations of citizens’ eligibility for sickness benefits and similar types of social insurance. By more or less cutting the GP out of the evaluation, the underlying problem is subtly redefined from a medical issue into a question about the citizen’s motivation and will- ingness to work. The paper traces the genealogy of these two clashes between medicine and universal welfare rights and how both childlessness and incapacity to work have been ‘demedicalized’ by the polit- ical system in order to smooth the ground for retrenchments. The qualitative case studies not only provide a detailed look into how politics take over medical decisions in order to regain control of access to wel- fare benefits. The paper also shows how the perception of target groups changes in the same process with sick people being replaced by ‘demanding’ citizens whose claims are far beyond what the welfare state should reasonably deliver.

AB - It is notoriously difficult to legitimize cutbacks in already existing welfare rights, but it somehow requires a redefinition of what falls within the limits of public responsibility. In Denmark, a universal welfare state, reforms have sought to regain political control over medical diagnoses and how they give access to wel- fare benefits. Since there is wide popular support for universal health and social insurance, retrenchment can be legitimized by problematizing the target group or by changing the perception of the problem from a medical illness into something, which is merely a personal interest or ‘need’. The paper compares two cases where retrenchment reforms have reframed medical conditions as personal preferences. First, access to fertility treatment has recently been cut off in the Danish health care system, because infertility is polit- ically reframed as putting their own interest ahead of the child. The second case concerns how doctors and medical aspects have been excluded from evaluations of citizens’ eligibility for sickness benefits and similar types of social insurance. By more or less cutting the GP out of the evaluation, the underlying problem is subtly redefined from a medical issue into a question about the citizen’s motivation and will- ingness to work. The paper traces the genealogy of these two clashes between medicine and universal welfare rights and how both childlessness and incapacity to work have been ‘demedicalized’ by the polit- ical system in order to smooth the ground for retrenchments. The qualitative case studies not only provide a detailed look into how politics take over medical decisions in order to regain control of access to wel- fare benefits. The paper also shows how the perception of target groups changes in the same process with sick people being replaced by ‘demanding’ citizens whose claims are far beyond what the welfare state should reasonably deliver.

M3 - Paper

T2 - The Annual APSA Meeting

Y2 - 29 August 2012 through 2 September 2012

ER -