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The dystopia of the automation of the healthcare system, the day Beveridge turned over in his grave

A few months ago, I asked the question of utopia and dystopia by re-reading Thomas More’s De optimo rei.

 Today, I would like to come back to the issue basing my observation on the latest developments concerning the automation and digitization of welfare in Europe, and the ethical issues that this raises, in the field of care, in a broad sense : care, universal credit… It may be time to really question our societies, their ability to create and recreate social bonds, trust, affect, empathy,…, their ability to maintain their humanity, both in the treatment of individuals by the central states, and in the daily interindividual relations on which each of us can act.

  The automation of the British healthcare system1 shows in retrospect that while many pre-existing problems remain, new challenges, specific to the system itself, are emerging2, at a time when, in the Netherlands, some politicians are questioning the possibility of extending the right to therapeutic euthanasia to elderly people in good physical health, but who are suffering « existential problems » (mental tiredness, depression…), and are convinced that they have lived enough3…

  In the United Kingdom, the freezing of the payment of benefits grouped under the universal credit label put beneficiaries into difficult daily conditions. The development of robotic processing units, « the virtual work force », the famous « artificial intelligences » of the healthcare system, dehumanized and unable of any empathy, unable of any case-by-case treatment of cases which mix unemployment benefits, family allowances, housing benefits, is becoming really problematic… It is an operating mode far from the ethics of the social worker, of the caregiver, far from the original, united and universal spirit of the British welfare system4. Beyond the British boundaries, the whole world turns to the same system, praising its efficiency, neutrality and transparency5. Social progress or return to Dickens dystopia ? The reality is a « modern time Oliver Twist legion » rising everywhere in a bipolar world, it’s the return of the daily living conditions of the Hard Times’ workers…

  Behind the tool, it is the political construction which is problematic, the displacement of the cursor which passes from the treatment of poverty as a social evil to the treatment of the poor, as a problem of the economic system. It is the loss of all the post-war welfare system : the solidarity in all its forms at the national scale. Behind these problems of file processing, delays, postponement, it is a whole part of the population that is living outside the healthcare and outside the allowance system in a great precariousness and in fine a life expectancy that, for some social categories, crumbles. Nothing more, nothing less…

  Beyond the dramatic individual problem, it is the future of an entire continent that is behind this process automation. In 2016 while British citizens are invited to vote on the brexit, European politicians tremble. The result falls, the whole Union questions its historical pilars and fifty years of common history and politics : « Europe can not do as before », « a painful choice that seriously puts Europe to the test » said the Elysee, while in Berlin a summit takes place, inviting France, Italy and the President of the European Council to face « this blow to Europe »…

 In Great Britain, D.Cameron resigns, N.Farage denounces a « European Union dying » and J.Corbyn invokes the growing impoverishment of the population as the cause of this historic vote, a vote of « fed up », a vote of « non confidence » rather adressing to british politicians than to UE community, in other words6. As we know, in January 2019, the first agreement was rejected by the Parliament, costing his post as Prime Minister to Theresa May7, while last weekend the postponement of the vote was decided by the House.

  For three and a half years, European press has filled its columns by writing about the rise of nationalisms and populisms across Europe, seeing in the brexit the case of a protectionist nation withdrawing on itself8. Without denying the real question of the opposition between defenders of a sovereignist Europe and defenders of a federalist Europe, the issue of brexit seems to be far more social than the expression of a simple anti-European feeling.

  To understand the issue, we need to remember the socio-economic policies that have been engaged since M. Thatcher, the progressive destruction of the British welfare state, particularly the restructuring of the NHS in the late 1980s leading to increased inequality between individuals but also between territories, by introducing market-type competition in healthcare structures. The reforms result in a development of impoverishment, the dismantling of trade unions and workers’ counter-powers, a liberalization of the labor market and a rise in unemployment particularly in the steel-production areas, which have become the abandoned territories of the post-industrialization, (still affected today)…

  Would Europe become populist ? Apart from the fact that the term « populism » raises questions9, it is up to us to reflect on these « anti-European revolts » that have shaken the construction of Europe for several years now. Why this disavowal ? In part, because at each new political and / or economic and / or social turning point, for decades now, politicians in various European countries have denounced the imperatives imposed by Brussels : liberalization of the market, control of sovereign debts, budgets, draconian austerity plan… And after having blamed European institutions for decades, politicians are now wondering about the people’s mistrust of these supranational institutions… It is very surprising to see political leaders looking for the deepest reasons of the crisis of confidence and the crisis of legitimacy that is shaking people across the continent… without a real questioning on the political foundations of governmental ethics10. It is becoming more and more difficult for politicians to ask citizens to valid an internal political agenda and at the same time denouncing the supremacy of Brussels over internal decisions. It is becoming increasingly difficult for citizens to understand the room for maneuver of decision-makers, even though they are participating in European summits… Flaw of a speech which causes a gigantic breakdown of confidence…

  The reality seems to be that just like the movement of yellow vests, brexiters have found a way to make their voices heard in the loud noise of post-subprime austerity crises. If we could stop to think brexit only as an expression of a visceral xenophobia, a refusal of otherness, we would begin to see the suffering of the popular classes, their feeling of abandonment and downgrading, the stagnation of some categories in poverty. The brexit, like the call of the poor worker who is sleeping in his car while working full-time, the movement of the yellow vests as the expression of solidarity of the nurse who lives in a room in a Parisian hospital because her income does not allow her to have a flat…

  Some local solidarities seem to reappear, facing the hardening of the living conditions of a whole part of the population of Europe. Maybe the referendum was a mistake, but now that it’s done and the situation is as it is, can we try to move forward, without continually replaying the match with additional « ifs » ? Instead of thinking of the brexit as a major tragedy in the history of Great Britain, now that the people have validated its implementation by referendum and it is difficult for leaders to disown their own people by holding a new vote… let’s see what will happen in the coming months…

  Can we hope for reforms really benefiting the population, the country being « liberated » from the constraints of Brussels so long denounced by political speeches ? Can we hope that Labor will grip the real challenges, posed by the population and try to improve daily life, by regaining control of the essential, vital public services of British society11 ? And that they restore care to an inalienable individual right ?

  Politicians must react and act responsibly, at the risk, if they do act without responsibility and without accountability, to lose the little credibility they still have and ultimately and at the risk of driving the entire society into the impasse of violence.

  If history teaches us anything, it is that « the poor », as a sociological figure, unlike the middle class, has nothing to lose and sometimes uses the most violent ways to be heard : the path of despair and powder.

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