were involved with the Skid Row residents at the time when the program was being implemented — among whom local activist General Jeff, also known as the “unelected mayor of Skid Row”. A sample of those interviewed include Police Officer Giddens from the Los Angeles Police Department (LAPD). The interviews, ranging from 20 to 120 minutes in length, were conducted in person and the interviewees were asked several open-ended questions. Their responses were all transcribed and analyzed. On top of reports, press releases and other academic sources, the year-long evaluation of the Safer City Initiative undertaken by Gary Blasi proved particularly useful, as his research team recalculated and refuted all of LAPD’s statistics on the supposed crime reduction brought about by SCI.

# Theoretical Framework: Homelessness in Neoliberal Cities

8. Neoliberalism usually refers to an economic concept advocating the promotion of free markets and the reduction of state intervention. Geographer David Harvey defines it as a theory of political economic practices that proposes that human well-being can best be advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterized by strong private property rights, free markets and free trade (Harvey 2005)

## Neoliberalism: A versatile Term with Numerous Ramifications

9. Geographers Jamie Peck and Adam Tickell divide neoliberalism in three main phases. The “proto neoliberalism” of the postwar period was succeeded by the “roll-back” phase of the 1980s, a “destructive moment,” when the social rights and protections established after the Second World War were dissolved. However, since the 1990s, the agenda has gradually moved from one preoccupied with the active destruction and discreditation of Keynesian-welfarist and social collectivist institutions (broadly defined) to one focused on the purposeful construction and consolidation of neoliberalized state forms, modes of governance, and regulatory relations (Peck, Tickell 2002: 384)

10. This marked the beginning of the “roll-out” period in the 1990s, which can be considered as an “evolutionary reconstitution of the neoliberal project in response to its own immanent contradictions and crisis tendencies neoliberal strategies”. As a result, city space became “a purified arena for capitalist growth, commodification, and market discipline [and] remained the dominant political project for municipal governments throughout the world economy” (Brenner and Theodore 2002).

11. It should be noted that substantial theoretical differences exist. Marxist thinker David Harvey considers neoliberalism as an ideological, hegemonic project aimed at transferring wealth and power from the poor to the rich. Since the Great Depression, the American economy has been reorganized through massive suburbanization while new markets as well as major innovations in transport and communication technologies have emerged. These were necessary conditions for capitalist expansion to occur. According to him, capitalism constantly seeks out new spaces so that it can keep growing. These “spatial fixes” reflect the “intrinsic need of capital to spread out over space in order to overcome its inherent crises of overaccumulation” (Charney).
Peck and Tickell also draw on Michel Foucault's work and consider neoliberalism as a process and a form of governmentality.

12. In the light of these considerations, neoliberalism can be envisioned quite differently depending on the aspects highlighted by different approaches. Although this would go beyond the scope of this paper, the case study presented here reveals how these analyses proved useful to understand the predominance of neoliberal ideology. On the one hand, Harvey's work helps understand intricate power relations in the city. On the other, Peck and Tickell help unfold the dynamics leading to the establishment of neoliberalism as a dominant doctrine. This account of history is necessary when studying the shaping of specific urban decisions that bolstered neoliberal policies. Indeed, these authors help understand to what extent the municipality, as well as other public entities such as the Police and judicial courts, are involved in instantiating local policies that reinforce neoliberal ideology. Neoliberalism is not just a matter of political and economic theory. It has concrete, urban implications with dramatic consequences on the most destitute individuals living in the city.

## Budget Cuts and their Consequences

13. In that regard, Peck and Tickell's theory is also useful to understand how the "spacialization" of poverty in Skid Row resulted from Reagan's "roll back" neoliberalism, how it helped prepare Los Angeles to more easily introduce the "roll out" phase, and ultimately SCI.

14. In the 1980s, the reorganization of welfare spending (deinstitutionalization) coupled with economic restructuring (deindustrialization) paved the way for homelessness (Wolch et al. 1988). Principles of deregulation and privatization were applied to many sectors. The Reagan administration cut public spending while encouraging free enterprise, stimulating competition and innovation. The idea of individual accountability led to drastic cuts in welfare state budgets. Under the Reagan presidency, many federal programs were transferred to state and local governments, while the non-profit sector was gradually called upon to replace federal government intervention, privatizing social aid (Wolch et al. 1988).

15. Some examples include the Housing and Urban Development budget. Under Reagan, $18.2 billion was allocated to assisted housing, compared to $30.9 billion under the Carter administration: between 1980 and 1988, the HUD budget was cut down by more than 50%. In 1981, the Reagan administration also passed the Omnibus Budget Reconciliation Act, which notably provided an increase in rent for housing tenants. Cardiss Colin, chairwoman of the House Government Operations Subcommittee on Manpower and Housing, warned that it would put more homeless people on the street (Biles 2011: 251-6).

16. Between 1982 and 1985, the administration cut the annual amount of federal funding for the poor by $57 billion. Between 1980 and 1988, the proportion of federal housing budget allocated for building new public housing units fell from 80% to 4% (Stuart 2016: 58-59). This shift toward greater wealth for some and declining aid for others corresponds to what Harvey has called "the restoration of economic power of high social classes" (Harvey 2005: 26).

17. In the same vein, the government decided to lower federal aid to cities, meaning that they had to find other sources of investment. Local governments were, and are now,
not only “expected to ally with business to improve their plight, they are also increasingly expected to behave as businesses as well.” The consequences of the Reagan administration’s “trickle-down economics” on the urban fabric were immense, and it comes as no surprise that homelessness intensified in the 1980s (Hackworth 2006: 26, 285).

## The Neoliberalization of Public Spaces

18 The neoliberalization of public spaces can be defined as a set of policies designed to attract more capital to alleviate cuts in local budgets. Finding strategies to attract more tourists and businesses has become a major characteristic of these policies, and this new approach to urban development has normalized market logic. In response to the growing and ongoing pressure of new entrepreneurial norms, cities must be more competitive and find new investment opportunities. For example, public-private partnerships are now a commonly-used tool in order to provide services to residents.

19 The withdrawal of the federal and local government paved the way for the removal of the homeless, as most major municipalities are engaged in a strong interurban competition to attract new urban actors and investors to develop growth. More than ever, urban spaces are a central element of a city and showcase its primary image. These spaces need to look appealing to attract more capital. The emphasis on cleanliness as the key strategy to revitalize neighborhoods has entailed getting rid of the “undesirables” — panhandlers, prostitutes, the mentally ill and homeless people. These “undesirables”, who do not fit the expected profile and are perceived as impediments to downtown revitalization, are removed from zones designed for economic development. Homeless people in particular are viewed as obstacles to the attractiveness of public spaces.

20 SCI serves as an indication of how the withdrawal of government funding, coupled with competition between cities, have shaped cities into entrepreneurial entities. SCI reflects the municipality's desire to push the undesirables further away from places of interest, and how interurban competition has led public powers to sanitize urban areas. In an illustration of the pervasiveness of neoliberalism, public places are perceived as investment opportunities, and cities feel compelled to defend their marketing images.

21 In the words of Randall Amster, Director of the Program on Justice and Peace at Georgetown University, “once domains of private property began to dominate the cultural and physical landscape, vagrancy began to be seen as a threat to capitalism” (Amster 2004: 110). As a result, one of the direct consequences of the neoliberalization of urban spaces has been the emergence of a strong incentive to “clean up the streets,” enabling fewer people to access these once-inclusive areas. Urban public spaces have become commodified entities that serve private businesses’ interests. The predominance of economic competition shows how entrenched neoliberal policies have become in urban settings.

## A Punitive Turn

22 The Safer Cities Initiative and other anti-homeless policies also reflect a “punitive turn” in criminal justice. Hyper-punitive policies can best be understood by looking at what French sociologist Loïc Wacquant called the “crisis of the welfare state.”
Wacquant argues it took the form of “the irruption of the penal state in America, and its practical and ideological repercussions upon the other societies subjected to the ‘reforms’ fostered by neoliberalism” (Wacquant, 2009: xiii).

23

At the end of the 1970s, the punitive model became a “managerial model” whose goal was to “make a profit” (Body-Gendrot 1998: 43). At the turn of the 1980s, a new punitive model emerged: rehabilitation and reintegration were supplanted by repression and exclusion. The goal of this new approach was to “handle flows and contain costs by carefully eluding the question of the causes and consequences of hyper-incarceration, and [to] turn away from the social fate of the inmate once his sentence has been served.” Statistics clearly show this shift in penal policy. The index of “punitiveness” rose from 21 prisoners per one thousand crimes in 1975 to 37 in 1985 and 75 in 1995, before jumping to 113 in 2000. In addition, by comparing the numbers of prisoners to the number of violent crimes committed, statistics also show that the justice system mostly sentences petty delinquents (Wacquant 2009: 127-8, 145).

24

In the last four decades, Wacquant notes there has been a clear shift in the role of the State:

> a protective (semi) welfare state [was gradually replaced] by a disciplinary state mating the stinging goad of workfare with the dull hammer of prison fare, for which the close monitoring and the punitive containment of derelict categories stand in for social policy toward the dispossessed (Wacquant 2009: 79)

25

The city of Los Angeles can be regarded as an especially fertile ground for neoliberal policies as the Safer City Initiative aptly illustrates both the neoliberalization of the city and punitive policies. Even if the official policy of the program was to “secure the street” and not to “clean it up,” it did remove the “undesirables.”

# Social Exclusion, Spatial Exclusion: The Safer Cities Initiative in Los Angeles

26

Before analyzing the program's implementation and its consequences, one must understand how the spatialization of Skid Row shapes social exclusion.

## Skid Row, Los Angeles

27

Skid Row is a fifty-block area where thousands of people live in extreme poverty in a specific perimeter. Crime rates there are among the highest in Los Angeles and it is also the most impoverished area in the city (Ghorra-Gobin 2002: 250). Many inhabitants live on the sidewalk and hundreds of tents are the homes of mentally disabled individuals, veterans and undocumented families. It is the largest homeless community in the United States: between 11,000 and 12,000 people sleep there each night (Gerry 2007: 239-51). Anyone walking through Skid Row can observe the blatant human misery. One does not need to be a psychiatrist to see that a great number of mentally-ill residents live on the streets of Skid Row. When I went there to distribute hygiene kits, people would run up to my group and rip the kits right out of our hands. I met numerous severely mentally-disabled individuals and illegal South-American families with children, some only toddlers. I also met a veteran who quickly became homeless after coming back from Afghanistan and losing his job, with no family support. There were also many people in wheelchairs.
<figure><img src="image_11.png" /><figcaption>Figure 1. Los Angeles. June 2014.</figcaption></figure>

Source: picture taken by the author.

28 This urban segregation is a result of a “containment policy” that started in the 1970s when the municipality decided to concentrate all forms of extreme poverty in one designated area. Historian Mike Davis considers that official policy has transformed Skid Row into one of the “most dangerous ten square blocks in the world” (Davis 1990: 232). On top of that, Downtown Los Angeles has a very high concentration of low-skilled employment. After losing manufacturing jobs, the district has surged in “internationally oriented producer services and finance capital”. According to geographers Robin Law and Jennifer R. Wolch, the rise of homelessness in Los Angeles occurred through the globalization of the urban economy of the city-region (Law and Wolch 1991: 129).

29 In the 1960s and 1970s, most residents of Skid Row were mainly working poor. Following a logic of individual responsibility as opposed to collective responsibility, the Reagan administration initiated several laws that led to a dramatic increase in poverty. Among others, it severely restricted federal aid for housing low-income people (Scott 2014: 869). In 2006, by the time SCI was implemented, the average rent in Los Angeles was 1750 dollars a month, 82% more than ten years earlier (Reese et al. 2010: 315). California has experienced a lack of residential construction in comparison with the job and population growth. This has led to increased housing prices driven up by wealthier residents (Khouri 2017). As a consequence, rents have risen steadily. Moreover, between January 2005 and October 2006, Los Angeles lost 9,000 rent-controlled apartments (Cleeland 2006). Such an increase undoubtedly gentrifies the neighborhood, pushing low-income residents further away from the area.

30 Social exclusion has been reinforced through the spatial organization of the city itself, since shelters, as well as aid which benefit homeless people, are only located inside the most impoverished urban communities, far from residential and commercial areas (Von Mahs 2015: 70). Therefore, the concentration of misery is the result of specific
political decisions. The history of Skid Row shows that it spatially segregated a population that was already isolated socially. Such policies, as well as anti-homeless laws, are symbolic of the pervasiveness of the neoliberal doctrine. Peck and Tickell rightly point out that

> zones of deeply impacted poverty and social exclusion may have been no-go areas for neoliberals during the 1980s, in its rollout guise, neoliberalism is increasingly penetrating these very places, animated by a set of concerns related to crime, worklessness, welfare dependency and social breakdown (Peck and Tickell 2002: 395)

31 This is particularly the case for Los Angeles. In the 1990s, Skid Row and the inner city started to attract the interest of developers and businesses. The “containment policy” was meant to appease them. But in the 2000s, the municipality had to find other solutions.

## A Strategy for Revitalization

32 The neoliberal rhetoric implies that it is in society's best interest that public resources should be used to facilitate and protect private investors. It is particularly striking in the case of Los Angeles where the business community is quite powerful and has been heavily involved in displacing homeless people through the use of private security forces. General Jeff, commonly referred to as the “unelected mayor of Skid Row”, has been a local social activist for the last twenty years and remembers when the anti-homeless policy was launched. He explained the underlying reasons behind the project: “the problem with this sales pitch is no matter where you go in Los Angeles, right in the middle of the donut is the hole: right in the middle of anything in LA is Skid Row” (General Jeff 2014). Indeed, Skid Row is located in Downtown Los Angeles and can be considered as an obstacle to revitalizing the city. Whereas the rest of the city looks attractive, Skid Row is discordant. This perception is also predominantly held by the business sector. Carol Schatz, CEO of the Downtown Association of Local Business declared: “Investment dollars will not flow to neighborhoods that suffer from crumbling sidewalks and pothole-filled streets” (Los Angeles 2020 Commission Report 2013).

33 In 2003, the newly-appointed LAPD Chief William Bratton and the mayor of Los Angeles decided to revitalize the city and suddenly enforce section 41.18(d) of the municipal code which provided that “[n]o person shall sit, lie or sleep in or upon any street, sidewalk or other public way except during parades and upon benches” (Gerry 2007: 241). Overnight, homeless people were banned from the streets and camping was deemed illegal. Even if this had been in the municipal code since 1968, this section was rarely applied. The police carried out mass arrests of those who committed minor offenses such as jaywalking, public drinking or loitering. This resulted in police harassment towards homeless people as well as the repeated use of extremely repressive methods.

34 Homeless people fell foul of the new policy. Hundreds of citations were given for misdemeanors such as sitting on the sidewalk or urinating in public. Those refusing to cooperate faced $1,000 fines and six months' imprisonment (Gerry 2007: 241-2). For a homeless person living on public assistance and earning little more than $220 dollars a month, paying such fines entailed not being able to meet their basic needs such as feeding themselves (Stewart 2003).
35

In February 2003, the American Civil Liberties Union (ACLU) filed a suit against the city of Los Angeles in the name of Jones and Robert Lee Purrie who lost all their belongings during an arrest. The judges did not consider that the new policy had targeted homeless individuals, but rather their behavior. The plaintiffs lost their first trial and appealed to the Ninth Circuit Court of Appeal. The Court of Appeal ruled in favor of ACLU and homeless people, and against the city of Los Angeles. The Court remarked that “human beings are biologically compelled to rest, whether by sitting, lying, or sleeping” (ACLU 2016). Given that the number of beds was limited in Los Angeles, the Court also stated that if “the only alternative to violating an ordinance is death, its enforcement cannot be anything but cruel and unusual punishment,” (Gerry 2007:250) which is prohibited by the Eighth Amendment to the Constitution. Jones v. City of Los Angeles (2006) represents a historic judicial decision stating that “The Eighth Amendment prohibits the City from punishing involuntary sitting, lying, or sleeping on public sidewalks that is an unavoidable consequence of being human and homeless without shelter in the City of Los Angeles.” In the final decision, judges considered that “section 41.18(d) is one of the most restrictive municipal laws regulating public spaces in the United States”.

36

Eventually, an agreement was reached between both parties. The homeless were allowed to sleep on the street but could not stay by business entrances during operating hours. Such anti-homeless laws, as well as the SCI, which I analyze further down, were made possible by the emergence of the so-called “broken-window theory”.

## The “Broken-Windows Theory” and its Consequences

37

Also known as “zero-tolerance policy,” the broken-window theory refers to a strategy to fight urban crime which emerged in New York City in the 1990s. This theory considers that physical decay and incivilities (e.g. graffiti or public urination) may incite other people to do the same. By suppressing “quality of life offenses” — all sorts of minor offenses such as drinking, sleeping, jaywalking, begging or littering in public — you will prevent more serious crimes from happening. The broken window theory was designed by conservative political scientists James Q. Wilson and George Kelling, the former Chief of Police of Kansas City who became a senior fellow at the Manhattan Institute, a neoliberal think tank. They were paid half a million dollars to help the city of Los Angeles design the SCI (Blasi and UCLA 2007: 5).

38

However, the “broken-window theory” is not a fully coherent concept and was not expounded in an academic journal, but rather in a cultural magazine, the *Atlantic Monthly*. Most importantly, it has never received any empirical verification (Wacquant 2009: 267). Published as a nine-page article lacking scientific grounding, this popular theory nonetheless became the main justification for harassing non-standard individuals, or “fixing the poor” in the words of anthropologist Forrest Stuart. It should come as no surprise that the broken-window theory sparked controversy. Scholars and sociologists have pointed out its multiple inconsistencies; Christian Parenti referred to it as “science of kicking ass;” and sociologist Loïc Wacquant wisely observed that “rapists and killers don’t head for another town when they see that graffiti is disappearing from the subway” (Wacquant 2009).

39

Three years after the Jones v. The City of Los Angeles decision stipulating that homeless people could not be banned from the streets, the city launched SCI, which represented
a “softer version” of the previous policy. SCI’s official primary goal was to make the area safer through 80 additional law-enforcement officers, making it the densest concentration of standing police forces in the country (Stuart 2016: 6). It continued to target quality of life offenses and the core idea remained the same: policemen could arrest any individual (mostly homeless people) for any type of minor offense. Twelve thousand citations were given in 2007, between 48 and 69 times the rate at which such citations are issued citywide (Blasi and UCLA 2007: 5).

General Jeff harshly condemned the LAPD's harassment strategies:

> It's bullying tactics but on paper, it's the “broken-window theory” [...] The officers were targeting low-level crime: jay walking, public intoxication, urination. They would beat people up, arrest people for nothing and that for a whole fifty blocks. That's idiotic but that's what the business sector wanted... (General Jeff 2014)

With SCI, the police continued to harshly condemn minor infractions and harass “the undesirables.” Unsurprisingly, it led to the increasing incarceration of homeless people who could not afford to pay the fines (Marquardt and Fuller 2012: 162). Countless homeless people were arrested for insignificant misdemeanors and repression was taken to extremes. One person reported being issued a littering ticket for simply flicking his cigarette ash into the breeze (Stuart 2016: 5).

On top of harassing people for insignificant misdemeanors, the program was problematic for several reasons. Contrary to its official policy aim, it failed to reduce crime. The LAPD claimed that crime had dropped by 35% after the first 8 months of SCI, as compared to 5% observed in the eight months preceding it (LAPD 2007). Blasi and his team, who conducted a one-year research to evaluate the impacts of the project, refuted such findings. They analyzed all the data again and found that criminality fell in the Skid Row area, without being able to prove causality. Firstly, special forces made few arrests for serious and violent crime (e.g. murder, rape), and most violent crime rates declined more outside Skid Row than within its limits. Secondly, given the greater density of officers on patrol compared to the rest of the city, it should come as no surprise that the crime rate fell. Thirdly, as numerous residents left the area because of police harassment and others were behind bars, it is legitimate to assume that it automatically led to a significant drop in the number of crimes reported (Blasi and UCLA 2007: 44). Despite the LAPD's claims, the crime reduction cannot be attributed to SCI.

Ultimately, the multiplication of punitive measures for insignificant actions that neither pose a real threat nor harm anyone is both unfair and inefficient to fight urban crime. Rather than contributing to eradicating poverty, such programs only displace and ignore misery.

## "People need shelters, not jail cells" (Los Angeles Times 1987)

Focusing exclusively on minor infractions such as public urination can be regarded as an interventionist mode of social control. The goal of such programs is to normalize the behavior of individuals considered as “undesirables” and force them to adhere to hegemonic expectations and norms: only the individuals deemed “desirable” may remain in public spaces; the others are to be displaced or incarcerated.

This disciplinary model can be considered as a spatial approach to social regulation as this measure is clearly applied against people who are unwanted in certain spaces. As
cultural anthropologist Joanne Passaro has noted, “public space has come to be seen
not as the last frontier of freedom, but rather as a frontline in battles over social
control” (Passaro 1996: 82).

<figure><img src="image_12.png" /><figcaption>Figure 2. Public bans. Skid Row. Los Angeles. June 2014.</figcaption></figure>

Source: picture taken by the author.

46 These anti-homeless laws reflect a discriminatory and ineffective approach to poverty, whose real goal seems to be making way for gentrification. They not only fail to fight serious and violent crimes; they also reinforce the processes through which neoliberalism exacerbates social differences and criminalize poverty.

47 According to Don Mitchell, these policies also redefine the very concept of citizenship: “These laws have a goal — perhaps not explicit but clear nonetheless — the redefinition of public rights so that only the housed may have access to them” (Mitchell 2012: 171). Therefore, they work as a social filter where only those who respect the current norms and standards are deemed acceptable in public spaces.

Civil Liberties and Human Rights

48 The ideal of unfettered capitalism and its implementation in neoliberal policies had intense repercussions on urban areas, where it fostered uneven spatial development. Whereas some areas grew even wealthier, the poor neighborhoods went from bad to worse.
Neoliberal Urbanism

49 As explained earlier, removing homeless people is a key feature of neoliberal urbanism. This aims at allowing the public spaces of a city to become viable sites for capital accumulation so that the urban core can be reinvigorated. Ideologically, policies targeting homeless people reflect the belief that individuals should be held responsible for their own condition and actions. Geographers Steve Herbert and Elisabeth Brown suggest that neoliberalism “increases the degree of ‘responsibilization’ devolved to local areas and individual citizens/consumers. In the process, notions of a collective public wither, as does the degree of shared obligation to the disadvantaged members of that collective” (Herbert and Brown 2006: 772). Indeed, neoliberalism portends that the emphasis should be put on the individual while rendering local authorities unaccountable.

50 Anti-homeless laws and policies revolve around this understanding of *laissez-faire* individualism that reached its height when homeless people started to be considered as deserving their condition. Following the neoliberal logic of minimal state intervention and the individual's responsibility for itself, this type of policy conveys the belief that urban poverty finds its roots in an individual's bad decision-making or simple lack of willpower. Instead of being helped, poor people need guidance and treatment. These policies serve as a means to justify discrimination and criminalize poverty.

51 General Jeff is aware of this endeavor to promote a positive image of the city and to secure urban spaces for new investments: “A lot of people have bought into the ‘smoke and mirrors’ campaign, the marketing hype: they thought great they’re cleaning up Skid Row, it is only going to be a matter of time and the property values are gonna go up...”(General Jeff 2014). His observation concurs with statements by the local business community:

> Downtown Los Angeles is on the cusp of an urban renaissance. Our fondest dreams of Smart Growth, with workers living in affordable, high-density buildings near transit, employment, cultural, and retail centers may finally become a reality in Downtown. However, this renaissance is threatened every day by street encampments, drug deals, overdoses, and panhandlers (Blasi and UCLA 2007: 10).

52 Restructuring the spatial organization of the city so it can serve business interests and ultimately help to enhance profits, has become the official priority. The goal is to attract a homogeneous middle class, made up of clean, passive consumers who actively contribute towards the local economy. Achieving this requires mobilizing the entrepreneurial identity of the city, which does not feature thousands of people sleeping on a sidewalk.

53 General Jeff also explained that the municipality's primary goal is to support commercial interests rather than to create public spaces that would be as inclusive as possible: “The business sector is trying to project this image of a newly-revitalized downtown around the world, so that international tourism and commerce can increase, and businesses can benefit from the additional revenue” (General Jeff 2014). For the municipality, the primary concern is protecting downtown land values and serving local commercial interests, and more precisely, those of public-private partnerships. On top of wasting public money and being incoherent, SCI and its ilk pose a real threat to civil liberties.
Neoliberalism and the Right to the City

54
Marxist thinker Henri Lefebvre shed light on the direct link between urban planning and sociology. He showed that the way a city is laid out can serve as a tool of social control by segregating individuals. To counter this socio-spatial segregation, he coined the concept of the "Right to the City" (in French: "droit à la ville"). Despite its ambiguity, this expression is helpful to understand that even though the street is commonly thought of as a public space that anybody can access, not everyone is equally welcome. Who has the right to the city of Los Angeles in the early 21st century? The answer appears to be only those who comply with current standards and can afford a roof over their heads.

55
Anti-homeless policies pose problems for several reasons. Firstly, they seek to cure the symptoms of poverty instead of addressing its causes. Not only does SCI oversimplify the concept of criminality, it conveys a paternalistic approach to poverty. Some of the SCI lieutenant's words illustrate it well: "Our job is to help them to make the right choice. If they don't want to make the right choices to get better, to move up and out of here, then we have to step in". Another officer made a similar comparison: "Ultimately, it's our job to set the standard. There is really nobody else who is doing it. When you look out on the streets, most people have pretty much communicated to us that they aren't willing to make good choices in their lives" (Stuart 2007: 108). During a personal interview, Officer Giddens took the comparison further and associated shelters with a family:
> They [shelters] have certain hours of operation just like a parent's house, they [homeless individuals] don't want to conform. People don't want to take advantage of them [...] There are lots of resources, we can house a lot of the population, there are 50% of them utilized (Giddens 2014)

56
However, this figure is highly inaccurate. Gary Blasi's report states that "The median number of actually available shelter beds in Skid Row has been four beds, at a time when the LAPD was counting about 1,000 homeless people living on the sidewalks each night" (Blasi and UCLA 2007: 5).

57
Even more worrisome, one of the policemen tried to dissuade homeless people from using the provided facilities if they weren't ready to make a real "change" in their "lifestyle." He went in front of a shelter and used speakers to broadcast the following message:
> There are people trying to get help here in the mission. If you want to get help, you're welcome to be here. If not, if you want to poison yourselves and engage in criminal activity, you're going to have to leave the block. I will not let you interfere with their positive change. If you decide you want to get better, you can come back (Stuart 2016)

58
His statement illustrates the neoliberal logic and how the local authorities make a stark distinction between the "deserving poor" and "undeserving poor." This binary perspective sends a clear message to the residents: those lacking the willpower are not welcome in Skid Row; worse, they do not deserve help.

59
Secondly, anti-homeless policies question the right to be different or to have an alternative lifestyle. The repression or prevention of serious crime no longer seems to be the priority of the police. Instead, their role is conceived of as guiding and educating individuals who are considered ill-adapted, if not abnormal. The police and the municipality have set new normative parameters for an "acceptable" public. The
systematic exclusion of “undesirables” embodies this desire to impose dominant
norms. In urban spaces such as Skid Row, only people who respect the new standards
are allowed. Decisions targeting homeless people are representative of the growing
belief that those at the bottom of the social hierarchy should not be helped but rather
disciplined.

60 These policies can only generate more resentment toward state institutions as they fail to tackle the real causes of poverty. Indeed, the municipality and the police can be held responsible for their respective proactive roles in supporting some users' use of public space over others and, by extension, directly favoring a specific social class over another. This new way to govern social relations in the inner city is aimed at attracting and maintaining a new affluent upper middle class that is actively consumerist. Forrest Stuart considers that this strategy of “social cleansing” is not about “disorderly places or quality of life” but about “policing poor people in poor places” (Stuart 2016). Finally, and maybe most importantly, these policies pose direct threats to democracy.

Public Spaces and Democracy

61 If citizenship goes beyond voting, then streets play a vital role within democracy, and having a common space available to all is essential. Even in the Internet era where most citizens can express themselves freely online, physical spaces have not become irrelevant, since the very concept of democracy requires access for everyone to a neutral, free and accessible space. The existence of an inclusive space where any group can express itself is of paramount importance to democracy. Under a tyrannical regime, demonstrations in public spaces are generally forbidden, demonstrating that public spaces possess a highly symbolic function. Public spaces can thus be considered as democratic linchpins and should be understood as forums for civil expression.

62 According to cultural geographer Don Mitchell, “the regulation of public space necessarily regulates the nature of public debate: the sorts of actions that can be considered legitimate, the role of various groups as members of the legitimate public and so forth” (Mitchell 2003: 182). By regulating behavior considered as “acceptable,” the authorities also regulate who should be allowed in public spaces. Mitchell described how anti-homeless laws aim at creating a “world in which a whole class of people simply cannot be, entirely because they have no place to be.” By criminalizing insignificant misdemeanors that pose no threat to others, anti-homeless laws endanger core principles of tolerance rooted in democratic societies: they question individuals’ and groups’ very right to exist.

63 Further to the importance of maintaining a public space that is accessible to everyone regardless of their social status, respecting civil liberties for all citizens is a key component of a democratic society. Civil liberties, like public spaces, are a social construct. They have often been legally defined, but result from collective action. They are not a natural occurrence, and if they have been socially constructed, they can also be “deconstructed” as it is the case with the SCI. In the light of rampant neoliberalism in advanced capitalist societies, the legacy of civil liberties remains extremely fragile in America in the early 21st century. Jim Crow laws, which enforced racial segregation in the Southern US, represent a relevant example in recent history that shows how freely accessible public spaces should not be taken for granted.
64

My case study only illustrates a more general tendency towards exclusion. Multiple laws passed across the US against panhandling and the like clearly target poor people. In Indianapolis, homeless people were even temporarily prohibited from voting. In some shelters, homeless people must wear orange outfits, similar to prison garb. In other cities, such as Atlanta, one cannot lawfully cross a parking lot unless one's car is parked within it (Wyly & Hammel 2003: 10-11). Harassing homeless people for their condition rather than for their actions has become increasingly ubiquitous. These policies threaten democracy as they inevitably entail punishment practices that not only intensify social divisions rooted in class and race, but also entail the criminalization of poverty.

## Conclusion

65

This paper has explored the dramatic importance of public spaces in contemporary societies in the context of pervasive neoliberalism. Entrepreneurial cities which prioritize economic profit increasingly remove “undesirables” (i.e. homeless people and other people perceived as problems) who tarnish the image of their public spaces.

66

The Safer Cities Initiative reflects a punitive turn that started in the 1970s and can be analyzed as a paradigm of neoliberalization through exclusion. Poor people are being evicted so that urban spaces can look attractive in order to gain capital. Police harassment fails to reduce criminality and further demonstrates the ways in which spatial exclusion and social exclusion mutually reinforce each other. Public spaces have become a commodity, serving the interests of the privileged few. According to geographer Myron Levine:

> Urban patterns are not inevitable. Patterns of growth and decline are not simply the product of human desires (for a better life, a larger home, and a safer neighborhood) and the workings of an unfettered free market. Rather, government policies as well as the exercise of private power, play a great role in determining just which communities grow and which decline (Levine 2016: 13)

67

In other words, if some dilapidated neighborhoods are plagued with violence and poverty while others benefit from a brand-new infrastructure, it did not result from a natural urban cycle but from a specific social construct, initiated by specific political choices.

68

Envisioning a more inclusive, more accessible city is possible. Many foundations and non-profits organize events that seek to promote public spaces and reverse the trend of privatization of public spaces. In Los Angeles, CicLAvia is an open streets initiative whose goal is to make various roads and streets accessible to non-motorized vehicles such as bikes or pedestrians so that they can enjoy urban areas they normally do not have access to. CicLAvia, whose goal is to “catalyze vibrant public spaces”, “engages with people to positively transform our relationship with our communities and with each other”.

69

In a different vein, the Right to the City was adopted by the World Urban Forum and also elaborated to form the World Charter of the Right to the City in 2004. Associations such as the Right to the City Alliance strive to put it into practice and fight to build a better urban future. They are a national alliance of racial, economic and environmental justice organizations seeking to fight against gentrification. Be it with car-free street
events or long-term initiatives, means exist and solutions depend on political willpower and struggles for social justice.

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Mitchell, Donald. *The Right to the City: Social Justice and the Fight for Public Space*. New York: The Guilford Press, 2003.

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Stuart, Forrest. *Down. Out. and Under Arrest: Policing and Everyday Life in Skid Row*. Chicago: U. of Chicago P., 2016.
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ABSTRACTS

Neoliberal policies have required a new way to envision urban areas. Municipalities try to bolster their image in order to attract new capital, which entails getting rid of the undesirables (the homeless and other people perceived as problems) who tarnish the image of their public spaces. This article explores the socio-political impacts of the Safer Cities Initiative, a zero tolerance policy program initiated by the city of Los Angeles in 2006. Drawing on the ‘broken-window theory’, the program’s official policy was meant to secure the streets and its primary goal was to firmly condemn misdemeanors. Camping was deemed illegal and homeless people were banned from the streets, jeopardizing civil liberties and questioning the right to be different. Drawing on first-hand interviews and reports, this article shows that this type of program represents a discriminatory and ineffective approach to poverty. It not only fails to fight serious and violent crimes, but also reinforces the processes through which neoliberalism exacerbates social differences and criminalizes poverty.

Les politiques néolibérales transforment l'appréhension des espaces publics. Les municipalités qui souhaitent redorer leur image pour attirer de nouveaux capitaux, s'emploient à se débarrasser des « indésirables » (les sans-abris et autres personnes perçues comme des nuisances) qui ternissent l'image de leurs espaces publics. Cet article explore les effets socio-politiques de Safer Cities Initiative (Initiative pour des villes plus sûres), un programme de « tolérance zéro » mis en place par la municipalité de Los Angeles en 2006. En s'appuyant sur la théorie dite de la « vitre brisée », la politique officielle vise à sécuriser la rue, en condamnant des infractions mineures avec fermeté. Camper est devenu illégal et les sans-abris ont été exclus de la rue, remettant en cause les libertés publiques ainsi que le droit à la différence. En s'appuyant sur des entretiens de première main et des rapports, cet article montre en quoi ce type de programme représente une approche de la pauvreté à la fois discriminante et inefficace. Ce programme est ne parvient non seulement pas à enrayer la criminalité la plus grave mais il renforce également les processus au moyen desquels le néolibéralisme exacerbe les différences sociales et criminalise la pauvreté.
## INDEX

**Mots-clés:** néolibéralisme, espaces publics, sans-abris, libertés publiques, Los Angeles, politiques urbaines, États-Unis

**Keywords:** neoliberalism, homelessness, civil liberties, public space, Los Angeles, United States, urban policies

## AUTHOR

### MARINE DASSÉ

Dr Marine Dassé holds a PhD in American studies. She currently teaches at the University of French Polynesia and is a member of the research team Gouvernance et Développement Insulaire. Her research deals with the urban and social impacts of neoliberalism in Southern California. Her other research interests include anti-consumerist movements and alternatives to global capitalism. Contact: mdasse[at]parisnanterre.fr
# Graphic Interlude: Neoliberalism in the Anglophone World

Eduardo Bardi

<figure><img src="image_13.png" /><figcaption>Figure 1. Common Agenda Poster</figcaption></figure>

Source: Eduardo Bardi.
<figure><img src="image_14.png" /><figcaption>Figure 2. Elite Financialisation</figcaption></figure>

Source: Eduardo Bardi.

<figure><img src="image_15.png" /><figcaption>Figure 3. Lived Experience of Austerity</figcaption></figure>

Source: Eduardo Bardi.
<figure><img src="image_16.png" /><figcaption>Figure 4. Mass Financialisation</figcaption></figure>

Source: Eduardo Bardi.

<figure><img src="image_17.png" /><figcaption>Figure 5. Resistance to Elite Financialisation</figcaption></figure>

Source: Eduardo Bardi.
<figure><img src="image_18.png" /><figcaption>Figure 6. Resistance to Elite Financialisation 2</figcaption></figure>

Source: Eduardo Bardi.

ABSTRACTS

This graphic interlude features a poster illustrating this issue's topic: neoliberalism, the workings of financialisation and means of resistance against this system.

Cet interlude graphique est composé d'une affiche qui illustre le thème de ce numéro, le néolibéralisme. Il détaille les mécanismes de financiarisation du monde et les moyens de résistance.

INDEX

**Mots-clés:** néolibéralisme, services financiers, économie, politique, résistance

**Keywords:** neoliberalism, financial services, economics, politics, resistance
# AUTHOR

## EDUARDO BARDI

Eduardo Bardi is a creative artist who works on visual communication, advertising, digital design, corporate and brand identity projects. His website: https://www.eduardobardi.com/
Contact: eduardo.b.bardi[at]gmail.com
# How To “Talk Left and Walk Right” in South Africa: Access to Medicines in the Neoliberal Era

An insight into the public market of antiretroviral treatments in South Africa

Charlotte Pelletan

## Introduction

> “I am not using strong words; I am using appropriate words. This is genocide”. Health Minister Aaron Motsoaledi (De Wet 2014)

## When the Minister of Health talks left...

1. In 1997, while the AIDS epidemic was spreading, the South African government explored changes to its regulation of patents in the Medicines Act and its National Drug Policy. It triggered a world-famous law case pitting the South African state against a coalition of pharmaceutical companies: the Medicines Act case, which concluded in 2001, also known as the Pretoria trial.

2. Since the Pretoria trial, debates on access to antiretroviral treatments (ARVs) have been polarized between activists — supported by the Minister of Health — who urge to apply exceptions (also called flexibility) to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the global pharmaceutical industry, which is keen to protect its interests. As a result, the HIV/AIDS epidemic has been highly politicized since the end of Apartheid, once through denialism and then with the massive roll-out of antiretroviral treatments after the Pretoria trial.

3. Since then, universal access to antiretroviral treatments has been a pillar of African National Congress (ANC) policy. After announcing constitutional equality, with section 27 of the constitution introducing access to health as a fundamental principle, the ANC
government has tried to ground its legitimacy in the achievement of these socio-economic rights, namely through equal access to treatments (Hodgson 2015). Health Minister Motsoaledi's governance has promoted a “welfarist” vision of the state, framed by the principle of universal socio-economic rights. One of his major proposals is the implementation of a National Health Insurance in South Africa (NHI): “NHI is a reflection of the kind of society we wish to live in — a society that will be based in values of justice, fairness and social solidarity” (Motsoaledi 2014). Health policies indeed seem to be used by Motsoaledi as a “specific legitimization resource for governments” (Fassin 1998). According to an industry manager, “every ANC president has left a legacy: Mandela has brought reconciliation, Mbeki the African Renaissance and Zuma will bring healthcare.” (Motsoaledi 2015b) As a matter of fact, AIDS response has been at the core of a broad reform project supposed to lead to the implementation of a National Health Insurance (NHI): “We know by now that there are four (4) highways along which South Africans are marching to their graves (...).” Among them is “a huge burden of HIV and AIDS and TB — this is the biggest highway of them all with many many lanes” (Motsoaledi 2016).

... And walks right?

4 Aaron Motsoaledi's mandate has been characterized by hyperactivity. His reform project was merely for the show, as demonstrated by the shilly-shallying around the implementation of NHI or his crusade against patents. Indeed, in spite of its strong rhetoric, the Department of Health has never resorted to TRIPS flexibility to reduce the price of medicines¹, nor has it developed alternatives to dependence on foreign pharmaceutical supplies. No long-term investment has been made to secure the supply of antiretroviral treatments in South Africa (Kudlinski 2013) and a strategy based on attracting direct foreign investment has been favoured. Consequently, in spite of WHO recommendations, local industry has developed little manufacturing capacity and relies almost exclusively on imported Active Pharmaceutical Ingredients (Kudlinski 2013). This situation leads to the Department of Health (DoH)'s strong dependence on multinational pharmaceutical businesses. Far from following a developmental approach to health systems, the Health Minister has designed an access policy based on a low-cost, rationalized supply, contrary to the Department of Trade and Industry (DTI)'s industrialization strategy.

5 The aim of this article is to explore the contemporary dynamics of the public supply of antiretroviral (ARV) treatments in South Africa. I will show that the development of ARV treatments has been paradoxically based on the development of the relationships between the state and multinational business. More precisely, the DoH has deepened its relations with the latter by establishing the public market as a strategic hub in South Africa. This way, the South African government has developed a strong influence on the market of medicines within the territory. This article suggests that, in a resource-constrained context which questions the country's capacities for traditional welfarism, the DoH strengthens its reach by vesting market rules. By vesting, we refer to "institutional work directed toward the creation of rule structures that confer property rights (Roy, 1981; Russo, 2001). Vesting occurs when government authority is used to reallocate property rights [...]." (Lawrence and Suddaby 2006).
Methodology

6 There is a wide body of research on the impact of neoliberalism on access to healthcare and medicines (for instance: McGregor 2001, Chapman 2014). Most of it deals with structural adjustment programmes in Southern countries and more recently on the effects of the financial crises (Legido-Quigley et al. 2016). The common narrative states that “the neoliberal offensive has had a major disruptive effect on social cohesion, as well as on people’s lives and morale, especially the most vulnerable” (Karamessini 2012: 176). Moreover, neoliberalism would entail the retreat of the state from its social functions, as the “important element of neoliberalism is the retrenchment of the welfare dimension of the state, which is seen as an impediment to the optimal functioning of the markets” (Mladenov 2015: 446). Based on the assumption that the decrease of public budget expenditure and predatory austerity result in the collapse of health policies, these studies overlook the concrete strategies implemented to circumvent these constraints.

7 This article criticizes such understandings of the workings of neoliberalism. By contrast, it is based on the methodological assumption that neoliberalism should not be studied as the retreat of the state but as a political production which carries specific social relationships (Boyer 2015). Resorting to heterodox economics and sociology helps escape the black-and-white distinction between strong (welfare) and weak (neoliberal) states developed for instance by varieties-of-capitalism literature (Hall and Soskice 2001), and sheds a light on a fundamental paradox: it takes a strong state to engineer its own downsizing. Neoliberal states do not disappear but turn into invisible market managers and keep steering market forces:

> It is too often forgotten that neo-liberalism seeks not so much the ‘retreat’ of the state, and an expansion of the spaces of capital accumulation, as the *transformation* of *state action* by making the state itself a sphere governed by rules of competition and subject to efficiency constraints similar to those experienced by private enterprises. [...] More profoundly, it signifies a transformation of the ‘format’ and role of the state, which is now perceived as an *enterprise in the service of enterprises*.
> 
> (Dardot and Laval 2013: 216, 228)

8 As Peck puts it, neoliberalization processes imply the successive “roll back and roll-out of state functions” (Peck 2013: 447). What it means is that the state does not disappear but rather restructures its links with all policy stakeholders: the state as a political project “is being replaced, not by fresh air and free markets, but by a reorganized state apparatus” (Peck 2013: 447) which conforms society to market forces. What is at stake in the analysis of neoliberal states is also a methodological challenge which entails that we look at “how neoliberalism is specified in a variegated landscape of institutional, economic and political forms” (Peck 2013). The historical, sociological and political modalities of its reorganization are at the core of the notion of neoliberalism, as Jessop suggests that we “put neoliberalism in its time and place” (Jessop 2013).

9 Such an approach of social and health policies in neoliberal contexts has been offered by Collier (2011) and Ferguson (2015). The former looked at the ways in which neoliberalism reshaped social welfarism by investigating post-Soviet Russia; the latter focused on Sub-Saharan countries. James Ferguson explains that, in a neoliberal context, the governments of those countries increasingly rolled out “extensive social welfare programs targeting the poor” (Ferguson 2015: 1). This way, he takes the
opposing view of the narratives which expatiate upon the fact that neoliberalism is systematically detrimental to welfarism and interventionism (Evans 2008).

10 Consequently, this article shows that access policies in South Africa are not based so much on the reform of intellectual property law but on the gradual transformation of the market according to health priorities and negotiations with industry. I shall resort to the theory of regulation elaborated by Robert Boyer. This research looks at the arenas of negotiation within the public market of medicines and shows that policies are horizontally negotiated, between state and non-state actors (Nay and Smith 2002). Such an approach is inspired by the sociology of regulation, which de-constructs institutions through the analysis of concrete interactions.

11 Countries' trajectories on access issues have been broadly studied for India (Correa 2013) and Brazil (Sweet and Keshab 2013). The public market of antiretroviral treatments is a core issue for access to medicines, all the more since it is the most attractive market segment for multinational pharmaceutical companies in South Africa. DoH control over the selection of antiretroviral treatments gives it power over multinational industrial companies. This article is especially based on the analysis of tendering processes, with an extensive use of interviews with state department civil servants and pharmaceutical companies managers. The interviews mainly took place in Johannesburg and Pretoria in 2015.

12 This article falls into three parts: the first provides a background on the policy forum around access to medicines that has developed both at the international and national levels. The second expatiates upon the case of South Africa, showing how the pharmaceutical market has gradually been vested by health institutions. The final part explains how the Department of Health has become the go-to institutional partner for industry stakeholders.

# The rising narrative of access to health in the global pharmaceutical sector

## Conflicting agendas: the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) versus the development of a right to health

13 Access to medicines has been put on the international agenda in a context of globalization of trade rules and commodification of knowledge. The dissemination of patents in Southern countries has led to a conflictual policy forum.² In South Africa, the political will to align with international trade regulations has been at odds with the necessity to respond to the huge burden of HIV/AIDS epidemic after a decade of denialism. The notion of access to medicines emerged as a reaction to trade globalization and more especially to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). At the same time, South Africa came to terms with Apartheid with a contradictory mandate: ensuring the development of constitutional and socioeconomic rights by promoting a developmental state while entering the global market.

14 Since then, constitutional equality has been the first achievement of ANC governments in the Post-Apartheid era (Section 27: Right to Health), but the achievement of socio-
economic rights has been continuously delayed by the global orthodox agenda. “The ANC government has been more interested in confirming its presence on the international scene and in conquering the international market than in ensuring socioeconomic rights” according to Professor V from the University of Kwazulu Natal (Professor V 2015). The ANC’s desire to integrate South Africa into international trade regulations after the end of the Apartheid embargo led to a quick U-turn in the government’s strategy. The adoption of the Growth Employment and Redistribution (GEAR) macroeconomic strategy in 1996 has been considered as the starting point of the neoliberal era, as it promoted trade liberalization. As soon as the World Trade Organization (WTO) was created, South Africa’s legislation aligned with the TRIPS agreement and also developed strong relations with the United States, with the 1994 Agreement on Government Procurement (GPA) for instance. In this rather conducive context, many multinational pharmaceutical companies have invested in South Africa, obtaining the licences which had previously been granted to local manufacturers during Apartheid.

Nevertheless, the rising opposition from civil society undermined the relations between the state and the pharmaceutical industry. In the second half of the 1990s, the South African population was facing a growing AIDS epidemic without any access to treatments in the public health sector, since the government had adopted a “denialist” position and justified its refusal to provide the population with antiretroviral medicines by arguing that Western Industry had brought the disease to Africa to open new markets (Fassin 2006). Opposition from civil society came to fruition during the “Pretoria trial” when the South African government, supported by civil society, faced 39 pharmaceutical companies in CCcourt. This law case also shed a light on access issues at the international level, as shown by the adoption of the Doha Declaration in 2001. This Declaration aimed at strengthening the flexibility of TRIPS agreements’ principles and emphasizes states’ right to use this flexibility principle. It epitomized international debates on global health goods and highlighted the issue of multinational companies’ social responsibility.

Since then, the narratives around access to medicines have posited a strong opposition between state and industry. According to these narratives, the state's duty should be to limit intellectual property rights. The 1999 report on the implications of TRIPS for access to medicines commissioned by the World Health Organization and the World Trade Organization (WHO and WTO 1999) was followed by the creation in 2003 of a WHO IP Rights, innovation and public health. Its report (WHO 2006) showed that patents are not an incentive to innovation in developing countries. In 2008, resolution WHA61.21/62.16 was passed by the World Health Assembly, calling for the creation of a global strategy and a public health plan. In 2015, a United Nations’ Secretary-General’s High Level Panel on access issues was set up to try and strike a balance between intellectual Property (IP) and health rights.

## In South Africa, a policy forum based on a binary vision of medicines

The opposition between access to medicines and patent protection has structured the policy forum in South Africa. A range of reforms have aimed at redefining the respective prerogatives of the state and of industry as regards access to antiretroviral
medicines. Nevertheless, the attempts to regulate prices and competition, with for instance the attempts to implement a compulsory Benchmarking Methodology in the public market or the Health Market Inquiry undertaken by the DoH in order to strengthen the competition law, or Intellectual Property Law have not been successful. This triggered a series of scandals that the difficulties of Intellectual Property reform illustrate well. Even though the Doha Declaration insists on the importance of resorting to TRIPS flexibility to increase access, South Africa is still striving to align its IP law with the Doha Declaration. In spite of the world-famous Pretoria trial of 2001, many stakeholders are reluctant to apply the TRIPS flexibility principle to the South African IP law.

18

In 2008, under the influence of the Department of Health, the Department of Trade and Industry launched a discussion to align Intellectual Property policy with Doha Principles. A Green Paper came out in 2013 and called for stakeholders' submissions. Two main advocacy coalitions emerged: on the one hand, the civil society “triad” made up of advocacy groups Section 27, Treatment Action Campaign and Médecins sans Frontières strongly supported the paper with their campaign “Fix the Patents Law,” calling for a gradual process of elimination of patents by de-connecting intellectual property issues from the price of medicines. This “epistemic community” (Haas 1992) also includes most academics and importers of generic medicines which are generally produced in India — even if the latter, by shifting to biosimilar production,³ is more and more interested in patenting opportunities. On the other hand, multinational companies represented by their industrial association oppose the reform, arguing that it would not be enforceable, due to lack of capacities. The South African Department of Science and Technology and part of the Department of Trade and Industry also questioned the IP reform project, arguing that it would lead to major divestment from South Africa. More discretely, South African generic manufacturers promote the conservation of Intellectual Property, since voluntary licences from originators are their major pipelines. As a consequence, the Intellectual Property reform proposal triggered a wide variety of positions which were overshadowed by the 2014 “Pharmagate,” when the leaking of a confidential document from a US consulting office, which outlined how major originator companies aimed to counter the Intellectual Property reform proposal, caused a major scandal, contributing to an ostensible break-up between the state and the pharmaceutical industry. Since then, the promoters of access to medicines have been able to influence industrial stakeholders more strongly, as will be shown below.

# Towards organizational change: health institutions at the core of pharmaceutical-market management in South Africa

## When the pharmaceutical market is vested with the Department of Health

19

The striking politicization of health in South Africa has resulted in the growing influence of the DoH in pharmaceutical public markets. Health is presented by the
Health Minister as the key to achieving socio-economic rights by the fulfilment of
constitutional rights:

It is particularly concerning that many participants appear to lack an
understanding of both the principles of social solidarity, and the need for
redistributive justice. These principles are enshrined in the Constitution and are
central to redressing the pervasive, historically entrenched inequality. It is
expected that stakeholders will have a variety of economic, political and
philosophical perspectives, the trend towards a conservative approach that lauds
free market principles is concerning, particularly given the internationally
recognised failings of the healthcare market. (DoH 2015: 2)

20 This use of the Constitution rests on the fact that the legitimacy of the post-Apartheid state is based on the duty to fulfil the social contract. Health is presented as a catalyst for equality and, as such, should be accessible to all:

> It is also important that the Inquiry focuses on the notion of health as a public good. This is important because the State is expected to put into place institutional, organisational and regulatory mechanisms to support the progressive realisation of the right to healthcare for every citizen. (DoH 2015: 5)

21 In South Africa, the Gini coefficient is one of the highest in the world and the claim for equality is at the core of ANC legitimacy. The NHI does not consist in growing public investment in health but in the state's ability to monopolize parts of private capital (in infrastructures, skills and funding) to re-orientate it towards a system of social solidarity. As a civil servant at the DoH argued, "you know that if poor people do not manage to reach basic welfare through their jobs and education, they might resort to violence." (DoH Civil Servant 2016)

22 Our research shows that the Department of Health appears as an ANC stronghold and acts as a game-ruler within government. A civil servant from DoH explained that the DoH had a strong influence on the other departments: "You know it's easy since we are from the same party. In other countries like France with many parties they would not let regulations pass as it happens for me at the Parliament. I hardly meet a resistance when I suggest a paper." (DoH Civil Servant 2016)

23 Improving access to health stands as a central political strategy. It takes the form of a struggle against the private health sector and the re-designing of public domain frontiers — at least symbolically: "NHI is a political decision of a nation hungry for justice and equality. It is based on political will and should not be subjected to obstacles driven purely by greed and self-interest of a selected few." (DoH Civil Servant 2016) It may also involve the shaming of pharmaceutical industry: "Two years ago, I was regarded as exaggerating or outright insane by some, when I spoke openly against Pharmaceutical companies that were planning a price onslaught against us. Today, that onslaught which I had foreseen is here with us." (Motsoaledi 2015a)

24 The Department of Health has been redesigning its mandate through its intervention in the public market of antiretroviral treatments. A significant milestone was the relocation of pharmaceutical contracts into the Department of Health. Previously, medicine procurement in the public sector had been the responsibility of the National Treasury, which was more broadly responsible for the management of public contracts. In 2009, a Ministerial Task Team advised that a Central Procurement Agency, directly responsible towards the Minister of Health, should be created. Its core structure, the Directorate of Affordable Medicines, was approved in 2011 by the National Health Council. From then on, it started to manage public tenders independently from the
National Treasury. A, who is a close observer of the government (Observer A 2015), explained that a blame game was going on between the Department of Health, the National Treasury and the Department of Trade and Industry. The latter two were put on the back burner as mere observers by the former, as shown by the example of the preference point system. Bids are awarded according to a 90/10 preference-point system. 90 points are allocated to price levels and 10 points to the companies' B-BBEE status level (which promotes the development of Black Business in South Africa). Historically, these B-BBEE points have been promoted by the Department of Trade and Industry, using section 5(2) of the Preferential Procurement Policy Framework Act (PPPFA) 2000, in order to improve the trade balance by developing local industry. Even though an unpublished DTI study showed that 20 B-BBEE points would still be cost effective, the Department of Health immediately limited this preferential procurement by establishing a maximum price which cannot exceed 10% of the price premium.

Moreover, the Department of Health was able to capture a set of regulatory processes and is consequently omnipresent in current pharmaceutical reforms. For instance, the Intellectual Property draft was released by the DTI and was supposed to be a trade issue. Nevertheless, the Department of Health's influence is strong. As an interviewee from French diplomacy put it: "Actually it is a DoH paper." (French Diplomat 2014) Our research shows that many civil servants at the DTI share views with the DoH and act as a relay for it. All in all, the Department of Health has gradually strengthened its leadership in the pharmaceutical sector in South Africa by vesting the market.

25

## The standardization of medicines in the public market: a low-cost policy

The DoH resorts to new-public-management techniques to implement its universal-access policy. We focus here on the techniques used to enable access to medicines within the public market of ARV treatments. These instruments avoid the controversial process to formulate political compromises and contribute to building a specific framing of access based on new public management.

26

In order to provide the bulk of patients with generic medicines, the guidelines have promoted the growing standardization of treatments — more exactly of therapeutic classes — on the basis of strict equality of patients at the lowest price. The HIV/AIDS burden on the health budget has kept increasing, as CD4 count is planned to be removed as an eligibility criterion⁴ and PrEP⁵ is being tried in some programmes for vulnerable individuals. This medicine-focused strategy has been a growing financial burden for the Health budget, as it has increased by 7% to 10% in the last 7 years, while the Health budget has declined as a proportion of the National Budget (Health Budget 2015). In such a context, the reduction of price per capita has been at the core of the antiretroviral medicines roll-out strategy; for instance, Y, a chief Manager at the DoH opened a meeting telling me “do you know that in South Africa we have the cheapest ARVs in the world?” (DoH Manager Y 2014). This means that universal access to medicines may be financially feasible only if prices are very low and monitored by new-public-management rationality. As a consequence, the public procurement of antiretroviral treatments is based on a price-focused selection process.

27

Indeed, the National Drug Policy articulated by the DoH is based on a tryptic: access, quality and rational use. Access and rational use are defined according to price issues:

28
access is defined as “equitable availability and *affordability* of essential drugs” while rational use is said to be “the promotion of therapeutically sound and *cost-effective* use of drugs by health professionals and consumers” (National Drug Policy 1996). The issue of the quality of the medicines is therefore firmly framed by the issue of price: only affordable medicines are to be provided. The emphasis on prices is omnipresent, as revealed in a slideshow presented by the Central Drug Programme: 10 slides out of 36 address prices and cost-effectiveness (PTC Workshop 2015).

29 This price-focused strategy stems from a twofold movement of standardization of medicines and depoliticization of the selection process. Indeed, it enables the government to focus on the price of medicines and thereby to avoid the broader issues of patent law and infrastructural failure in South Africa. The process of medicine selection is extremely technical. An interview with J, a manager at Central Drug Procurement (CDP) at the Department of Health (CDP), shows how quantitative medicines selection is:

> We do some pharmaco-economic analysis and the medicine might prove to be cost effective but we might not be able to afford it. We really look at affordability. So when we have big shifts in treatments we also look at impact analysis to see what will be the impact on the budget. So something might be cost effective but not affordable for us. The question is: can you use this new commodity with your budget? First we look at the clinical evidence: is it safe? And then we go to the cost issue. We do a lot of cost minimization. If you have medicines A and B and the outcomes are barely the same, we compare them. And then once we know it's cost effective we'll see if it's affordable for us to use that given the budget that you have.
> (CDP Manager J 2015)

30 The semantic fields used in the whole interview are linked to data, bureaucracy, prices and guidelines. New-public-management techniques are broadly used during the drug selection. It highlights the focus on efficiency, cost-effectiveness and “optimality”. The CDP resorts to a range of instruments and techniques in order to objectify the selection process. The members of the National Essential Medicines List Committee (NEMLC) and of the Pharmacy and Therapeutics Committee (PTC) sign Declaration of Interest and Confidentiality forms to ensure transparency, and recruitment process are based on tangible signs of technical skills: most civil servants at the Department of Health have a PhD in Pharmacy or Medicine and have an academic background. Furthermore, medicine standards are at the core of medicine selection: the Essential Medicines List (EML) and Standard Treatment Guidelines ensure the standardisation of care: “Guidelines aim to standardise care, reduce local variation (equity), and improve health outcomes”.⁶ The methods used to select medicines are based on quantitative pharmaco-economic analysis such as cost-effectiveness analysis. Evidence-based medicine is also at the core of medicines selection and shows the technicity of decision-making; the Essential Drug List (EDL) uses the “Strength of Recommendation Taxonomy” (SORT) which aims at rationalizing many types of evidence through a unique taxonomy.

31 The development of a National Health Insurance (NHI) has even increased medicine standardization. The variety of medicines supplied by the government is to be reduced thanks to the establishment of therapeutic classes. It means that within a basket of medicines with similar indications, only one will be included within public supply: “these therapeutic classes have been designated where none of the members offer a significant benefit over the other registered members of the class” (DoH, 2012). The
Pharmaceutical Task Group, an industrial working group, has noticed in a submission
that:

the medicine options currently available to patients in the public sector are
considerably wider than the Essential Medicines List, to which the White Paper
refers at a number of points [...]. The PTG recommends that [...] the NHI should seek
to broaden the accessibility of different medicines for different patient needs,
rather than attempting to ration or restrict this. (Pharmaceutical Task Group 2015:
10-11)

32

This quote is telling, since it highlights a paradox inherent to NHI: the implementation of a unique healthcare system, said to be the fulfilment of universal access, is likely to reduce the variety of medicines available to patients. Moreover, attempts by civil society to protect the variety of supply come up against closed institutions and practices. For instance, the South African National AIDS Council (SANAC), which is a platform designed to build a comprehensive response to the AIDS epidemic, does not always take into account some interventions from civil society, as was suggested by the Treatment Action Campaign (TAC Provincial coordinator 2015).

33

. An employee at Doctors without Borders (MSF) South Africa even explained that “any
special medical condition is out of control in the public sector.” (MSF Employee 2015) In
other terms, in order to achieve a strong political project, the South African state
reduces its prerogatives over medicines in a defined and restricted perimeter.

The antiretroviral public market as a nexus between
state and industry

A myriad of relational contracts between the Department of Health
and a few empowered companies

34

In contrast with the transnational policy forum around access presented in the first part of this article, I now wish to demonstrate that the public market of medicines is a major arena of negotiation: this is where already-identified players bargain the material and symbolic dimensions of medicines. Negotiation arenas, where the implementation of policy is worked out, are narrower than policy forums.

35

The nexus between state and industry is located within the public market, more
accurately during the tendering process. The selection of bidders is not merely based
on cost-oriented criteria but also on tight relationships between the procurement
department and a small number of companies. My study shows that state regulation
consists in the social delimitation of the public market. Since Department of Health
influence over the market of medicines is strengthening, companies attempt to get
closer to the Central Procurement Unit at the DoH. More and more often, they
underline their links to the public sector and try to act in compliance with the state.
Most of my interviewees from pharmaceutical companies explained that the public
sector has become central to their business. As a manager in a pharmaceutical company
asserted, "When NHI is implemented [...] It will be the moment when our relations with
the State will count." (Pharmaceutical Company Manager 2015) Building relations with
the State is critical to maintaining a minimum of predictability and to secure
investment in some types of medicines such as antiretroviral medicines. The same
manager explained:
Why do companies stick to the state? Because there is so much uncertainty concerning National Health Insurance. Then, I think that we will have to take more and more into account the social responsibility required to invest in emerging countries. (Pharmaceutical Company Manager 2015)

36 Companies endeavour to get closer and closer to DoH civil servants. One of the interviewees said that he came to visit the Health Minister at the hospital, while the aforementioned manager explained that his company contacted the Department of Health right after the 2014 Pharmagate:

> We just asked for a face-to-face meeting with the Deputy Director General in order to show them that we are not opposed to them. We finally agreed on looking at DoH policy. But DoH was the first state department we came to see. I have to say that [Name of his company] has been the only one to get a face-to-face meeting with them. (Pharmaceutical Company Manager 2015)

37 The growing importance of the health public sector has resulted in a strong competition between industrial stakeholders to access public tenders. The necessity of cutting costs has implied the selection of foreign generic companies. The procurement department — a division within the DoH — has favoured new types of providers, namely generic multinational companies, generally from India because of their price competitiveness. The public supply of medicines is locked around specific policy brokers who come from industry and try to monopolize the market while they reinforce the public sector's purchase power. A civil servant at the DoH explained that the DoH had developed strategies to attract new importers:

> At that time [in 2008] local companies were the main suppliers. We said: "ok, if you want us to buy local then give us the money to buy enough medicines for all." I went to India and asked them why they were not interested in exporting to South Africa since we are the biggest market for ARVs. They replied that in South Africa the public market was only taking local manufacturers. Indeed, local companies were creating pressures on competitors. We decided to change it and we integrated the Indians into the tenders. (DoH Civil Servant 2016)

38 Therefore, the state's capacity to implement its policies is essentially linked with its dependence on multinational generic companies which, by importing cheap Active Pharmaceutical Ingredients (APIs) from India and China, are able to provide public tenders with the cheapest antiretroviral medicines (Kudlinski 2012). Avoiding originators and local manufacturers in favour of multinational generic makers has been essential to the implementation of access to antiretroviral medicines, in spite of the Department of Trade and Industry's developmental policies.

39 These companies would have limited interest in entering low-profit bids with strong uncertainty, since the ARV tender lasts only two years. By resorting to strategic use of Black Economic Empowerment, that is to say regulation which promotes the transfer of stakes in white-owned businesses to a new class of black investors, packaging selection (which can favour specific providers) and continuous pressure on prices, the public tenders tend to favour a limited number of companies through relational contracts. During the interviews, this category of stakeholders describes strong links with the state: a CEO of one these pharmaceutical companies evokes a "relationship": "we get on well with the Department of Health, we actually get on well". His emphasis on "transparency" and on the predictability of their agreements "we have always been on tenders since 20 years" shows that the development of the partnership stands for a long-lasting agreement with the state (Pharmaceutical Company CEO 2015). Moreover, their relations with the state are not channelled by industrial associations. They resort
directly to a limited number of key stakeholders at the DoH, as V, an employee of an
industrial association explained:

— Do you resort to an umbrella body to defend your interests?

— Sometimes, it's better to act on your own. Generally that's what we do since we already have strong relations with the government. (Employee V 2015a)

Indeed, V suggested that the relations between the state and businesses have a strong personal dimension:

— You see, the relations that these companies have with the state are more ... personal. (Employee V 2015b)

These stakeholders also have advisory roles towards the Department of Health and the Department of Trade Industry. In fact, an employee of Aspen Pharmacare is an advisor to the Trade Minister. These empowered companies define themselves as “practical” organizations which can provide the state with technical guidance since, as S, a manager in such an empowered company argued, “in the DoH, they are all academics [...] they are a liberation party, they do not know how to design policies.” (Manager S 2015)

The government has undertaken the construction of a state-owned plant to produce antiretroviral medicines' APIs nationally and provide its entire population with treatments. Most of my interviewees call into question the government's ability to understand market dynamics. As manager S argued, "Government wants its own facility, it's indicated in the 10th point of healthcare reform. The big issue is that they will never manage to supply for all South Africans. This policy doesn't make any sense, its unique goal is to appeal to people." (Manager S 2015) These critical viewpoints show how state and industry are intertwined in policy implementation and shows that industry is able to engage with health policy-makers.

## The public tenders as a state disciplinary apparatus

The companies' position is ensured by an implicit loyalty towards the state. If they break these relations by adopting an ill-adjusted behaviour, such as setting high prices or mismanaging their supply chain, they are likely to lose their contracts. In his 2017 budget speech, Health Minister Aaron Motsoaledi offered a pungent criticism of pharmaceutical industry's role on medicine pricing, but ended up listing companies and private health providers who have been contributing to a Fund. By making these companies visible and presenting them as models, the state labels them as "good pupils." Contrariwise, some companies can be blacklisted by the government. The necessity to be seen "on the side of the state" stems from the fear of being frozen out of the public market. South African company Adcock Ingram, for instance, was suddenly kicked out of the tenders after its prices were not considered competitive enough by the tender department.

All in all, these elements suggest a strong state regulation in the ARV market. Thanks to the development of a benchmarking methodology project to ensure low prices and even the establishment of a Health Competition Inquiry, the DoH has been able to force the private health market into complying with price requirements. In 2014, the South African Competition Commission started a market inquiry to look into high prices in the private healthcare sector, which aimed at investigating the general state of
competition in the health market. This Inquiry betrays the growing reach of the National Department of Health which aims at imposing medicines' affordability even in the private healthcare sector. The benchmarking methodology is a telling example, constituting a sort of "ghost regulation". As a civil servant at the DoH argued, the methodology has never been really used, since companies virtually respect the principle of low prices:

> You know, we initially designed an International Benchmarking Methodology for originators, to control prices. They have to apply by giving prices of their country markets and then if prices suggested in South Africa are higher, we look into it and try to investigate. But they do not want to explain why it may be more expensive in South Africa so they automatically suggest lower prices. We never need to resort to methodology actually. (DoH Civil Servant 2015)

Within the ARV policy arena, industry ends up accepting the rules of the game and even internalizes control. All in all, industrial stakeholders accept state intervention not through unilateral domination, but by voluntarily accepting specific rules and regulations for determined issues and products in exchange for access to the South African market. Companies accept these rules in this specific arena dedicated to access to antiretroviral medicines and let the state have hold on patented medicines as if, more or less symbolically, they were falling into the public domain. The partial requalification of medicines as a public good can be observed through the state's ability to label medicines as belonging to the public domain, as shown by two examples. The first is the 2008 Intellectual Property Rights from Publicly Financed Research and Development Act, known as the IRP Act, which came into effect on 2 August 2010 and ensures that intellectual property emanating from publicly-financed R&D is protected and commercialised for the benefit of the people of South Africa, knowing that the state retains 'walk-in rights' for health.⁷ A second example regards public tenders: an originator company has granted a patented medicine to the public tenders. It has given it off label and the state takes care of its commercialization which is usually the purest expression of industrial property. As an employee of this company argued, "that's indirect marketing! The state takes care of communication for us!" (Pharmaceutical Company Employee 2015)

## Conclusion

The growing commodification of medicines questions the scope of state prerogatives in the health sector. In such a context, collective action to enable access to medicines is channelled by critiques of neoliberalism in favour of a traditional vision of the "welfare state" as modelled by Esping-Andersen, announcing the imminent collapse of neoliberalism (Wallerstein 2015). On the contrary, this article shows, through the example of ARV public-sector supply in South Africa, that medicine supply is organized in accordance with a neoliberal rationality. Indeed, the South African AIDS policy is not destroyed but designed by neoliberal mechanisms. Indeed, the access policy is paradoxically based on a quantitative vision of medicines, which emphasizes its price and calls for an ongoing standardization of treatments. These one-size-fits-all ARV medicines betray a macroscopic vision of health, far from an anthropological perspective of patients, as a professor at the School of Public Health at the University of Western Cape argued (UWC Professor 2015). In a resource-constrained environment, traditional welfarism is replaced by *ad hoc* mechanisms. In South Africa, this situation
has resulted in ambiguous but tight relations between state and industry, where the
state has had to engage with industry to implement its access policies, from conflicts in
policy forum to cooperation in a restricted policy arena: the public market of
antiretroviral medicines. The latter has enabled the Department of Health to design
new price standards and to challenge the configuration of patents. As a conclusion, we
suggest that the South African government fulfils its universal access policy by vesting
the market of medicines. This study is in line with Ferguson's approach of neoliberal
health policies. The author claims that these policies "may be transforming the field of
political limits and possibilities" (Ferguson 2015). Indeed, the South African
government's ability to adopt industry's narratives to weigh in negotiations stands for
a concrete and efficient way of avoiding the bottlenecks implied by litigation around
patents. This behaviour may pave the way for other Southern countries which do not
have strong and independent industrial capacities.

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## Interviews

CDP Manager J. Interview with the author, Pretoria, June 2015.

DoH Civil Servant. Interview with the author, Pretoria, November 2016.

DoH Civil Servant. Interview with the author, Pretoria, September 2015.

DoH Manager Y. Interview with the author, Pretoria, March 2014.

Employee V. Interview with the author, Johannesburg, August 2015b.

Employee V. Interview with the author, Johannesburg, May 2015a.

French Diplomat. Interview with the author, French embassy, Johannesburg, March 2014.

Manager S. Interview with the author, Centurion, August 2015.

Motsoaledi. Interview with the author, Johannesburg, 2015b.

MSF Employee. Interview with the author, Johannesburg, August 2015.

Observer A. Interview with the author, Centurion, September 2015.

Pharmaceutical Company CEO. Interview with the author, Johannesburg, September 2015.

Pharmaceutical Company Employee. Interview with the author, Pretoria, October 2015.

Pharmaceutical Company Manager. Interview with the author, Centurion, August 2015.

Professor V. Interview with the author, Durban, April 2015.

TAC Provincial coordinator (Gauteng province). Interview with author, Johannesburg, September 2015.

UWC Professor. Interview with the author, Cape Town, April 2015.

## NOTES

1. The 1997 South African Intellectual Property Laws Amendment Act was passed hurriedly as an alignment to the TRIPS agreement. It took the form of a set of compromises between the two major parties, which did not incorporate TRIPS flexibilities into the law.

2. The notions of policy forum and policy/negotiation arena were offered then refined by public policy scholars Eve Fouilleux, Bruno Jobert and Pierre Muller (Boussaguet et Muller 2005; Fouilleux 2000; Jobert 1994). These authors investigate the ways public policies are legitimized, negotiated and implemented. Jobert (1994) makes a distinction between formal negotiation arenas and what he calls policy forums (*forums politiques*). The notion of negotiation arena refers to places where individuals negotiate the material and concrete conditions of policy implementation. While the arenas are usually limited to formal processes and decision makers,
the notion of policy forum applies to broader aspects of policy making. It refers to the places
which are vested by a diversity of actors such as public servants and experts as well as opinion
leaders and the media, in which they incrementally develop common definitions of social life and
common mindsets, by questioning existing rules and creating new ones.

3. A biosimilar is a biological medical product that is almost an identical copy of an original product, by contrast with simpler, chemical generic medical products.

4. See the abstract of Ford et al (2015): "For more than two decades, CD4 cell count measurements have been central to understanding HIV disease progression, making important clinical decisions, and monitoring the response to antiretroviral therapy (ART). In well-resourced settings, the monitoring of patients on ART has been supported by routine virological monitoring. Viral load monitoring was recommended by WHO in 2013 guidelines as the preferred way to monitor people on ART, and efforts are underway to scale up access in resource-limited settings".

5. Pre-exposure prophylaxis or PrEP is the use of an antiretroviral medication to prevent the acquisition of HIV infection by uninfected persons. See "Pre-exposure prophylaxis" on the WHO website: http://www.who.int/hiv/topics/prep/en/

6. CPD presentation, Pretoria, June 2015.

7. See the University of Cape Town website: http://www.rci.uct.ac.za/rcips/ip/pfbill.

ABSTRACTS

One of the modalities of access to medicines in South Africa consists in the paradoxical
dellegation of regulatory functions to non-state actors — namely, but not only, industry. Drug
policies in neoliberal globalized states are characterized by their insertion into a global trade
system which promotes a growing commodification of medicines. At the same time, calls for the
reform of national drug policies rise significantly. State formation in South Africa has been
characterized by continuous negotiations and compromises with business, which at first sight
questions the possibility of access policies. Opening the black box of the South African state
amounts to demonstrating the state's ability to roll out a political project which endeavours to
have the pharmaceutical industry adopt the notion of universal access in a neoliberal context.
This article attempts to shed a light on access mechanisms through the analytical deconstruction
of the public market of antiretroviral medicines as a set of intertwined social relations. In South
Africa, the role of industry, as heterogeneous as it is, has been deeply ambiguous and often
denounced by civil society. Still, its role has been critical to ensure the supply of medicines. As a
result, the Department of Health has been broadly dependent on industry, regarding the
innovation agenda, the security of supply and industrial policy.

Une des modalités d'accès aux médicaments en Afrique du Sud consiste dans la délégation — paradoxale — de fonctions régulatoires à des acteurs non-étatiques, en particulier - mais pas seulement - les industriels. Les politiques du médicament dans les Etats globalisés néolibéraux sont caractérisées par leur insertion dans un système commercial mondial qui promeut la marchandisation croissante des médicaments. Parallèlement, les demandes de réforme des politiques du médicament conduites au niveau national ont crû de manière significative. La formation de l'Etat sud-africain a été marquée par des négociations continues et des compromis avec les entreprises, ce qui pourrait sembler susceptible, de prime abord, de remettre en cause la
possibilité-même de mettre en œuvre des politiques d'accès aux médicaments. Lorsqu'on ouvre la
boîte noire de l'Etat sud-africain, on peut constater que l'Etat s'emploie à mettre en œuvre un
projet politique visant à ce que l'industrie pharmaceutique adopte le principe de l'accès universel
aux médicaments dans un contexte néolibéral. Cet article met en lumière les mécanismes d'accès
aux médicaments en analysant le marché public des traitements antiviraux comme un ensemble
de relations sociales entremêlées. En Afrique du Sud, le rôle des industriels — quelle que soit leur
hétérogénéité — a été profondément ambigu, et dénoncé à ce titre par la société civile. Toutefois,
le rôle de l'industrie pharmaceutique a été décisif pour garantir l'approvisionnement en
médicaments. Il en résulte que le Ministère de la santé sud-africain a été largement dépendant
des industriels en ce qui concerne aussi bien l'innovation que la sécurisation de
l'approvisionnement et le développement industriel.

INDEX

**Keywords:** HIV/AIDS, patents, South Africa, TRIPS, access to medicines, pharmaceutical industry, neoliberalism

**Mots-clés:** VIH/SIDA, brevets, Afrique du Sud, ADPIC, accès aux médicaments, industrie pharmaceutique, néolibéralisme

AUTHOR

CHARLOTTE PELLETAN

Charlotte Pelletan is a Ph.D student in Political Science at the Bordeaux Institute of Political Science. Her Ph.D. research aims at re-thinking access to medicines through the reconnection of health systems, the architecture of the pharmaceutical industry and innovation dynamics. She co-wrote with Palesa Sekhejane (HSRC) a book chapter entitled "HIV and AIDS Triumphs and Struggles: Developmental Gap for Biomedical Sciences and Healthcare Systems Innovation in South Africa" for an upcoming book edited by Busani Ngcaweni Sizonqoba: *Outliving AIDS in Southern Africa* (HSRC/AISA). She teaches political science at Paris-Dauphine University. Contact: charlotte.pelletan[at]gmail.com
# Neoliberal Metaphors in Presidential Discourse from Ronald Reagan to Donald Trump

Jérôme Viala-Gaudefroy

1. Neoliberalism is an ambiguous and complex concept. Unlike Keynesianism, it is not a unified doctrine (Davies 2017: 19). It is sometimes employed without any clear definition, or its meaning reduced to *laissez-faire* economics. The difficulty in defining neoliberalism may come partly from the asymmetry of its usage. Today, it is used almost exclusively in the negative sense, and no one self-identifies as a “neoliberal” (Boas and Gan-Morse 2009: 138-40). Its meaning is also context-dependent and the result of a complicated historical development (Coles 2017: 21).

2. The word itself goes back to the 1890s (Oxford English Dictionary), but the idea of a new form of economic liberalism really emerged in the 1930s. It was developed by continental European intellectuals who worried about the decline of classical liberalism and the rise of government economic intervention through social programs, regulation and planning. It was rather moderate in comparison to classical liberalism (Boas and Gan-Morse 2009: 145). For the 30 years following World War II, however, a Keynesian-style monetary and fiscal policy of state intervention in the economy became the dominant economic model. At the same time, economists such as Milton Friedman and Friedrich Hayek, who promoted market competition and criticized government intervention in the economy, became prominent thinkers in the Chicago School of Economics. As they were relegated outside the mainstream, their views grew more radical (Palley 2005: 21). The economic crisis and social turmoil of the 1970s put these “neopolitarians” in the spotlight, as the economic paradigm shifted towards a favorable view of deregulation, limited governments, and free markets (Coles 2017: 21, Steger and Roy 2010: 11).

3. This major change was made visible in the economic rhetoric and policies of Margaret Thatcher in the UK, and Ronald Reagan in the US. While Tories and Republicans were fully embracing this shift, a less visible transformation was also taking place on the Left. In the United States, as the adjective “liberal” became a derogatory epithet among
American conservatives in the 1980s, a few left-wing intellectuals and politicians began to adopt the label “neoliberal” to describe their beliefs. Although these intellectuals never explicitly identified with pro-market policies, they greatly contributed to the acceptance of free-market principles by rejecting the legacy of the New Deal and the New Left, by criticizing programs like Social Security and Medicare, by strongly attacking unions, and by claiming to “no longer automatically favor big government or oppose the military and big business” (Peters 1983: 9). Eventually, the collapse of Soviet communism in 1989-1991 was seen by many as the triumph of a market-oriented economic philosophy now linked, at least rhetorically, to the idea of democracy and freedom (Steger and Roy 2010: 47). George H. Bush’s “Freedom’s victory” was presented as the victory of free markets and the defeat of political oppression in the form of planned, state-owned economies. On the left, neoliberal economics became the foundation of the “New Democrats” and the “Third Way”, exemplified by the policies of Bill Clinton. The 1994 North Free Trade Agreement (NAFTA) is a good illustration of such a policy supported by every administration from Ronald Reagan to Barack Obama. It reflected a similar economic philosophy of expanding free market economies and free trade throughout the world. Despite some practical adjustments, most recently in the aftermath of the 2008 financial collapse, this consensual view lasted until Donald Trump. Domestically, however, strong disagreement remained between Republicans and Democrats on the role of government in the economy, particularly regarding the question of regulation and health care.

Still, some scholars have shown that neoliberalism does not necessarily mean limited governments. Neoliberalism, they claim, is not about states ceding power but about “replacing political judgment with economic evaluation” and “justifying decisions in terms of logic of markets” (Davies 2017: 21). This means that neoliberalism is not the same as classical liberalism — with its emphasis on free markets — but rather takes the form of state planning for free markets and competition. However, the case remains that from a rhetorical viewpoint, both in terms of what the neoliberals say, and what critics often say they are obsessed with, neoliberalism has consistently pushed free trade and free markets.

This paper focuses precisely on the rhetoric regarding these two tenets of neoliberalism. It explores how US presidents have produced and shared a coherent narrative since the early 1980s, including on the role of government in the economy, despite political differences on a topic like health care. This discourse is characterized by the sacralization of free markets and free trade, on the one hand, and a wary view of government intervention as an impediment to freedom, on the other. This article also argues that, although Donald Trump’s rhetoric may appear to mimic that of his predecessors, his discourse actually represents a disruption in the doxa regarding trade or the expansion of the free market. Drawing on the rhetorical and cognitive approaches established by Lakoff and Johnson (1981), and further developed by Chilton (2004), and Charteris-Black (2011), this article analyses the conceptual metaphors that both reveal and produce concrete meaning for abstract economic notions. As linguist George Lakoff and philosopher Mark Johnson have shown, metaphors are meaningful windows onto the historical, cultural and social experience of a country, and the metaphorical structure of the fundamental concepts in a culture is coherent with the basic values of that culture (1981: 22). More than a figure of speech, a metaphor is, first and foremost, a tool for understanding and framing. It operates as a device of simplification by using familiar meaningful terms to talk about unfamiliar and often
abstract concepts. Market and trade are, for instance, commonly framed through metaphors of physical freedom like movement and journey. This means that “free market” and “free trade” are understood not as mere economic systems but rather as basic rights virtually indistinguishable from democracy and political freedom, making regulations and government intervention impediments to freedom. President Clinton’s concept of “market democracies” in the 1990s epitomized this fusion between political and economic freedom.

## A Deterministic Model

According to Lakoff, freedom itself is an abstract political concept with a tangible reality often “expressed through metaphors fundamentally understood in terms of our bodily experiences,” particularly through the metaphors of movement and journey (2006, 29-30). Such metaphors enable politicians and presidents to conceptualize long-term purposes, including economic and political goals in foreign affairs.

## Metaphors of Journey and Movement

In the United States, many considered the end of the Cold War as Ronald Reagan's victory, a vindication of his policy and free-market rhetoric. After all, Ronald Reagan had warned the world that the free market was “the one true path” to development (1987-09-21). The exultation of the “end of history” even led some to believe that the advent of liberal democracy and the capitalist market represented the final stage of human evolution. As the Soviet bloc was collapsing, President George H. Bush expressed his delight that former communist countries were “taking early steps towards free markets” and “that the world move[d] in this direction” (1990-01-12). Similarly, Bill Clinton presented the free market and democracy as “the only proven path” to follow (1994-07-07), and as the traveler “on the march” (1995-05-08), and Barack Obama noted that “countries like China, India, and Brazil [were...] moving toward market-based principles” (2011-05-25). This discourse of a progressive movement represents more than a simple motion forward; it signals a journey because it has direction and purpose. Life-as-a-journey is a common metaphor in the English language (Charteris-Black 2004: 74). There is evidence to suggest, however, that journey metaphors are more prevalent in American political discourse (Charters-Black 2004: 107), perhaps because it resonates with the American historical experience of journeys westward, across the land or across the sea. Ronald Reagan, for instance, presented free trade and free markets in navigational terms, and advocated to get “the boat of free markets and free trade [...] moving in the direction of prosperity,” comparing trade war to “shooting holes” and calling for strengthening “the boat of free markets and fair trade so it can lead the world to economic recovery and greater political stability (1982-20-11). In her study of President Reagan's trade rhetoric, political scientist Delia Conti concludes that this was his “most frequently-used trade metaphor” (1995:101). It is a powerful imagery of experiential collectivity: “We're in the same boat with our trading partners”, he also said in the same speech, thus emphasizing the stakes and the risks of trade wars that could sink the boat. The journey may also be vertical. For instance, President Reagan also compared freedom in the marketplace to a “ladder of social and economic advancement for all people, step by step improving the lot of every individual from top to bottom.” (1985-06-21). This
upward movement emphasizes success from a hierarchical business-like perspective (Eubanks 2000: 156).

8. In times of crisis, journey metaphors become useful rhetorical tools, as they offer guidance and provide confidence. In 2008, presidents Bush and Obama both reiterated that free people and free markets were the “surest path” to prosperity and growth (2008-11-14, 2008-11-15, 2011-03-19). These metaphors also encourage the audience to accept “short-term suffering for worthwhile long-term objectives” and they help make sense of a dire situation by giving it a moral perspective (Charteris-Black 2011: 67). This is how Barack Obama used this metaphor at the beginning of his presidency when the financial meltdown was becoming a full-blown crisis:

> Our journey has never been one of shortcuts [...] the long, rugged path toward prosperity and freedom. (Inaugural Address, January 20, 2009)

> It is time to put in place tough, new, common sense rules of the road so that our financial market rewards drive and innovation, and punishes shortcuts and abuse. (Address Before a Joint Session of the Congress, February 24, 2009)

9. Here, “shortcuts” amount to cheating and to an easy way out of the rules, contrary to “the long, rugged path” of the national journey, a reminder of the pioneer’s journey that emphasizes the protestant work ethic that ultimately leads to “prosperity and freedom” (2009-20-02). The journey metaphor doubles as a justice metaphor (shortcuts are wrong / long journeys are right). Here, the value of the reward is thus correlated with the hardship of the journey. In all these instances, capitalism is destined to succeed and expand, and Americans are on a mission to redeem and remake the world in their own image, a variation of the old American concept of Manifest destiny.

## Metaphors of Nature: Garden, Water and Weather

10. Presidents also use organic metaphors and metaphors of nature to frame the “natural” outcome of the journey as peace and prosperity. Ronald Reagan praised “international trade” for providing the “fruit of human talents that transcend boundaries of geography and culture” (1988-05-05). George H. Bush associated markets with “fruits” (1990-12-03) and a “harvest that everyone can share” (1989-09-25), and Bill Clinton stated that free markets were “growing” and “flower[ing] throughout the world” (07-26-1993), and that you could “reap their benefits” (1997-09-22). He also declared with satisfaction that they were even “taking root on every continent” (1996-08-05). Such metaphors are evocative of the Garden of Eden, an image used extensively by President Clinton who dreamed of “a garden of democracy and prosperity and free enterprise in every part of this globe” (1993-02-26).

11. The idea that the land will magically produce growth and wealth brings to mind the myth of the frontier, and what historian Richard Slotkin called “bonanza economics” linking economic growth to the discovery of new land (1993: 17-8). The vast, untapped reserves of free land in the old West became the new overseas markets that need “opening up” (1988-05-05, 1993-02-17, 1998-01-7, 2008-01-28). With the success of the space shuttle, Ronald Reagan even saw space, the ultimate new Frontier, as a place offering “new opportunities for free enterprise” (1985-02-06). Along with the journey metaphor, these tropes form a metaphorical network deeply rooted in the American mythical past. Here too, metaphors serve as political tools to illustrate a complex situation in simple terms that echo the national mythology, and resonate with the way
Americans understand their mythical position in the world. Organic metaphors also reinforce the idea that expanding free market capitalism is determined by nature itself.

12 Free trade is also commonly presented through organic metaphors, in particular liquid metaphors:

> The freer the flow of world trade, the stronger the tides for economic progress and peace among nations. (Radio Address to the Nation on International Trade, August 6, 1983)

13 In presidential discourse, free trade has been frequently associated with the “free flow” of a variety of elements that include goods and ideas (1991-09-23), goods and services (1993-02-26), goods and capital (1995-04-20), information and people (1998-05-18), and more generally and most commonly, of commerce (1990-03-08, 1994-09-28 2002-05-14, 2006-07-31, 2006-10-13, 2011-28). Other organic metaphors may also result in making economic crises seem more “natural” and therefore more acceptable. In his remarks on the national economy in 2009, for instance, Barack Obama employed a weather metaphor to talk about the recession:

> This recession [...] was caused by a perfect storm of irresponsibility and poor decision-making [...]. Markets and economies naturally ebb and flow [...] a normal downturn in the business cycle. (Remarks on the National Economy, April 14, 2009)

14 The image of the storm underlines the exceptional and violent quality of the crisis as opposed to the regular “ebb and flow” of markets and economics — an expression that evokes the “natural” tide of the business cycle, an image also used by Ronald Reagan (1983-08-06). The connotation is that crises are part of the laws of nature, and the solution is not to change the system but to better prepare through new policies. This association of nature and a capitalistic economic system connotes a deterministic model.

15 The water metaphor is also one of Donald Trump's favorite tropes but, contrary to his predecessors, he sees this flow as something dangerous, invasive and dangerous from which protection is needed. The reduction of trade barriers, he says, has “allowed foreign goods to flow freely into our country” (2017-10-11). He applies the metaphor to more than just commerce, using it to evoke more pressing threats from the outside world. One of the greatest threats to the American nation, according to Trump, is the flow of illegal immigrants who have “flooded in” (2017-29-04). Dangerous elements, people associated with crime, violence (particularly the MS-13 gang), drugs and terrorism (2017-24-02, 2017-26-02) are “pouring” across the border. Whether it is people or commerce, these metaphors illustrate Donald Trump's unerring vision: the world is a dangerous place with potential threats from which the nation must be protected through physical walls or economic tariffs.

## Machine Metaphors

16 Paradoxically, the market may also be presented as an artificial construction through the machine metaphor.¹ Just like organic metaphors, the machine metaphor illustrates the inescapability of the free market economic system as well its progressive nature. In his 1988 State of the Union Address, four months after the October 19 “Black Friday” stock market crash, President Reagan continued to express his belief in “the free market as an engine of economic progress” (1988-01-25). George H. Bush used the same imagery of the “engine of progress” (1990-01-31) that would “fuel growth”
(1989-09-25) and George W. Bush talked about trade and free markets as “the engines of the world’s economy” (2005-02-21). Similarly, President Clinton called them “the best engines we know of for raising living standards, reducing global poverty and environmental destruction, and assuring the free flow of ideas” (2000-01-27-) or the “great engines in this extraordinary economic machine” (1994-10-24). The machine metaphor sometimes overlaps with a movement metaphor driven by consumers who “determine the direction and the workings of the marketplace” (1994-07-07, 1994-10-24).

17 This machine metaphor continued to be used even after the 2008 financial meltdown: if the market machine is not “functioning,” declared George W. Bush, it is because it needs “the grease necessary to keep the gears of our financial system turning,” i.e. liquidity (2008-10-10). The crisis is therefore not a failure of the machine, but only a temporary malfunction that needs “fixing” (2008-11-13). Even Barack Obama, who was more circumspect and recognized market failures, employed the same metaphor to emphasize how the “market can spin out of control” (2009-01-20) and how the free-market machine only needs “smart regulations” to “work as it should,” to “work better” (2011-05-25, 2012-01-24).

18 These examples illustrate how, in the last 35 years, the United States presidents have all framed market and trade through the same metaphors that emphasize a sense of inevitability within the neoliberal philosophy. Remarkably, Donald Trump seems to be breaking with this doxa of the past 40 years on two accounts. Firstly, because although he has been using the organic metaphor to speak about free trade, he has primarily presented it in negative terms, as a threat to the nation's interest and economic health. Secondly, contrary to his predecessors, he has shown no interest in spreading either political or economic freedom throughout the world. In fact, in the first year of his presidency, he only mentioned “free market” in two of his remarks and speeches, and only once in his tweets. The comparison with his predecessors is striking, as shown in the following graph:
<figure><img src="image_19.png" /><figcaption>Comparison of the number of presidential speeches and remarks containing the phrase “free market” in the first year of each presidency (1945-2017).</figcaption></figure>

Comparative computer-generated analysis with the R program for Statistical Computing of the presidential papers archived online on *The American Presidency Project*, University of California.
<http://www.presidentycusb.edu/>.

*in the cases of the first Johnson presidency and the Ford presidency, the speeches and remarks taken into account cover a 12 month period.

** Donald Trump's disourses and speeches in this comparative study do not include his tweets.

Source: comparative computer-generated analysis of the presidential papers archived on *The American Presidency Project*, University of California, https://www.presidentycusb.edu/.

19 The only market Donald Trump seems to be interested in is the stock market, the growth of which he attributes to his election. He mentioned it in 75 of his speeches and in 42 of his tweets within the first year of his presidency. It would be premature to conclude that Donald Trump is not a neoliberal in his own right, however.

A Moral Model

20 As free markets and free trade have been presented as the only economic options that lead to peace and prosperity for the United States and the world, they have also been framed in moral terms, most notably by linking economic freedom to political freedom. In his address to the United Nations General Assembly in 1986, Ronald Reagan made the organic connection very clear: “economic freedom,” he said, “is the inseparable twin of political freedom and democratic government.” (1986-09-22). With the end of the Cold War, political freedom and free markets were constantly associated to the “triumph of liberty over dictatorship in every corner of the globe” (1990-05-12) and to the liberation from “oppression” (1993-04-01, 2001-02-27). Bill Clinton linked human rights to the market by calling for the expansion of “market democracies” at the United Nations (1993-09-27) and George W. Bush reinterpreted the commitment of NATO and the European Union to a commitment of “democracy, free markets, and common security” (2001-06-15). Similarly, Barack Obama saw a historic trend toward “free societies, free governments, free economies, free people” (2011-11-17). The free-market economic model has also been presented through a number of metaphors that precisely emphasized its moral nature.
## Personification

21 Just as recent presidents have often spoken allegorically about freedom, they have also repeatedly given human qualities to the market. George H. Bush noted that free markets are “well-informed” and constitute a system with “wisdom” (1990-02-05), whose actions are moral as they contribute to the “defense of the environment” (1990-02-05), and even “provide levels of prosperity, growth, and happiness” (1991-09-23); Bill Clinton emphasized the “power” and “logic” of the free market (1999-06-12); and Barack Obama saw open markets as agents of change, providers of the “chance to create and succeed” (2011-09-11). In other words, they warrant the American Dream. George W. Bush also embraced the moral view of free markets and trade that “have helped defeat poverty and taught men and women the habits of liberty” (2003-05-09, 2001-07-17). In this moral account, opposing free trade or the free market is morally wrong. “Those who protest free trade are no friends of the poor,” since they “deny them their best hope” (2001-07-17). George W. Bush made it clear that markets were no longer a means, but an end in themselves: if “corporate criminals must pay a price”, he claimed, it is for no other reason than for “the sake of our free market” (2002-09-26).

22 Even as the effect of the financial crisis continued to worsen, Barack Obama urged his audience to “help restore a free market that’s fair” (2009-05-17-9). The word “restore” implies a health metaphor, a common conceptual metaphor in times of economic crises which identifies the status of the market with terms like “health,” “healthy,” “recovery.” The “flow of credit” was compared to “the lifeblood of our economy” (2009-02-24, 2009-02-10). It was one of the most recurrent metaphors used by President Obama at the beginning of his first term (Sacco 2009). On the other hand, regulations were no longer obstacles to economic freedom but necessary elements in a “healthy market” in which “a quick profit” was considered unhealthy (2009-02-24). The belief in the morality of the market, just like the belief in American exceptionalism, also stems from a positive view of competition grounded in a strong sense of self-confidence prevalent in American culture (McNaught 2009: 126).

## A New God?

23 Not only is the market presented as a moral agent and a benevolent force, it is also endowed with supernatural power. Ronald Reagan referred to the “magic of the marketplace” in more than 15 different speeches between 1981 and 1988, including in his more prominent remarks:

> [...] the United States believes the greatest contribution we can make to world prosperity is the continued advocacy of the magic of the marketplace [...] (Address to the 41st Session of the United Nations General Assembly in New York, September 22, 1986.)

24 As China was opening up to a market-oriented economy, he noted how the “free market spirit” had “enlivened the Chinese economy” (1984-05-01), and in his famous speech at the Brandenburg Gate in West Berlin in 1987, President Reagan marveled at how “free markets are working miracle after miracle of economic growth” (1987-06-12). In a less dramatic fashion, George H.W. Bush called the market a power “unleashing a new force” (1989-02-09), and a “force of progress” (1989-09-25). Expressing his belief in America’s mission after the fall of communism, Bill Clinton
called on Americans to become “leaders in the great crusade of the post-Cold War era to foster liberty, democracy, human rights, and free-market economies throughout the world” (1993-03-26).

<figure><img src="image_20.png" /></figure>

The market was not just powerful, according to Barack Obama it is the “greatest force the world has ever known for creating wealth and opportunity” and “for economic progress in human history” (2011-11-17, 2012-04-10). God’s promise to the Pilgrims has become “the promise of the free market” (2011-01-28) and its power is what America’s “ultimate success will always depend upon” (2010-08-09). If one defines religion as humanity’s “acknowledgement of a greater or a superior power to which one owes fortune, obedience and respect,” then the similarities between the market and God himself become striking (McNaught 2009: 129).

<figure><img src="image_21.png" /></figure>

Applying his belief in America's mission to expand freedom to the world through economic opportunity, George W. Bush was explicit in expressing his vision of the powers of the free market and free trade "to transform our world" (2006-02-15). In his 2002 State of the Union address, he claimed that "in every region, free markets and free trade [...] are proving their power to lift lives" (2002-01-29) — "lift" evokes a verticality traditionally associated with spiritual transformation. According to President Bush, free markets have quasi-magical powers of social transformation that can be applied "to the needs of the poor" through free trade (2001-07-17). This power of transformation echoes America's own mythical story of a country transformed "from a rugged frontier to the greatest economic power in history" (2008-11-14).

<figure><img src="image_22.png" /></figure>

Through these metaphors, we can identify a number of characteristics of the free market traditionally attributed to the divine. Firstly, it is benevolent, as it is a force that brings peace and prosperity. Secondly, it is omnipotent, since it is unavoidable and part of natural law. Thirdly, it is omniscient, as it meets the needs of all people. And finally, it must become omnipresent, as the goal is to expand it throughout the world so it can be felt everywhere at the same time. On the whole, these metaphors seem to confirm the view of economist Lester Thurow that market theory "is a political philosophy [...] approaching a religion" (Thurow 1984: xviii). This was true until Donald Trump's election, who, contrary to his predecessors, has virtually no interest in political freedom and democracy, except for a few opportunistic rhetorical mentions of Cuba, Venezuela, Syria and North Korea.

## Trade-is-a-game Metaphor

<figure><img src="image_23.png" /></figure>

Free trade in particular is commonly framed through game metaphors. It is an attenuated, less hostile version of the war metaphor as it involves not only winners and losers but also rules and order. It is also a very common metaphor in the culture and language of business (Hamington 2009: 473). The game metaphor is essentially a moral metaphor that brings into play concepts of fairness and justice. The core narrative of this metaphor is that Americans will necessarily be the winners, as long as the rules are fair.

<figure><img src="image_24.png" /></figure>

One of the main arguments put forth by presidents in support of free trade agreements is that, through these deals, they are able to “level the playing field” of commerce. This sports metaphor is a subset of the game metaphor and is one of the most recurrent expressions used for international trade in politics. Every president from Ronald Reagan to Barack Obama have used this metaphor to push for free trade agreements
that would standardize the rules and “level the playing field” for the American
workers. As the following excerpts show, this game metaphor is expressed in a striking
similar fashion in presidential discourse:

If the United States can trade with other nations on a level playing field, we can outproduce, outcompete, and outsell anybody, anywhere in the world. (Address Before a Joint Session of Congress on the State of the Union, February 4, 1986)

Level the playing field, and Americans will outthink, outproduce, and outperform
anyone, anywhere, anytime [...] I put my faith in your talent to compete: America
doesn't cut and run. We compete. (Remarks at Louisiana State University in Baton
Rouge, Louisiana, March 6, 1992)

Given a fair chance and a level playing field, we can out-innovate, out-produce, and out-compete any people. (The President's Radio Address, November 20, 1993)

With open markets and a level playing field, no one can outproduce or outcompete the American worker. (Address Before a Joint Session of the Congress on the State of the Union, January 31, 2006)

Our workers are the most productive on Earth, and if the playing field is level, I promise you, America will always win. (Address Before a Joint Session of the Congress on the State of the Union, January 24, 2012)

30 Each quote also expresses a strong belief in national superiority, evoking American exceptionalism and self-confidence. The reasoning is always that trade agreements will “level the playing field” for American workers who will be able to completely and necessarily win. Bill Clinton tried to convince the unions that NATFA was a good agreement for the American workers using this game metaphor (1994-24-09), and it is also how Barack Obama introduced the negotiations on a Trans-Pacific Partnership (TPP) (2013-02-12). The game metaphor also implies that the freedom that comes with “free trade” and “free market” is not *laissez-faire* but rather based on fair rules.

31 Ronald Reagan was the one who redefined free trade as fair trade to justify his protectionist measures, particularly regarding Japan, while remaining consistent with the principles of free trade and competitiveness (Conti 1995: 92).

We had clear evidence that Japanese companies were engaging in unfair trade practices that violated an agreement between Japan and the United States. We expect our trading partners to live up to their agreements. As I've often said: Our commitment to free trade is also a commitment to fair trade. But you know, in imposing these tariffs we were just trying to deal with a particular problem, not begin a trade war. (Radio Address to the Nation on Free and Fair Trade, April 25, 1987)

32 President Bush senior and President Bush junior both declared that freedom and fairness go hand-in-hand (1990-01-31, 2004-01-20). Similarly, Bill Clinton saw in free-trade agreements opportunities to shape global commerce and guarantee that the rules are fair to the American workers. In 1997, he advocated that a “yes vote” for free-trade deals “means that America helps to write the rules for the new global economy” (1997-11-08). This was the reason for participating in trade deals, including as recently as 2015 with the TPP (2015-01-20). The president ensured that the trade deals would be beneficial as long as the trading partners “played by the rules” (2015-01-25).

33 These metaphors reveal a coherent consensual view of the market as a benevolent force inasmuch as it works fairly, i.e. according to rules that America could write and enforce. The failure of the market is essentially that of the individuals who misuse it. It is seen as an anomaly in the game. As Presidents from Ronald Reagan to Barack Obama all share this vision, it might be considered to have become a national mythology in itself.
Donald Trump may be seen like a heretic in this respect, however, at least rhetorically speaking. It is important to note that Donald Trump has used the same game metaphors for trade and has expressed a similar belief in American exceptionalism. “When there is a level playing field, —and I’ve been saying this for a long time—” he said to Boeing workers in Charleston, “American workers will always, always, always win” (2017-02-17). This is what other presidents had said for decades, which is why the idea that “the terrible trade deals” are why American workers were not given that “level playing field” should resonate with the so-called “forgotten Americans” (2017-02-21). Expanding on the game metaphor, Trump takes on the heroic role of the righter-of-wrongs in a world divided between winners and losers, promising that “America is going to start winning again, winning like never, ever before,” and that “we’re not going to let our country be taken advantage of anymore” (2017-02-17). In this speech, Trump offers once again a very antagonistic view of the outside world akin to a villain doing “tremendous cheating.” His rhetoric also signals a semantic shift in which “fair trade” has replaced “free trade” as the main goal put forth by his administration, which he stated very clearly:

> So I know that's always been a point of contention, but to me it's just fair. It's just fair. It's reciprocal. It's fair. And so we're going to be doing a lot of work on that, and that's becoming a very, very important factor—fairness. Because I believe in free trade. I want so much trade—somebody said, oh, maybe he's a total nationalist —which I am, in a true sense—but I want trade. I want great trade between countries. But the word “free” is very deceiving, because it's good for them, it's not good for us. I want fair trade. (Remarks to the National Governors Association, February 27, 2017)

If Donald Trump sounds like a disrupter, his rhetoric offers a moral narrative that is essentially coherent with the story told by previous presidents. It is undeniable that his opposition to free trade deals conflicts with one of the tenets of classic *laissez-faire* economic liberalism. This does not signal, however, a return to the post-war Keynesian economics.

## Obstacles to Economic Freedom

One important way to understand the real impact of neoliberal thinking is to study what constitutes obstacles to prosperity and freedom in presidential discourse.

### The Shifting Meaning of the Wall

For decades, presidential rhetoric conceived of walls and barriers as obstacles to economic and political freedom. This metaphorical framework was firmly situated in the narrative of the Cold War in which obstacles to freedom, both economic and political, were symbolized by the “Iron Curtain,” barriers, and walls. When Ronald Reagan famously asked USSR Premier Gorbachev in his speech at the Brandenburg Gate in West Berlin in 1987 to “tear down this wall,” he linked political freedom and peace to the “economic miracle” of free market and free trade. Similarly, his successor, George H. W. Bush, praised “freedom’s advance” in “a movement towards political pluralism and a free-market economy,” adding that “barriers stand in the way” and “unneeded restrictions and regulations act as dead weights on their own economies and [are] obstacles to foreign trade” (1989-25-09). Bill Clinton warned of “democracy’s prospects
[...] dimmed [...] by trade barriers" (1993-26-02) and later celebrated the dismantling of "the blocs and barriers that divided our parents' world" and the hard work of governments "to tear down trade barriers abroad" (1993-04-02). George W. Bush cited Ronald Reagan's speech in West Berlin, commended him for believing "that no human barrier could hold back the spread of human liberty" (2003-11-11). In his last State of the Union message, Bush promised he was working "to break down barriers to trade and investment wherever we can" (2008-01-23). In his discourse, regulations and tariffs constitute obstacles that "prohibit the free flow of trade" (2008-04-21). Naturally, it follows that such barriers must be "lowered" (1991-02-06), "reduced" (2012-05-19), or "eliminated" and "torn down" to allow for the circulation and flow of economic activity (1990-06-11, 1998-06-08, 1998-05-18, 2005-09-14).

38

Even as the most serious economic crisis since the Great Depression was looming, the priority was still to maintain the free market and the "free movement of goods and services," George W. Bush warned in the wake of the 2008 financial meltdown (2008-11-14). Barack Obama continued to be largely influenced by the Cold War narrative when, in Strasburg, France, he reminded the Europeans that "we must not erect new barriers to commerce, that trade wars have no victors," and that "the freedom that our nations stood for throughout the Cold War was the opportunity that comes from free enterprise and individual liberty," (2009-03-04), pointing also to the uselessness of "walls of concrete and barbed wire" that "are ultimately no match for the will of ordinary men and women who are determined to live free" (2014-07-11).

39

This is where Donald Trump's rhetoric constitutes a dramatic shift from all his predecessors since the 1980s. His narrative frames the nation as a container that is under constant threat from dangerous elements "pouring and flooding in". The main conclusion of this narrative is the need to build walls and barriers as a means of protection (2017-25-01). Trump's key surprising difference, especially compared to previous presidents, is that his rhetoric as a candidate is very similar to his rhetoric as a president. President Trump has continued to repeat his promise to build a "great wall", "a real wall, not a little wall like some people said" (2018-02-02), "a great border wall to stop dangerous drugs and criminals from pouring into our country" (2018-23-02). In addition to his promised great southern border wall, he also refers to what could be called a "protectionist wall" through the renegotiation of NAFTA (2018-01-05), which led to the rebranding of NAFTA into USMCA to give the president a political win (Donnan 2018). This protectionist wall also takes the form of tariffs imposed as a form of punishment on countries deemed unfair to the United States like China or Canada, but also against countries that refuse to take back their criminals (2018-02-02). He even connects the metaphorical and the physical walls by promising that the wall on the border will be paid for by Mexico with what it "makes from the U.S.," thanks to NAFTA (3:25 AM - 18 Jan 2018).

## Government vs. Freedom

40

One of the most visible features of neoliberal thinking is a shift in the role of government that has occurred since the 1970s, when a rollback of the government's regulatory power began with the first wave of deregulation. It was Ronald Reagan who popularized a more anti-government rhetoric, encapsulated in his now iconic remark in his 1981 Inaugural Address: "government is not the solution to our problem;
government is the problem.” In economics, the government is seen as an obstacle to
the workings of the free market machine:

Government, with its high taxes, excessive spending and overregulation, had
thrown a wrench in the works of our free markets. In essence government was
trying to run the economy, but was ruining it instead. (Remarks to Brokers and
Staff of the New York Stock Exchange in New York, March 28, 1985)

41 His successor, George H. Bush, continued to promise “fewer regulations” and “less bureaucracy” (1989-02-09). Even at the end of his term, he continued to present taxes and regulations in terms of “obstacles” that “hindder growth” and must be “cleared away” in order to “set the economy free” (1992-01-28). This view that taxes and regulations constitute impediments to freedom has been central to the Republican platform since Reagan. Like his father, George W. Bush also vowed to remove “needless regulations, unnecessary, burdensome, cumbersome, costly regulations” (2001-03-26). He was particularly fond of the expression “tax relief” which he used more than any other president. This metaphorical phrase frames taxes as a form of affliction to be eliminated or from which one wishes to be liberated (Lakoff 2006: 13). The Democratic presidents of the post-Cold War era used this same expression repeatedly.

42 Regarding deregulation, Bill Clinton continued the policy of the previous administrations, especially after the Democrats lost both the House and the Senate in the 1994 midterm elections.² He also boasted of “reducing government positions, cutting government programs and eliminating regulations,” giving “states the freedom from burdensome Federal Government regulations” (1995-07-08, 1995-07-15). Sixteen years after Ronald Reagan, Bill Clinton tried to close the debate on the role of government by promoting an intermediate vision where “government is not the problem, and government is not the solution.” (1997-01-20). His view of government was also defined in relation to freedom: he advocated for “a government that empowers our people to make the most of their own lives but is smaller and less bureaucratic and less burdensome than it has been” (1995-07-15).

43 Barack Obama also tried to strike a balance between government action and freedom. He advocated rolling back government intervention in “instances where the gains in security from government action are not worth the added constraints on our freedom” (2009-09-09). Early in his presidency, he made clear that he did not believe that government had the answer to every problem, emphasizing that the United States was “a nation built on the strength of individual initiative” (2009-03-14). His attempt at giving a definition that would please both conservatives and progressives is best illustrated in his 2012 State of the Union address when he evoked “Republican Abraham Lincoln” and his belief that “government should do for people only what they cannot do better by themselves and no more” (2012-01-24). In practical terms, this vision of what he called a “smart government” meant a limited role for government within specific areas such as defense, education, transports, research, Medicare and Medicaid, Social Security and unemployment insurance (2012-04-12). At the same time, he pointed out that “the danger of too much government is matched by the perils of too little, that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited” (2009-09-09).

44 Even the 2007 subprime mortgage crisis, followed by the 2008 financial meltdown and major economic crisis did not alter the dominant narrative. Even as he admitted that he had to “step in with dramatic Government action,” George W. Bush continued to
profess his strong belief in “free enterprise” and assured the public that his “natural instinct [was] to oppose Government intervention” (2008-09-24).³ In October 2008, he warned that “the Government’s role will be limited and temporary [...] that these measures are not intended to take over the free market, but to preserve it” (2008-14-10). Even in the post-economic crisis era, Barack Obama was very cautious in his rhetoric, pushing back against accusations of hampering freedom through regulations. As he promoted “commonsense safeguards to protect the American people,” he also ordered “a review of Government regulations” in order to “reduce barriers to growth and investment” (2011-01-25). Ten months before the 2012 presidential elections, the president was on the defensive:

> I've approved fewer regulations in the first three years of my Presidency than my Republican predecessor did in his. I've ordered every federal agency to eliminate rules that don't make sense. (State of the Union, January 24, 2012)

Eventually, only “sensible regulations” would be permitted to remain since they encouraged “fair competition” (2015-01-20). Despite the clear differences between Republicans and Democrats on the role of government, the dominant narrative of American politics is still the relationship between government involvement and personal freedom.

President Trump has offered the most negative rhetoric on government.⁴ In terms of domestic economic policy, he has eliminated more regulations and cut more taxes than his predecessors, at least in terms of raw numbers.⁵ From a traditional conservative viewpoint, he conceives of regulations in terms of interference to freedom; they “tie down” the economy and “chain up” prosperity (2017-06-09). Taxes and regulations are framed as “crushing,” “crippling” and even “punishing.” Trump wants to “free our economy [...] from the terrible tax burdens,” particularly, he insists, the “workers that are so burdened with taxes” (2017-11-09, 2017-11-29). Similarly, the Paris Climate Accord “hamstrings the US” and keeps it “tied up” and “bound down” (2017-06-01). As a showman, President Trump even acted out the red-tape metaphor by literally cutting a red ribbon symbolizing ‘Red Tape’ while standing next to several huge stacks of paper during his address on deregulation (Brenna 2018). In his remarks, he clearly opposed regulations with freedom, and with the “national spirit” of a people, made of “explorers and pioneers and innovators and inventors,” who have been hurt badly by regulations. He concluded by saying: “let’s cut the red tape. Let’s set free our dreams” (2017-12-14).

## Health Care and the Market Narrative

Even in the context of the dominant narrative that opposes government intervention with freedom, there remain ideological differences between Republicans and Democrats. It is probably the subject of health care that best illustrates this framing war for the meaning of freedom. In his 1985 State of the Union Address, Ronald Reagan considered health-care vouchers as a way to “help working families shop for services that they need” (1985-02-06). Here, the verb “shop” implies that health care is a consumer service like any other, and that people should be able to choose a particular service. In the following decades, the question of health care would become the focal point that illustrates the divide between the two parties. Tellingly, in 1992, at a campaign fundraiser, George H. Bush called heath care “the Grand Canyon of philosophy that separates the two sides in this election” (1992-08-02). He warned
against a move toward “a nationalized system, a system which will restrict patient choice” (1992-01-28). His son, George W. Bush, also raised the specter of “a nationalized health-care system” that would “dictate coverage and ration care” (2003-01-28). Donald Trump has adopted a very similar rhetoric about health care. He speaks of “empowering States and consumers,” so they have “the choice and the freedom to make the decisions” (2017-03-10). Freedom is thereby associated with choice and opportunity. Interestingly, President Trump mentions the benefit of the market exclusively when he addresses the issue of health care. In his first address before a Joint Session of the Congress in February 2017, he promised to give Americans “the freedom to purchase health insurance across State lines, which will create a truly competitive national marketplace” (2017-02-28). In this respect, he shares the traditional conservative philosophy of his Republican predecessors — the belief in “the power of the private marketplace to let insurers come in and compete for your business,” and against “regulations [that] drive up health-care costs” (2017-03-13, 2018-01-29).

48 Having campaigned on the promise of health-care reform, President Bill Clinton first focused on freedom of access to health care for every American family as his primary goal (1995-01-24, 1996-01-23, 2000-01-27). One of the most contentious terms in the health care debate was, and still is, the idea of a “mandate,” a requirement that all individuals purchase health insurance constituting an “obvious” restriction of freedom. President Clinton tried to change the narrative by contrasting what some call an “employer mandate” with “the principles of fairness and responsibility”, and by turning the fear of cost into the benefit of a “vital investment” and a defense of “freedom of Americans to live without fear” (1993-09-22). Faithful to his centrist approach between traditional liberalism and the conservative alternative, Bill Clinton promised a combination of private market forces and a sound public policy that would support competition with caps on prices if competition did not work (1993-09-22). He framed health care both as a right (2009-09-08) and as a consumer product, urging “Congress to reach across the aisle and write into law a consumer bill of rights” (1998-01-27). As early as in January 1993, in his *Remarks and Exchange With Reporters on Health Care Reform*, the president chose to talk about “consumer choice” and not, for instance about “patient choice” (1993-01-25).

49 Like Bill Clinton, Barack Obama framed his reform of health care both in terms of freedom of access for those “who’ve been denied coverage” and the freedom “to choose an affordable health care plan in a competitive market” (2010-01-27). He also presented himself as the heir of past Republican presidents such as Theodore Roosevelt “who first called for reform” (2009-02-24, 2009-09-09). He referred to Abraham Lincoln’s definition of government to illustrate his own vision of a health-care law that relied on a “reformed private market, not on a Government program” (2012-01-24). In his Address Before a Joint Session of the Congress on Health Care Reform in 2009, he also vowed to protect Medicare, a very popular federal program, calling it “a sacred trust that must be passed down from one generation to the next” (2009-09-09). Essentially, the “Patient Protection and Affordable Care Act” retained the previous structure of Medicare, Medicaid, and the market-based insurance through employers. What is striking, however, is that the dominant narrative remains that of the free market. George Lakoff and Elizabeth Wehling observe that the very word “affordable” in the title of the law fits the metaphor of health care as a product, as do other words commonly used by Obama such as “market,” “purchase,” and “choice” (2012: 21).
President Obama is very clear: his plan would “give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market” (2010-01-27). As Lakoff and Wheling noted, Barack Obama formulated his health care act by “placing the product metaphor in the context of the commerce clause of the Constitution, Article I, Section 8, which gives Congress the right to regulate commerce” (2012: 21). This is exactly how he presented his reform:

> So the fact is, the product of the Affordable Care Act for people without health insurance is quality health insurance that's affordable. And that product is working. It's really good. And it turns out, there's a massive demand for it.

> So let me just recap here. The product is good. The health insurance that's being provided is good. It's high quality, and it's affordable. People can save money, significant money, by getting insurance that's being provided through these marketplaces. The prices are lower than we expected, the choice is greater than we expected. (Remarks on the Patient Protection and Affordable Care Act, October 21, 2013)

50

The central question of how the purchase of a “product” can be justifiably imposed by law remains central here. It seems that by framing health care as a consumer product rather than a patient’s right, President Obama precisely undermined the very justification for the individual mandate at the heart of his reform. The dissonance between the president’s rhetoric and the law may have contributed to the unpopularity of the individual mandate (Karpman and Long 2017). It made it easier for the Trump administration and the GOP to repeal this aspect of the law.

## Conclusion

51

The metaphors employed in presidential discourse from Ronald Reagan to Barack Obama reveal the continuous narrative of a deterministic economic and political model around the idea of economic freedom. Notwithstanding some political differences, at the core is the belief that free markets and free trade are both natural and moral agents that will lead to peace and prosperity for all, if properly applied, and that government intervention should be limited as it represents a restriction of these freedoms. The fallout of the 2008 financial crisis, followed by a government bailout of the system, did not alter this enduring vision in the following years — the economic crisis was seen as a simple malfunction of an otherwise principled system. Even the very contentious topic of health care has been debated through a rhetoric dominated by a strong faith both in the market and in a limited role of government, including by those like Clinton and Obama who pushed for strong reforms. This period of about 35 years, from Ronald Reagan to Barack Obama, is thus remarkable for its rhetorical consistency regarding free trade and the free market, but it may be coming to an end.

52

On the face of it, Donald Trump seems to represent the burlesque embodiment of the neoliberal doctrine: his public persona was shaped by a culture that praises individual survival and competition; he was elected on the promise to run the country like a business; and he has used his presidential power to change the country, deciding and firing at will, while others execute his policy decisions. That is how he has been running his cabinet. His economic rhetoric and policy, however, also constitute a disruption of the narrative that prevailed in the previous 35 years. His rejection of free-trade deals and his lack of interest in free markets and democratic expansion represent a shift away from the neoliberal order towards one of nationalism and protectionism.
That is why prominent members of the Republican Party have been, for once, vocal in their criticism of Trump's threat of waging a trade war (Aleem 2018). Of course, he is not the first president to take protectionist measures to help entire categories of American industry. Ronald Reagan, while an apologist of free trade and free markets, imposed quotas on Japanese cars in 1981, on steel from Japan and Europe in 1983, and tariffs on Japanese semiconductor products in 1987. But these were limited measures. In the meantime, Reagan negotiated a trade agreement with Canada that led to the 1988 Canada-United States Free Trade Agreement and, ultimately, to NAFTA. More importantly, as political scientist Delia Conti concluded, rhetorically, Ronald Reagan "consistently upheld the ideal of free trade as the theme and goal of his administration" (Conti 1995: 103-4). He was also quite aware of the failed policies of President Herbert Hoover's protectionist measures in the 1930s. One can contrast how Reagan viewed trade wars to what Donald Trump wrote on Twitter:

> In the 1930's, the world experienced an ugly specter—protectionism and trade wars and, eventually, real wars and unprecedented suffering and loss of life. (Radio Address to the Nation on International Free Trade November 20, 1982)

> Trade wars are good and easy to win. [...] we win big. It's easy! (Donald Trump — Tweet, @realdonaldtrump, Mar 2, 2018 05:50:34 AM)

53 Donald Trump's policies may be difficult to assess as his discourse and action often lack consistency, and it may be too early to draw definite conclusions about the long-term influence of his rhetoric on US politics. One issue where he has had a long-standing consistent view is trade: he has often repeated how the US "was not respected," and was "taken advantage of" by the rest of the world, including by its neighbors thanks to NAFTA. As much as Reagan complained about the trade deficit, he was not, like President Trump, ready to take the world to the brink of a trade war as a negotiating tool.

54 Trump's obsession with the national trade deficit is one of the identifying characteristics of the mercantilist doctrine that held sway in Europe between the 16th and 18th centuries. Its goal was to achieve a favorable trade balance in order to increase or maintain national power and wealth (Magnusson 2015: 6, 21). In those days, wealth was measured by the amount of "international reserves" at the disposal of the state, so international trade was necessarily a zero-sum game where one nation only could win what the other lost. This has been the core of Donald Trump's nationalist discourse about a world made of winners and losers, where every nation has to compete for its share of the cake. That is why, in his inaugural address, he pledged that America would "start winning again, winning like never before" (01-20-2017). Mercantilists wanted to limit competition, and despite his claim that he wants a "fair deal," Trump is not really interested in fair competition: when the European Union offered to scrap tariffs on cars, he said that it was "not good enough" because "the [European] consumer habits are to buy their cars, not to buy our cars" (Micklethwait, Talev, and Jacobs 2018) — hardly a statement from someone who believes in either the free market or fair trade deals.

55 Another characteristic of mercantilist policies was that they were designed to benefit a particular class of society: the merchants and manufacturers (Magnusson 2015: 4). This is also consistent with what seems to be Trump's neoliberal policy: his tax cuts on the wealthy, his deregulation of big business and the financial industry. Despite his constant attack on the so-called "Deep State" (2017-06-16), 2017-11-28), including Federal employees whom he calls "unelected bureaucrats" (2017-02-17c, 2017-07-03,
56

2018-01-26), President Trump has not been shy about using the federal powers of his administration to help the coal and oil industries, to put pressure on private companies like Amazon, Boeing and Lockheed (Mufson and Lynch 2018). And, of course, Trump's nationalistic rhetoric, encapsulated by his "America First" slogan and his insistence on national sovereignty and the end of "globalism" is consistent with the mercantilist outlook. His is a new brand of mercantilism based on "a zero-sum conception of the benefits to individual states from international trade" (Ahmed and Bick 2017). "America First" exalts loyalty and devotion to the nation and places the American nation above all others and, even more so, above supranational institutions

One may wonder if Donald Trump may represent a temporary local anomaly or a more long-term global trend signifying the end of a cycle. As nations feel that they have lost power as a result of globalism and the interdependence of free trade, they might want to regain their power by advancing similar policies. The rise of nationalism throughout the world may give us pause. If neoliberalism has failed, its replacement by neo-mercantilism may be even more worrisome since, as history has taught us, mercantilism and trade wars ultimately leads to real wars between nations. In the light of today's situation, Ronald Reagan's words when he addressed the nation on free trade seem like a cautionary tale:

> Yet today protectionism is being used by some American politicians as a cheap form of nationalism [...] Our peaceful trading partners are not our enemies; they are our allies. We should beware of the demagogues who are ready to declare a trade war against our friends — weakening our economy, our national security, and the entire free world — all while cynically waving the American flag. The expansion of the international economy is not a foreign invasion; it is an American triumph, one we worked hard to achieve, and something central to our vision of a peaceful and prosperous world of freedom. (Radio Address to the Nation on the Canadian Elections and Free Trade, November 26, 1988)

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# Corpus

## Ronald Reagan

1983-11-20, Radio Address to the Nation on International Free Trade November

1983-08-06, Radio Address to the Nation on International Trade

1983-11-20, Radio Address to the Nation on International Free Trade November

1985-02-06, Address Before a Joint Session of Congress on the State of the Union

1984-05-01, Remarks Upon Returning From China

1985-03-28, Remarks to Brokers and Staff of the New York Stock Exchange in New York

1985-05-24, Remarks at the Annual Meeting of the National Association of Manufacturers

1985-06-21, Remarks at the Annual Convention of the Lions Club International in Dallas, Texas

1986-09-22, Address to the 41st Session of the United Nations General Assembly in New York

1987-06-12, Remarks on East-West Relations at the Brandenburg Gate in West Berlin

1987-09-21, Address to the 42nd Session of the United Nations General Assembly in New York

1988-01-25, Address Before a Joint Session of Congress on the State of the Union

1988-05-05, Proclamation of World Trade Week

## George H. W. Bush

1989-02-09, Address on Administration Goals Before a Joint Session of Congress

1989-09-25, Address to the 44th Session of the United Nations General Assembly in New York

1989-11-22, Thanksgiving Address to the Nation

1990-01-12, Remarks to the Chamber of Commerce in Cincinnati, Ohio

1990-01-31, Address Before a Joint Session of the Congress on the State of the Union

1990-02-05, Remarks to the Intergovernmental Panel on Climate Change

1990-03-08, Remarks at the National Transportation Policy Meeting

1990-05-12, Remarks at the Liberty University Commencement Ceremony in Lynchburg, Virginia

1990-12-03, Remarks to a Joint Session of the Congress in Brasilia, Brazil

1991-02-06, Remarks and a Question-and-Answer Session at a Meeting of the Economic Club in New York

1991-09-23, Address to the 46th Session of the United Nations General Assembly in New York City
1992-01-28, Address Before a Joint Session of the Congress on the State of the Union

1992-03-06, Remarks at Louisiana State University in Baton Rouge, Louisiana

1992-08-02, Remarks at a Fundraising Brunch for Rich Williamson in Rosemont, Illinois

## Bill Clinton

1993-01-25, Remarks and an Exchange With Reporters on Health Care Reform

1993-02-17, Address Before a Joint Session of Congress on Administration Goals

1993-02-26, Remarks at the American University Centennial Celebration.

1993-03-26, The President's News Conference With Chancellor Helmut Kohl of Germany

1993-04-01, Remarks to the American Society of Newspaper Editors in Annapolis

1993-07-26, Remarks to the Conference on the Future of the American Workplace in Chicago, Illinois

1993-09-22, Address to a Joint Session of the Congress on Health Care Reform

1993-09-27, Remarks to the 48th Session of the United Nations General Assembly in New York

1993-11-20, The President's Radio Address

1993-12-15, The President's News Conference

1994-07-07, Address to the Polish Parliament in Warsaw

1994-09-28, Partnership for Economic Progress: Joint Statement on Principles and Objectives for the Development of Trade, Economic Cooperation, and Investment

1997-10-24, National Consumers Week

1995-01-24, Address Before a Joint Session of the Congress on the State of the Union

1995-07-08, The President's Radio Address

1995-07-15, The President's Radio Address July

1996-01-23, Address Before a Joint Session of the Congress on the State of the Union

1996-08-05, Remarks on International Security Issues at George Washington University

1997-01-20, Inaugural Address

1997-02-04, Address Before a Joint Session of the Congress on the State of the Union

1997-02-24, Statement Announcing the Fast Track Legislation Team

1997-09-22, Remarks to the 52nd Session of the United Nations General Assembly in New York

1997-11-08, The President's Radio Address

1998-05-18, Remarks at the World Trade Organization in Geneva, Switzerland

1998-01-27, Address Before a Joint Session of the Congress on the State of the Union

1999-06-12, Commencement Address at the University of Chicago in Chicago, Illinois

2000-01-27, Address Before a Joint Session of the Congress on the State of the Union
## George W. Bush

2001-06-15, Address at Warsaw University

2001-07-01, Remarks at the World Bank

2001-03-26, Remarks to the Community in Billings

2002-01-29, Address Before a Joint Session of the Congress on the State of the Union

2002-05-14, Remarks on Signing the Enhanced Border Security and Visa Entry Reform Act of 2002

2002-09-26, Remarks at the Corporate Fraud Conference

2003-01-28, Address Before a Joint Session of the Congress on the State of the Union

2003-05-09, Commencement Address at the University of South Carolina in Columbia, South Carolina

2003-05-21, Commencement Address at the United States Coast Guard Academy in New London, Connecticut

2003-11-11, Remarks at the Heritage Foundation President's Club Luncheon

2004-01-20, Address Before a Joint Session of the Congress on the State of the Union

2005-09-14, Remarks to the Plenary Session of the United Nations General Assembly in New York City

2005-02-21, Remarks in Brussels, Belgium,

2006-01-31, Address Before a Joint Session of the Congress on the State of the Union

2006-02-15, Remarks on Health Care in Dublin, Ohio

2006-07-21, Remarks at the Port of Miami in Miami

2006-10-13, Remarks on Signing the Security and Accountability For Every Port Act of 2006

2008-01-28, Address Before a Joint Session of the Congress on the State of the Union

2008-04-21, Remarks at a United States Chamber of Commerce Reception in New Orleans

2008-09-24, Address to the Nation on the National Economy

2008-10-10, Remarks on the National Economy

2008-11-13, Remarks to the Manhattan Institute in New York City

2008-11-14a, The President's Radio Address

2008-11-14b, Remarks at a State Dinner With Financial Markets and World Economy Summit Participants

2008-11-15, Remarks at the Summit on Financial Markets and the World Economy

## Barack Obama

2009-01-20, Inaugural Address

2009-02-10, Remarks on Economic Stabilization and a Question-and-Answer Session in Fort Myers, Florida

2009-02-24, Address Before a Joint Session of the Congress

2009-03-14, The President's Weekly Address
2009-04-03, Remarks at a Town Hall Meeting and a Question-and-Answer Session in Strasbourg

2009-04-14, Remarks on the National Economy,

2009-05-17, Commencement Address at the University of Notre Dame in South Bend, Indiana

2009-09-09, Address Before a Joint Session of the Congress on Health Care Reform

2010-01-27, Address Before a Joint Session of the Congress on the State of the Union

2010-08-09, Remarks at the University of Texas at Austin in Austin

2011-01-25, Address Before a Joint Session of the Congress on the State of the Union

2011-01-28, Remarks at the Families USA Health Action 2011 Conference,

2011-03-19, Remarks to the Brazil-United States Business Council Summit in Brasilia

2011-03-28, Address to the Nation on the Situation in Libya

2011-05-25, Remarks to the Parliament in London

2011-09-11, Remarks at “A Concert for Hope” Commemorating the 10th Anniversary of the
September 11 Terrorist Attacks

2011-11-17, Remarks to the Parliament in Canberra,

2012-01-24, Address Before a Joint Session of the Congress on the State of the Union

2012-04-10, Remarks at Florida Atlantic University in Boca Raton, Florida

2012-05-19, Camp David Declaration

2013-02-12, Address Before a Joint Session of Congress on the State of the Union,

2013-10-21, Remarks on the Patient Protection and Affordable Care Act,

2014-11-07, Statement on the 25th Anniversary of the Fall of the Berlin Wall

2015-01-20, Address Before a Joint Session of the Congress on the State of the Union

## Donald Trump

2017-01-25, Remarks at the Department of Homeland Security

2017-02-17, Remarks at the Boeing Company Manufacturing Facility in North Charleston, South Carolina

2017-02-24, Remarks at the Conservative Political Action Conference in National Harbor, Maryland

2017-02-27, Remarks to the National Governors Association

2017-02-28, Address Before a Joint Session of the Congress

2017-02-28, Address Before a Joint Session of the Congress

2017-03-10, The President's Weekly Address

2017-05-18, The President's News Conference With President Juan Manuel Santos Calderon of Colombia

2017-06-01, Remarks Announcing United States Withdrawal From the United Nations Framework Convention on Climate Change Paris Agreement

2017-06-09, Remarks by President Trump on Regulatory Relief
2017-29-04, Remarks at a "Make America Great Again" Rally in Harrisburg, Pennsylvania

2017-10-11, Remarks at the Asia-Pacific Economic Cooperation CEO Summit in Danang, Vietnam

2017-11-29, Donald Trump on Tax Reform in St. Charles, Missouri

2017-12-14, Remarks on Deregulation

2018-01-29, Remarks at a Swearing-In Ceremony for Secretary of Health and Human Services Alex M. Azar II and an Exchange With Reporters

2018-02-02, Exchange With Reporters at the United States Customs and Border Protection's National Targeting Center in Sterling, Virginia.

2018-02-23, Remarks at the Conservative Political Action Conference in Oxon Hill, Maryland.

2018-03-02, @realdonaldtrump, 05:50:34 AM.

## NOTES

1. The expression "economic machine" itself can be traced back to President Herbert Hoover who used it in the years following the crash of 1929, for instance when he expressed his hope that his economic recovery program will "further process of speeding up the economic machine" in his *Statement About Unity of Action on the Economic Recovery Program* (May 13, 1932). Source: *The American Presidency Project*, http://www.presidency.ucsb.edu/ws/index.php?pid=23085&st=economic+machine&st1

2. See for instance Clinton's 1996 Telecommunications Act PL 104-104, or his 1999 Gramm-Leach-Bliley Act PL 106-102 in the financial sector, which ultimately led to the 2008 meltdown. See also Jack Godwin (2009).

3. *The Emergency Economic Stabilization Act* of 2008 is commonly referred to as a bailout of the US financial system.

4. Besides his negative rhetoric on the government's role in the economy, President Trump has also launched a most aggressive campaign against his own government agencies such as the CIA, the FBI and the Department of Justice, and has greatly undermined the Environmental Protection Agency. This attack on the administrative state is at the core of the alt-right ideology represented by the president's senior advisor for policy Steve Miller or former White House Chief Strategist Stephen Bannon (Viala-Gaudefroy 2018).

5. It is still early regarding the assessment of Trump's deregulation. See Kessler (2017) and Jopson (2018).

## ABSTRACTS

Neoliberalism is a complex and ambiguous concept that has been consistently referred to by critics of an economic policy based, at least rhetorically, on free market and free trade in the last few decades. These two major tenets of neoliberalism have dominated the discourse of American presidents since the beginning of the 1980s. The same period has also been characterized by an increased tendency to tie these economic policies to freedom, a core value of American identity
that came to be defined primarily in economic terms. Starting with Ronald Reagan, economic freedom rather than political liberty became the measure of virtue, as the “free world” admitted more authoritarian regimes in its ranks in the name of anti-communism (Numberg 2003). The collapse of the Soviet bloc only served to bolster the vision that free market and free trade alone could bring prosperity and political freedom. This would become the dominant worldview at international institutions such as the World Bank and the IMF and would be solidified in the rhetoric of Republican and Democratic presidents alike (McNaught 2009). Drawing on the rhetorical and cognitive approaches developed by Lakoff and Johnson (1981), Chilton (2004) and Charteris-Black (2011), this paper analyses how conceptual metaphors in presidential discourse have contributed to creating a mythical vision of free trade and free market since the 1980s. The metaphors of movement, journey, nature, machine and sport resonate with the way Americans understand and experience their national identity, at the center of which are the values of freedom, competition and progress. They have turned an abstract economic philosophy into a comprehensible and sacred story at the heart of the American model. This model has been one of expansion of free markets and free trade. It has also been pervasive even in the domestic sphere, in the way a divisive issue like health care was framed through a positive market narrative. Despite policies that may have occasionally seemed to contradict the faith in the market, especially in the wake of the 2008 financial and economic meltdown, presidential discourse remained focused on free trade and free markets. This economic crisis may have triggered the first cracks in the mostly consensual view of free trade and free market in political rhetoric across the board. This article argues that much as there was a neoliberal consensus for 35 years, President Trump has been the great disrupter of neoliberal rhetoric by rejecting free trade agreements and by ignoring altogether the virtue of free market, a notion almost entirely absent from his discourse. He has replaced the neoliberal doxa with a discourse centered on the trade deficit and on short-term accumulation of national wealth and power. He has embraced the virtue of national sovereignty while rejecting what he called “globalism”. He has offered an antagonistic vision of a world in which international trade is conceived as a zero-sum game. This new vision is reflected in the metaphors used by a president who has challenged the norms of presidential rhetoric at many levels.

Le néolibéralisme est un concept complexe et ambigu, auquel se sont constamment référés, au cours des dernières décennies, les critiques d'une politique économique promouvant, sur le plan rhétorique au moins, le marché et le libre-échange. Ces deux principes majeurs du néolibéralisme ont dominé le discours des présidents américains depuis les années 80. Cette même période a vu une tendance croissante à associer les politiques économiques à la liberté, une valeur au cœur de l'identité américaine qui a été finalement définie en termes économiques. C'est notamment avec Ronald Reagan que la liberté économique plutôt que la liberté politique est devenue systématiquement la mesure de la vertu. Ceci alors que le « monde libre » acceptait des régimes autoritaires dans ses rangs au nom de l'anticommunisme (Numberg 2003). L'effondrement du bloc soviétique n'a fait que renforcer l'idée que, seuls, le marché et le libre échange pouvaient conduire à la prospérité et à la liberté politique. Ce qui deviendra le point de vue dominant d'institutions internationales comme la Banque mondiale ou le FMI et allait davantage s'ancrer dans la rhétorique des présidents aussi bien républicains que démocrates (McNaught 2009). Cet article s'appuie sur l'approche cognitive développée par Lakoff et Johnson (1981), Chilton (2004) ainsi que Charteris-Black (2011). Il propose d'analyser comment, dans les discours présidentiels, les métaphores conceptuelles ont contribué à la création d'une vision mythifiée du libre-échange et du marché construite depuis le début des années 80. Ces métaphores du mouvement, du voyage, de la nature, de la machine et du sport font écho à la façon dont les Américains conçoivent et expérimentent leur identité nationale fondée sur les valeurs de liberté, de compétition et de progrès. Elles ont permis de transformer une philosophie économique abstraite