The making of the healthcare self : State metamorphoses, activation, responsibilisation and red-green alliance’s healthcare reforms in Germany

The coalition government in Germany (1998-2005) of the social democrats and the greens instituted several healthcare reform measures marking a paradigm shift and thus setting the direction of reform for subsequent governments’ healthcare politics. Agreeing with governmentality studies perspectives on recent transformations of govern-ing western democracies that have been analysed as ambiguously offering new opportuni-ties (= more freedom) and bringing new disciplinary measures (= more force), it can be shown that many measures are geared towards the activation and responsibilisation of insurants. In doing so, they produce what we call a “healthcare self”. This is characterised by a feeling of personal responsibility for one’s health, knowledge of options to obtain health, a high degree of reflexivity in health issues and willingness to pay for healthcare costs, because they are seen as an investment in one’s own prosperity. This is founded in a moral discourse and an institutional restructuring, which we consider a sign for a basic metamorphosis of the concept of the state into what we call a new state arrangement