Is Labour abolishing illness?

The new rules on incapacity benefit stake everything on a major gamble: that a large proportion of c

Incapacity benefit has become one of this year's favourite scare stories. Hardly a day passes without a new headline deploring its soaring costs and the rising numbers of claimants who get "something for nothing", at the expense of decent, hardworking taxpayers. We are told that we are footing an outrageously escalating bill for 2.4 million people, a million of whom shouldn't be on the benefit at all, and each successive work and pensions minister vows to be more ruthless than the last.

The true picture is somewhat different. The unreported version, which can be culled from Department for Work and Pensions (DWP) data, is that only 1.4 of the 2.4 million actually receive any payment, the rest get national insurance credits only, and numbers have been falling since 2003. The basic benefit is worth barely £3,000 a year. After two small rises in the first year there is no further increase, other than index-linking. All those who get the benefit have to pass a rigorous "personal capability assessment" (PCA) with doctors appointed by the DWP; and they can be re-examined at any time. The audited estimate of fraud is under 1 per cent - the lowest of any part of the social security system.

Nonetheless, the 2007 Welfare Reform Act is now being implemented across the country. It replaces support, as of right, for illness/disability (one of the planks of our rapidly disappearing welfare state) with a new, conditional employment and support allowance. Claimants are held on a basic allowance until it is confirmed that their capability for work is limited. This is determined by a "work capability assessment" tougher than the old PCA. Those deemed capable of one day returning to work (and the arbiters are health professionals rather than doctors) must engage in a series of "work-focused" interviews and activities. These include, among other things, "condition management", which in practice is likely to consist of group sessions loosely based on cognitive behavioural therapy. All this brings an additional slice of benefit that can, however, be cut for those who do not engage in it without "good cause" - a potential loss of 40 per cent of income. Ultimately, any whose capability for work remains limited through failing to follow medical advice, or "any prescribed rules of behaviour", face a period of disqualification. (A further provision of the act, to be piloted in nine areas, is that people served with Asbos - antisocial behaviour orders - can face cuts in their housing benefit for refusing local authority offers "to help address any problem behaviour".)

A main selling point of the reform was the great savings it would bring. It would staunch the outflow of benefits and get many people into jobs where they would pay tax and provide for their old age. This government's cherished goal is an employment rate of 80 per cent of the working-age population - though it is difficult to find any reasoned argument in support of this since our present rate of 75 per cent is, with Canada's, the highest in the world. The government accepts that employers must be paid to take on people with an illness record and, for the time being, it has pledged not to cut the benefits of existing claimants. Any immediate savings, therefore, can only come from bumping as many as possible off the benefit, shaving future benefit levels (already well in hand), and making it harder for newcomers to get it in the first place. Delivery is being farmed out to private agencies paid by results - which means, of course, the setting of targets. The next few years will be a bad time to have a crippling accident or succumb to a serious disease, particularly a psychiatric or neurological one that does not have obvious outward symptoms.

Blaming the "cheats"

The reform of incapacity benefit has been over ten years in the making, leaving in its wake a dense trail of commissioned reports. A curious thing about this voluminous material is how little information it contains on the actual health conditions for which benefit is paid. This is no accident, for the reformers long ago made up their minds that claimant numbers are too high, therefore a large proportion - usually put between a third and a half, but lately upped to 70 per cent in some quarters - must be spurious. An appeal to history is repeated like a mantra that, back in 1979, only 700,000 claimed the old sickness/invalidity benefits. Since then, money has been poured into the NHS while health care, living standards and longevity have improved beyond all expectations. People must be healthier, which proves that huge numbers are exploiting a slack and obsolete system. Who is to blame, apart from outright cheats? It can only be the self-indulgent, who fancy themselves sicker than they really are, and complacent GPs who let them think they are too ill to work.

Crucially, the reformers bracketed illness with disability. The disability lobby had long argued that "disability" was a discriminatory label imposed by society, and it was bent on removing the barriers to work that excluded those so labelled and kept them in poverty. But the bracketing brought confusions - for those with disabilities may be extremely fit (consider the disabled athlete), whereas the able-bodied can be extremely ill. More confusion arises with conditions such as "stress", "anxiety" and "chronic fatigue" that sound trivial. As for "back pain", how unreasonable is it to take time off sick for something best dealt with by a stiff upper lip and the odd aspirin? It is easy for those in good health to pooh-pooh such things, agreeing with the government that "Work is the best therapy".

The government's declared mission is to "liberate" claimants, to bring them into its "reformed, coherent welfare state for the 21st century". It seeks to overturn a culture based on the "medical model" of illness that allows them to "drift" on to long-term benefits without realising that "symptoms, feeling unwell, sickness and incapacity are not the same" - hence the appeal of cognitive behavioural therapy, which it understands as a treatment that will talk the sick into believing they can lead normal lives.

Doctors - so often the refuge of desperate people trying to find out what is wrong with them - should as far as possible be excluded from the process. Even those working for the DWP have opinions that are "unfounded, of limited value and counter-productive", while GPs are "unaware of the importance of work, the absence of which leads to depression, poor health, higher rates of suicide and mortality, poverty, and social exclusion". (The quotations are from a 2005 study from the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, whose ideas and rhetoric infuse the reform. Unum Provident is an American firm, the largest disability insurance company in the world, which is currently in litigation in different countries for refusing to pay out on some of its policies.) A private agency has now taken over the running of its first GP surgery here, and doctors dealing with disability living allowance are advised not to invite patients to explain how their condition affects them.

Features of the reform are familiar from other policy areas. First, a demonisation of a needy or vulnerable group, followed by a rebranding: so claimants become not even "clients" but "customers" (as in the just published "Commissioning Strategy" document); incapacity benefit becomes employment and support allowance; sick notes are redrafted for doctors to certify, not what patients can't but what they can do. Next come "partnerships", on an unchallenged assumption that the public sector has failed. The new system is farmed out to for-profit or non-profit-making agencies paid by results. This entails targets, and where targets are set, sanctions follow, for any who "fail to recover".

There are features of the new programme that look intelligent and humane, doubtless owing much to the efforts of the disability lobby. They include a longer and more flexible bridging period (and a back-to-work grant) between benefits and work, and a broader view of "work- focused" activities. The crunch will come with those described as not able or prepared to engage "because [of] the nature and severity of their health condition, or more a matter of attitudes, perceptions and expectations which may or may not be accurate . . . It is a question of what the claimant cannot do vs what they will not do."

For the reform stakes everything on a gamble: that a large proportion of claimants, present and to come, are fit enough to work. There seems no way of proving or disproving this, other than trying it out, at the risk of much waste of public money, and much personal grief. Deliberate rejection of the "medical model" deprives us of all we might have learned (from the wealth of data available) of the impact of illness on our society.

I have scratched my head long and hard over this reform (among other things sending out lengthy submissions to all concerned during the long consultation phase in 2005-2006) because so much in its theory and rhetoric contradicts my own experience: of chronically and seriously ill family members and friends, of several years as a Mind volunteer, and further years of peripheral involvement in action groups for chronic fatigue conditions. All this has indelibly impressed me with the courage of many who live with horrible complaints, the sheer hard work involved in their day-to-day coping, their relentless search for any amelioration, let alone cure, often at costs hard to spare from limited resources.

I have witnessed, too, and at close quarters, the hurt and stress of living difficult lives as people have to do, in a perpetual culture of disbelief and threat, where some of the most valiant are blamed for their conditions and conflated with the alleged "can't work, won't work" unemployed. For the message of the reform that comes across, for all its fashionable rhetoric, is that a person is valued only as a productive unit. Compassionate cases aside, those too ill to work are outside society and money spent on them is wasted. Sickness, disablement and inability to work have no place in a modern society - they can't and shouldn't be afforded.

No one pretends that illness is not a blight, imposing personal and social costs going far beyond the financial; but - pace the government - no one as yet knows how to remove it from the human condition. Why waste valuable time and resources on an ill-founded reform, when they could instead be used to further understanding of the real impact of illness on our society?

Alison Ravetz is a professor emeritus of Leeds Metropolitan University who writes on housing policy and welfare reform

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery

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Jupiter in the Élysée: how long can Emmanuel Macron's good luck last?

Before entering politics, he studied Machiavelli and the art of gaining and holding power. But is the young French president a lion or a fox?

“A prince, being compelled knowingly to adopt the beast, ought to choose the fox and the lion; because the lion cannot defend himself against snares, and the fox cannot defend himself against wolves. Therefore, it is necessary to be a fox to discover the snares and a lion to terrify the wolves.”

This was Niccolò Machiavelli’s advice to young rulers in the notorious handbook that he wrote for them, The Prince, in the early 16th century. The ruler needs to be a strong lion to scare off the wolves but also a cunning fox to recognise the traps that the lion might fall into. We are very far here from the simplistic idea that “the ends justify the means”, a phrase that does not appear in the book – a Machiavellianism that was caricatured later to blacken his name.

As a young philosophy student at Paris Nanterre University, Emmanuel Macron would have known the difference, and the “lion and fox” analogy has been doing the rounds among political commentators in France as a way of characterising his rule.

Macron wrote his undergraduate dissertation on Machiavelli, exploring his ideas about politics and the representation of history in his work. This was before he went to the Paris Institute of Political Studies – better known as Sciences Po – where many aspiring French politicians go, and to the École nationale d’administration, France’s elite finishing school and its equivalent to Oxford’s politics, philosophy and economics course.

The story of his subsequent vertiginous rise to the top is well known: after spending some time as an inspector of finances in the French ministry of economy and serving as the deputy rapporteur for the commission to improve French economic growth, headed by Jacques Attali, he broke with the French high civil service to become an investment banker at Rothschild & Cie, making himself a tidy sum. François Hollande called him back to politics in 2012, making him his deputy secretary-general at the Élysée before naming him as minister of the economy, industry and digital affairs in 2014. Upon leaving government and breaking with the Parti Socialiste (PS), Macron founded his own political movement – En Marche! – in 2016, with which he swept to the presidency to become France’s youngest leader since Napoleon, at the age of 39.

Like Machiavelli before him, who served as a senior civil servant and diplomat in the Republic of Florence, Macron has the experience of high civil service and political position. But unlike Machiavelli, who was removed from his job when the Medici family returned to power in 1512, Macron has attained his country’s highest political office. He is exactly the type of “new prince” for whom Machiavelli was writing: someone who has only recently come to power, who is lacking an established structure and must stabilise his position in order to rule. To the new prince, Machiavelli’s advice was to be both a strong lion, ready to remove one’s enemies forcefully if need be, and a sly fox, to avoid the traps that the lion might not see.

Macron has described his presidency as “Jupiterian”, after the Roman sky and lightning god, the king of the other gods: he will be an aloof but strong leader, thundering orders from on high. This suggests that Macron has decided to be a lion. But has the young prince who declared that he wanted a renaissance of France forgotten the Florentine’s advice about also being a fox?

***

Macron outfoxed his PS rivals in his rise to power. Sensing that Hollande’s record unpopularity – it fell as low as 4 per cent – would be a death sentence for anyone associated with him, he fled the government’s sinking ship after only two years as economy minister. He was right: Hollande never recovered, becoming the first incumbent French president of the Fifth Republic not to seek a second mandate. Macron also avoided the trap of the PS primaries, which was to account for his main centre-left rival, the former prime minister Manuel Valls. Valls fell victim to the anger within the PS rank and file over the reform of the labour market, perceived as betraying the left-wing values of the party – a reform first piloted by Macron and pushed through parliament by decree by Valls.

Macron the fox avoided paying the price of the political fallout that engulfed the labour market reforms that he had instigated and succeeded in detaching himself from Hollande’s toxic legacy. Within the party, the principal beneficiary was Benoît Hamon, who had rebelled against the government’s policy of austerity, and he won the PS primaries. But that victory was short-lived. Hamon was quickly overtaken by the far-left firebrand Jean-Luc Mélenchon, who appeared to be the more credible left-wing anti-Hollande candidate. As a result, a large space opened on the centre left for Macron, who wanted to occupy the centre ground – a space that would not have existed with Valls as the PS candidate.

His positioning of himself as being beyond left and right was also astute. First, it presented Macron as being the credible, centrist alternative to Marine Le Pen of the Front National (FN) – if one didn’t support Mélenchon and oppose one extreme with another. It also sowed confusion in the traditional left- and right-wing parties: those closer to Hollande and Valls, not recognising themselves in the more leftist and ecological programme of Hamon, turned to Macron; and so, too, did the supporters of the failed centre-right candidate Alain Juppé, who, not recognising themselves in François Fillon’s economically Thatcherite and Catholic, socially conservative platform, found themselves drawn to Macron.

Presenting a new opposition between progressives and conservatives – mirroring Le Pen’s “patriots v globalists” rhetoric – Macron captured the French zeitgeist. He played to two audiences usually kept separate by the play of political parties. And when the centrist candidate François Bayrou offered to form an alliance, Macron the fox jumped at the opportunity. That gave him a 5 per cent boost in the polling, after which he never looked back.

While Macron the fox was using all of his cunning on the political plane, Macron the lion was consolidating his authority within his En Marche! movement, which carries his initials. Portrayed as a political start-up, with an informal, horizontal organisational structure – “helpers” (not employees) used the informal tu to address “Manu” – it is, like most unicorns, highly centralised around its boss, Macron, who makes all of the key decisions. It was he who hand-picked the 428 candidates who ran under his banner for the legislative elections. Whereas the PS and the Republicans hold internal elections to designate candidates, La République En Marche! (as Macron’s party was renamed after his presidential election) is the most centralised political party in France.

Macron the lion also showed his claws in the second-round debate with Marine Le Pen – a debate that Jacques Chirac had refused to have with Le Pen’s father, Jean-Marie, when the then FN leader made it through to the second round of the presidential contest in 2002. He forcefully confronted her, and the debate was the turning point of the second round. After it, Macron’s ratings jumped 7 per cent to the 66 per cent he was elected on.

In the subsequent legislative election, La République En Marche! won by itself a majority of seats, something rare in the Fifth Republic, which is normally led by a coalition of right-wing or left-wing parties. Macron can now rule without his centrist allies the Mouvement Démocrate (MoDem), whom he ruthlessly eviscerated from his government, throwing out its hapless leader, François Bayrou, whose initial support had provided him the boost without which he would never have made it into power.

***

Macron’s capture of the presidency and the national assembly has brought about accusations of a one-party state. It is true that Macron the lion holds the reins of the two most powerful institutions of France, but he has no control over the local branches of government. Moreover, the assembly is one of the most diverse that the Fifth Republic has ever had: there is a record number of female deputies (223, up from the previous legislature’s 155), ethnic minorities are better represented, and the two extremes – whether Mélenchon’s La France Insoumise or Le Pen’s FN – are present.

With many of his deputies being political novices, however, Macron the lion will be able to dictate how he wants things at the assembly to proceed. That both Mélenchon and Le Pen (for the first time in the assembly) have elected positions will suit him: beneath their shooting matches, his party will go about implementing the reforms he has promised. His appointment of a moderate right-winger close to Juppé, Édouard Philippe, as prime minister continues to sow discord within the established political parties, leading to factions of both the PS and the Republicans to declare themselves Macron-compatible, or willing to be “constructive”. As such, there is no strong constituted opposition in the assembly, the role falling to Mélenchon’s 17 deputies. Macron the lion is implementing Macron the fox’s policy of divide and rule.

Macron has a radical view of how the assembly should work, one he laid out in his manifesto. Instead of the usual back and forth between the left and right, he wants the assembly, whose deputies he will reduce by a third, to transform itself into an evaluative body. Its role will be to judge the policies announced by the government, revise and amend them where necessary, then vote them into law. What Macron wants to do is to transform the assembly into an expert body of assessors, which explains why he brought so many deputies from civil society into his party.

In an essay entitled “The Labyrinths of Politics”, written in 2011 for the magazine Esprit, Macron presented his vision of how politics should be conducted. He had joined the editorial board of Esprit after serving as the philosopher Paul Ricœur’s editorial assistant in the late 1990s and wrote several reviews and articles over the next ten years. In “The Labyrinths”, he criticised the “hiatus” between political debate and policy implementation: once a political decision had been made, there was a disconnect between that decision and its implementation.

To solve this problem, Macron the lion proposed to clarify the role that each institution was to play, so that public policy might be able to overcome its immobility and become efficient again. He argued that the ideology of the left and right had to be replaced with proposals for competing visions of society.

In his US-style State of the Union address to the joint houses of parliament at the Palace of Versailles, Macron the lion reiterated this vision. The point of the exercise was to determine the responsibilities of each of the institutions: he, as president, would offer a grand vision of society; his prime minister would elaborate its details; the parliament and senate would evaluate it before voting it into law. The top-down nature of the approach is confirmed by his desire to pass one of his most contentious measures, the reform of the labour market, by decree, which would mean that parliament could vote only to approve it. He has also publicly brought into line anyone who might deviate from this procedure – not least his prime minister, whom he corrected over the timing of fiscal reform, and his army chief of staff, General Pierre de Villiers, who was forced to resign after criticising the reduction of the military budget. He reminded both that he was their boss.

***

Macron the lion’s consolidation of his power on the domestic front continues apace. He has promised to end the state of emergency that has been in existence since the November 2015 terrorist attacks in Paris, but by bringing many of these measures into common law, thereby substantially increasing the power of the state.

That Versailles, the seat of the French “Sun King”, Louis XIV, should play such a prominent role in Macron the lion’s establishment of his power should come as no surprise – he has pursued what some have described as a “monarchical” style of governance. In an interview in 2015, when he was still minister for the economy, Macron explained that since the beheading of King Louis XVI during the French Revolution, political power in France has felt empty, incomplete. This thesis of democracy as an “empty space” was developed by the political philosopher Claude Lefort, though Macron does not seem to have been influenced by him. Since the king’s death, on Macron’s account, great leaders such as Napoleon or Charles de Gaulle have been able to occupy that space, whereas others, such as Hollande, have failed. Macron the lion king has every intention to fill it, for his presidency to be a true republican monarchy.

It was at Versailles that Macron the lion welcomed Vladimir Putin for his first state visit and gave him a public dressing-down over the role that the Russian media had played in the French elections, peddling conspiracy theories about him (there were suggestions that he was living a secret life as a gay man). The choice of location was astute. Because of his KGB training, Putin values being able to understand the international partners he has to deal with. By bringing him to Versailles, Macron sent a signal to Putin that France, too, could play the type of 19th-century power politics that Russia indulges in. Moreover, that the invitation took place during a celebration of Peter the Great was intended to remind Putin of Russia’s Western vocation.

By bringing Putin to Versailles, Macron also announced to the world that he was returning to what he calls the “Gaullist-Mitterrandian” line of foreign policy. This means Paris being a natural ally of Washington, but willing to follow its own independent objectives and also serving as an intermediary between Washington and Moscow. With his now infamous white-knuckled handshake with Donald Trump, Macron the lion showed (literally) that he had the strength to hold his own against one of France’s oldest friends.

Macron the lion committed one mistake, however, after the Trump handshake, which was to explain why he did it: authority needs no explanation. And it backfired. In the US president’s rationale for leaving the Paris climate change agreement, he cited Macron’s handshake. To make amends, Macron invited Trump to attend the Bastille Day military parade in Paris to mark the centenary of US entry into the First World War, which Trump seemed to enjoy. Any good lion would appreciate the display of military power – Trump is no fox – but it allowed Macron to pass a foxlike message to his American counterpart: that there is a link between global warming, which encourages the migration of those people from the Muslim countries whom he wants to ban from entering the US, and terrorism. Trump said he would think about it.

Machiavelli’s criterion for success for a young prince is duration: the new prince must be able to stabilise his power and rule over a long period. This is how Machiavelli would judge Macron. Will Macron succeed, or will the streets thwart his reforms? He has at least five years ahead of him, but will he be re-elected? Would that be success in Machiavelli’s eyes? Will Macron even run for a second presidential term?

Essential for success is what Machiavelli calls “Fortuna” – that is, luck. Macron has been remarkably lucky so far. Had it not been for the “Penelopegate” fake jobs scandal, it would be Fillon we would be discussing today as French president. And Macron has also come to power in a period when Europe is renewing itself with growth, which will help his target of reducing unemployment to 7 per cent, down from the almost 10 per cent that it stands at.

***

For Machiavelli, Fortuna is a woman and she favours the brave. In particular, she favours young, brave men – characteristics that Macron has. To make the best out of Fortuna, one needs virtù, that elusive value of having good judgement. It is virtù that transforms fortune into an opportunity, and Macron has showed good virtù so far, from escaping Hollande’s sinking PS ship to creating his own party, forming a coalition with François Bayrou and engaging in a televised debate with Marine Le Pen.

Fortuna is, however, fickle. So what will happen when Macron’s luck runs out? Will his virtù desert him, too? Machiavelli’s advice to maintain a strong state is to keep the people contented and the grandi on side. His choice of Édouard Philippe, who was a little-known mayor of Le Havre, as prime minister was inspired, as Philippe owes his position to Macron. He has kept the support of the grandi of both parties by bringing them into government. But he has also alienated his old ally Bayrou, and his public humiliation of the army chief of staff has been criticised.

What the prince should fear are conspiracies from within and conspiracies from without. On the international stage, Macron has developed his independent line but crucial to his success in Europe will be his continuing good relations with Angela Merkel. His recent nationalisation of the French shipyards at Saint-Nazaire in Brittany has infuriated his Italian partners, and he has sent his economy minister to Rome to make amends.

At the domestic level, Machiavelli’s counsel is to avoid being hated at all costs. As a liberal (still a dirty word in France) and a former employee of a Rothschild bank, seen as close to employers and wanting to reform the labour market, making it easier to hire and fire, Macron is already hated by a section of the population. He must ensure that this section does not become too large. To do so, he must show himself to be a courageous, firm and decisive leader.

His real test at the domestic level will come in September, when the inevitable street protests against his labour reforms will take place in Paris. Reform of the labour market has been one of his top priorities, so if Macron were to vacillate, he would lose authority. In the choice between being loved and being feared, Machiavelli recommends fear.

Macron’s popularity is high, with approval ratings reaching 64 per cent in June. These have inevitably dropped – at the time of writing, they were down to 54 per cent – but his popularity is also his best protection against internal conspiracies. He will have to be wary of the ambitions of Prime Minister Philippe, whom he has already called back into line on several occasions. But if his popularity remains high, he will be safe.

Macron’s drop in the polls comes, in part, as a result of cuts to housing benefits and a delay in tax cuts, so he must be sure to keep the people content. One of the president’s projects is the “moralising of public life” – to end some of the nepotistic practices of politics (employing one’s family members, for example) that seem to hark back to the ancien régime. Completing that reform of the political class will keep the people who want change on his side.

In the next five years, Macron will have to use all of his lion strength and fox cunning to establish his rule and make it last into the next presidency.

Hugo Drochon is an historian of late nineteenth and twentieth century political thought, with interests in continental political thought, democratic theory, liberalism and political realism. His book Nietzsche’s Great Politics came out with Princeton University Press in 2016. 

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery