Foucault reminds us that biopolitics is describes a kind of power structure according to which some will be compelled to live (or have their lives as members of a favored population optimized), while others will be allowed to die. As he puts it, “the ancient right to take life or let live was replaced by a power to foster life or disallow it to the point of death” (HS1, 138). Although much work has focused on techniques by which biopower works to optimize a population, it is worth attending to the disallowance of life, the thanatopolitics that is the other half of biopower, because the Republican party is engaged in producing a very effective case study.
As Foucault says a few pages later, “a power whose task is to take charge of life needs continuous regulatory and corrective mechanisms. It is no longer a matter of bringing death into play in the field of sovereignty, but of distributing the living in the domain of value and utility” (HS1, 144). Those who are deemed to be without sufficient value or utility are allowed to die. Much attention here has focused on Foucault’s brief remarks on “race” war in Society must be Defended, where he proposes that biopower creates a “race” of those who must die, so that “we” can live. He is thinking of Nazi Germany and the logic of cold war deterrence, but current Republican policies show that thanatopolitics can operate at a much more granular and subtle level.
I am of course talking about the AHCA, the mean-spirited tax cut for the wealthy, sponsored by gutting the (limited) ability of the Affordable Care Act (ACA) to provide for the needy. Various theorists after Foucault – François Ewald in particular – have emphasized the role of insurance in biopolitics as it comes to regulate and define acceptable behaviors according to actuarial risk. Here we see its role in thanatopolitics. There’s a good analysis of the AHCA’s evolution and structure here; suffice it to say that the law, if enacted, would end up in at least 24 million people losing access to insurance (largely by gutting Medicaid and ending the mandate that people have insurance. Republicans are flatly lying about this). It also allows states to scale back guarantees for coverage of those with pre-existing conditions, and allow states to scale back what services have to be included in health insurance; the primary target appears to be maternity and contraceptive coverage. Apparently the old, white men who are behind this forgot that they had mothers who required medical care. There’s a fig leaf $8 billion to fund high-risk pools, which no one qualified thinks comes near to the cost of funding those pools. It’s not a full regress to pre-ACA levels, but it’s about as far as things can go without requiring enough votes in the Senate to overcome a filibuster.
The ACHA amounts to a declaration that the already sick and the poor should be allowed to die while fostering and lining the pockets of, the rich. On the one hand, by transferring precarity and risk to those least able to deal with it, the ACHA expresses the sophomoric neoliberalism of people like Paul Ryan. Rep. Robert Pittenger (he’s from my district in NC) announced that nobody need worry; as part of paean to the wonders of federalism, he opined that “people can go to the state that they want to live in.” This is of course the extension of market logic to everything: everything is a free market choice, and those who don’t like where they live can just choose another place! Aside from the cruelty of this logic that becomes apparent to anyone who has a career or a life in a given place, or who can’t afford to leave, etc., Pittenger is just repeating a particularly bad argument about the rights to exit that Susan Moller Okin, among others, long ago dismantled in the context of group rights. As Okin pointed out at the time, assertions of a right to exit tended to particularly disadvantage poor women: those who both need an exit right the most, and who are least able to take advantage of it.
On the other hand, it’s worth remembering what counts as a pre-existing condition, because there is both actuarial and moral judgment involved. Ohio Senator Sherrod Brown tweeted a long list of both common and rare conditions that would be labeled as pre-existing, and a lot of these can’t possibly be construed as the patient’s fault. But the moral elements are there too: suffering PTSD or from and STI after a sexual assault gives rape victims a pre-existing condition. Drug addiction counts too, which expresses the wish that the masses in left-behind economic areas (many of them Trump voters) are going to be stuck with their opiates, and access to treatment programs gutted. Good to know that they are “forgotten no more.” Congressman Mo Brooks of Alabama gave the game away when he declared the people who have lived “the right way” don’t get pre-existing conditions.
But the AHCA wasn’t the only Republican mischief last week. On Thursday, President [sic] Trump also signed an executive order designed to allow religious organizations to engage more directly in politics from the pulpit, thus trying to marginalize the population of those who don’t participate in those organizations. The order does a lot less than religious conservatives wanted (typical of Trump, there was a lot more fanfare than substance. The issue here seems to be that he vetted it with some lawyers first), which was to be granted the right to discriminate against LGBTQ people in the name of religious freedom, but it did also try to set in motion the ability of employers to deny contraceptive coverage to their employees. It would be tempting to see this merely as more of the GOP “war on women,” but the larger effects show something more subtle, a more nuanced fostering and disallowing of life – both as zoe and bios – than is contemplated by the stark examples of death camps and nuclear weapons. Two concluding points.
First, and as Foucault emphasized, regulation of sexuality remains central to biopolitics. However, we can also witness the decoupling of sexuality and reproduction, as noted by Paul Rabinow and Nikolas Rose:
“For Foucault, sexuality was crucial, in part, because [it] was the hinge that linked an anatamo-politics of the human body with a biopolitics of population. But today, perhaps for as long as the last 50 years, these issues have become decoupled. Sexuality has been disengaged, to a degree, from the symbolic and practices of reproduction, and reproduction itself has become the object of a series of forms of knowledge, technologies and political strategies that have little to do with sexuality” (208)
Thus the GOP desire to discourage women from having sex unless that sex is designed to produce children. This moralizing has been documented often enough not to be worth detail here. However, even within that frame, there is a politics at play, a recognizably neoliberal one: by trying to end maternity coverage, the AHCA stands for the proposition that only women who are financially fortunate should be bringing children into the world; this is covered by the fig leaf that people who don’t like their state can just leave it. In the neoliberal United States, the poor (of all races) are among those who are to be allowed to die.
Second, the ACHA shows that quotidian regulatory and statutory laws can be effective means of thanatopolitics. Foucault’s remark that thanatopolitics involved the mobilization of entire populations "for the purpose of wholesale slaughter in the name of life necessity” (HS1 137) is overstated, or at least too narrow. We of course have excellent evidence of that in racial politics in the U.S., and things like the prison-industrial complex and the school-to-prison pipeline. In the current case, applying a study that said that for every 455 people who gained insurance, one life was saved per year, the Chiacago Tribune ran the numbers and concluded that around 43,000 people a year would die in the event of a full Obamacare repeal. Even if that figure is off by a lot, it makes a point. It is not the case, as HHS Secretary Tom Price lied, that cutting Medicaid will make it “more responsive.” It is also not the case that, as Rep. Raul Labrador lied, “nobody dies” for lack of access to healthcare. To be blunt: contra Agamben, the camp may not be the archetypal form of modern biopower, because the camp represents something too obvious. We need to be afraid of regulatory thanatopolitics too. Hopefully the AHCA will die a quiet death in the Senate, and last week’s exercise will serve mainly to show clearly the values of the Republican coalition, at least those who bothered to read the bill before voting for it. In the meantime, I’ll give the last word to Chauncey DeVega:
“There is a moral obligation to speak plainly and directly in a time of crisis. To wit: The Republican Party’s so-called health care reform is designed to kill, injure and bankrupt the poor, the sick and the weak, in order to line the pockets of the 1 percent. As Republicans have repeatedly shown, the supposed “party of life” is actually the “party of death.”
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