# The Drivers of Technological Hegemony: French Welfare Computerization and the Politics of Technology

Maud Barret Bertelloni

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# The Drivers of Technological Hegemony: French Welfare Computerization and the Politics of Technology

Maud Barret Bertelloni¹,²

¹ COSTECH, Université de technologie de Compiègne, ²médialab, Sciences Po
maud.barret@sciencespo.fr

## Abstract

Since Langdon Winner sparked debate on the politics of artefacts (1980), authors in philosophy of technology have regarded politics as intrinsic properties of artefacts, examined as standalone objects, endowed with agency (Verbeek, 2006; Latour, 2007; Marres, 2012).

The history of French welfare computerization during a period of contentious reform (1963-1979) and the imposition of a specific, “medium” configuration, centralizing information processing and institutional decision-making power, offers a sociohistorical case study to critically reconceptualize the politics of technology.

Through empirically informed philosophical inquiry, this article examines the constitution of a form of “technological hegemony” (Feenberg, 1999), discusses the notion’s relevance and limits, and advances an understanding of politics as extrinsic properties of technology arising from its encounter with its institutional context. It further redefines the correlative notion of technological democracy as the capacity of minority actors to effectively engage in institutional development, deployment and use of technology, reopening foreclosed technological possibilities.
In 1969, when the French Social Security system launched its first Computerization Plan, no coherent doctrine existed regarding the potential of computers for welfare. No single understanding of computers existed either, as they were just beginning to be appropriated by bureaucracy as a "revolutionary" technology (Neumann 2013). Local welfare agencies, the *caisses*, their national counterpart, the *caisse nationale*, its supervising ministries, as well as trade unions and employers' unions involved in the management of the *Sécurité sociale* all agreed that computers were necessary to improve welfare provision. However, they developed diverging positions regarding their potential and their role in the institution.

The technological conflict that ensued unfolded in a context of major institutional turbulence. Two years prior to the computerization plan, in 1967, Georges Pompidou's government initiated a major reform, aimed at centralizing welfare institutions under state control, dismantling the decentralized model of workers' self-management that governed the institution since its birth in 1945 (Valat 2001). In this context, the debate over the potential of computers became entangled with institutional conflict, both as an end and a means for all actors involved in its management to secure control over the institution. Within just a few years, the early computers deployed by the *caisses* were replaced by a national, centralized configuration under the control of the *Caisse nationale* and its supervising ministries. How was this techno-political configuration imposed? And what were its implications?

Engaging with empirically informed philosophical inquiry, this article builds on a socio-historical account of the computerization of the French healthcare fund, the *Caisse Nationale d'Assurance Maladie* (CNAM) to examine the relations between politics and technology. It seeks to develop a processual account of the levers through which a given technology can be shaped and imposed according to the interests of social actors, and the way in which, in turn, it can sustain power relations amongst them.

Following Langdon Winner's seminal article on the politics of artefacts (1980), various authors in philosophy of technology have engaged with the question of the politics of technology. They elaborated competing accounts regarding the political determination
of artefacts through conception, usage or public participation (Verbeek 2006; Davis 2020; Marres 2012). These approaches, however, tend to focus on single artefacts and the way they embody values and norms, or elicit action. Also responding to Winner, several authors in science and technology studies (STS) elaborated fine-grained accounts of the relationship between artefacts and their political implications, focusing on the "social shaping" of artefacts or the way in which they "script" action across their milieu (Joerges 1999; Akrich 1987; Bijker et al. 1987). Although finely empirically grounded, they tend to regard artefacts as the result of social and institutional relations, at the risk of overlooking their "agency" in the conflictual processes associated with the development of technology.

Drawing on these approaches, my inquiry focuses on a case of heavily contested technological choice – welfare computerization in France – as a site for examining the entanglement of institutional and technological conflicts, the resulting constraints on technological development, and their institutional consequences. Building on Canadian philosopher Andrew Feenberg's critical theory of technology, and his notion of "technological hegemony" (Feenberg 1999), I describe how a specific vision of computerization was imposed as part of a greater institutional conflict within the healthcare branch (CNAM), and how its subsequent naturalization constrained later technological and managerial choices within the institution.

Relying on archival documents collected by Christian Prieur, who served as the head of the CNAM from 1968 to 1979, this article sheds light on the efforts of ministries, trade unions and employer's unions to impose their vision of computers for the *Sécurité sociale's* healthcare branch. Although these archival materials, preserved at the French National Archives (boxes 20080146/6-20080146-8), illustrate a history viewed "from above", at the level of the leadership of the CNAM, they remain attentive to the plurality of voices in conflict over its computerization, striving not to erase the conflict but rather to document it¹.

Such an approach, contrary to the often pacified narratives found in sources close to the institution (see notably Vanremortere 2009; Kounowski 2002), enables us to examine the multiplicity of technological configurations that existed at the outset of the
computerization of the CNAM (1). It makes it possible to identify the levers through
which one option, the "medium configuration", was imposed amongst many others,
consolidating the *Caisse Nationale* and its supervising ministries' position in institutional
management (2). The notion of technological hegemony here allows us to describe the
way in which this tentative entanglement became naturalized over time – sustaining not
only existing power relations, but the very idea that no other "configuration" could
ever be possible in the institution (3). As we shall see, such a redefinition of the politics
of technology elicits a radical reconceptualization of technological democracy,
understood neither as plural participation in public debate over technological choices
(Callon et al. 2001; Latour 2004), nor as enlarged participation in technological
conception (Ehn 1989), but rather as the capacity of minority actors to effectively
engage in institutional development, deployment and use of technology, reopening
institutional possibilities and thereby enlarging the potential of technology (4).

1. The many possible computer “configurations” of the *Sécurité sociale's* healthcare branch

The deployment of computers in the *caisses primaires* of the French healthcare fund did not wait for the national Computerization Plan in 1969. Their first use in the *Sécurité sociale* can be traced around 1962-1963. By 1968, the institution already counted 51 computers in operation, including 7 for its healthcare branchii. In addition to that, the vast majority of *caisses* used computers on lease provided by contractors, who were entrusted with processing information for benefit payments and medical statistics. Thus, the stakes of the first Computerization Plan concerned not only the definition of computers for welfare, but rather the definition of the institution's information processing "configuration", at a time in which its organization was being radically reconfigured.

1.1 Computers amid turbulent institutional reform

One of the singularities of French welfare after World War Two, in comparison with its
European counterparts, concerned its management. Rather than being run by the state
at national level, as it was the case with the British system in the aftermath of the
Beveridge Report, French *Sécurité sociale* as it was instituted in 1945 relied on a plurality of local agencies, named *caisses*, to administer social benefits of all kinds<sup>iii</sup> (Valat 2001). These *caisses* were run in an autonomous fashion and their management boards were predominantly occupied by unions, which detained 2/3 of their seats. From 1945 to 1967, the *Sécurité sociale*, including the *caisses primaires* in charge of health insurance, was substantially self-managed, with unions administering a budget akin to that of the State (Da Silva and Friot 2022).

This distinctive organizational arrangement elicited significant opposition, notably from the employers' union (CNPF) and the Ministries of Social Affairs and Finance, both of which regarded it as an undesirable stronghold of worker power. By 1967, the tensions surrounding this structure culminated in the issuance of the *ordonnances*, through which the Gaullist government led by former Prime Minister Georges Pompidou sought to reassert authority over the institution and to reframe the *Sécurité sociale* "as one element among others of State social policy" (Da Silva and Friot 2022, p. 164). Despite significant opposition from trade unions, the *ordonnances* reorganized the welfare system in three main branches: healthcare, old-age and family benefits – each placed under the authority of a national body, the *Caisse Nationale*, governed by a board designed structured in such a way that trade unions lost their majority representation (Valat 2001).

In general, information-processing technology plays a critical role in welfare institutions, whose core function revolves around the collection, evaluation, and administration of data to determine and deliver welfare entitlements<sup>iv</sup>. The centrality of technology can partly explain the tensions surrounding the definition of potential and capacity of computers for the institution. In this context, however, information technology became entangled with broader questions of authority and decision-making during the period of institutional *interregnum* initiated by the reform. Compounding these tensions was the launch of the "Plan Calcul" (1966–1975), a state-led initiative to foster a domestic computer industry, which designated public administrations—including the welfare *caisses*—as its first market and testing ground (Mounier-Kuhn 1994). As a result, computing technologies, crucial to the functioning of welfare, also found themselves drawn into the heart of an emerging industrial and political conflict.
## 1.2 A plurality of understandings of computers

When the CNAM was charged in 1969 with implementing its first Computerization Plan, there was "no overarching vision for IT policy". Instead, multiple approaches emerged at the level of each *caisse primaire*, promoted by different stakeholders<sup>v</sup>. The *caisses primaires*, the *caisse nationale*, its supervising ministries, and the *Délégation à l'informatique*, a supervising body established by the *Plan Calcul*, all developed their own specific project for the computerization of the *Sécurité sociale's* healthcare branch. While trade unions advocated for computers to automate benefits provision and to simplify social legislation – without compromising the *caisse's* autonomy –, the employer's prioritized internal efficiency, cost containment and the creation of new markets for the emerging French technology industry. Meanwhile, the CNAM and its supervising ministries viewed computerization as a tool to increase administrative control by improving case processing and reducing operating costs. Thus, conflict revolved not only around the intended purposes and potential of computers, but also around their potential for institutional management.

In practical terms, by the mid-1960s, a few *caisses* had begun "integrating all tasks related to benefits payment into the computer<sup>vi</sup>". The *caisses* of Paris, Grenoble and Lyon adopted an extensive view of the potential of computers and automation. The latter, after initially relying on IBM's service bureau, installed in July 1967 an IBM 360/30 to process benefit statements. By 1970, it began exploring the concept of "integrated management." The idea was to move beyond the automation of routine tasks toward the full computerization of information processing. A 1972 report highlights the uniqueness of this experiment:

> Up until then, the experience of the *caisse primaire* in Lyon (...) remained at an embryonic stage of computer usage: there was no true automation (the liquidator's task remained unchanged), and even less so any prospect of institutional management integration. (...) By developing logical analysis, [the technicians of the CPAM in Lyon] observed that a computer could
perform certain parts of the liquidator's [the worker in charge of information processing] work<sup>vii</sup>.

Figure 1 illustrates this transformation of information processing work. The system developed in Lyon corresponds to the system described in the second column and includes the integration of steps 2 to 5, condensed into one:

We can therefore see that only in the second case is information processing truly changed, meaning that only then can we truly speak of genuine computing. It would undoubtedly be better to limit the rest to being described as 'advanced invoicing,' since, with or without electronics, nothing else is really being done<sup>viii</sup>.

<figure><img src="image_3.png" /><figcaption>Figure 1. Two diagrams summarizing benefit processing operations in the healthcare branch. The right column describes the simplified steps associated with « integrated management » : welcoming the beneficiary, single-step information processing, and archival classification<sup>ix</sup>.</figcaption></figure>
In contrast with this extended understanding of computers and automation, the one retained by the CNAM appeared as rather rudimentary. It was named the “medium” configuration (“configuration moyenne”) and was not advanced from a computing perspective, since it corresponded to what would have described as “embryonic” automation by the note on the Lyon experience. Developed with the assistance of the private company STERIA, commissioned “to produce minimal processing programs,” it mainly concerned reimbursement activities. Initially tested in five centers (Évreux, Melun, Rouen, Nancy and Toulouse), it retained the “classical” information processing chain described in the left column of Figure 1 and left the organization of work virtually unchanged.

While unions were generally supportive of computing, they opposed this specific development. This understanding of computing implied definite loss of autonomy of the *caisses* when it came to equipment purchases, organization of work, and the concentration of decision-making power away from the *caisses* themselves.

## 1.3 Configurations: articulating technology and institutional management

Far from being mere “choices” of one tool over another based on well-established needs, or on pre-established technological options available on the computing market, competing visions of computers thus reflected different conceptions of their potential and use within the institution, as well as the distribution of decision-making power. Table 1 illustrates different visions of computers, their specifications, and the associated models of institutional organization. These can be understood as competing computer configurations for the CNAM, each promoted by different actors involved in its management.

<table><thead><tr><td>Actor</td><td>Computerization objectives</td><td>Technological specifications</td><td>Decision-making center over technology</td><td>Institutional distribution of power</td></tr></thead><tbody><tr><td>Caisses primaires</td><td>Improvement of information processing and benefits provision.</td><td>Various constructors and configurations, continuation of</td><td>Caisses and inter-caisse groupings</td><td>Autonomy of the caisses, groupings across caisses on a voluntary basis.</td></tr></tbody></table>
<table><caption>Table 1. Summary of possible computing configurations for the healthcare branch<sup>x,xi</sup>.</caption><tr><td></td><td></td><td>mechanographic processing.</td><td></td><td></td></tr><tr><td></td><td></td><td>Caisses of Lyon, Paris, Angers: "integrated configuration" automating information processing</td><td>Caisses and inter-caisse groupings</td><td></td></tr><tr><td>Caisse Nationale (CNAM)</td><td>Gaining management efficiency, improving benefits provision and producing medical statistics and risk evaluation.</td><td>The "medium configuration": minimal automation. 4 constructors (CII, IBM, Honeywell, Philips). National software developed by STERIA. The "recast version".</td><td>CETELICs, CNAM, commission à l'informatique and supervising ministries.</td><td>Centralized decision-making under the authority of the CNAM, "vertical" computer groupings in CETELICs.</td></tr><tr><td>Employer's Union (CNPF)</td><td>Controlling medical consumption and negotiating with medical practitioners.</td><td>Integrated configuration, then support for national models.</td><td>CETELICs, CNAM, commission à l'informatique and supervising ministries.</td><td>Centralized decision-making under the authority of the Caisse Nationale, "vertical" computer groupings in CETELICs.</td></tr><tr><td>Ministères de Tutelle et Délégation à l'informatique</td><td>Ensuring C.I.I. equipment promotion. Increasing workload while reducing management costs.</td><td>The "medium configuration" in order to promote C.I.I. equipment.</td><td>CETELICs, CNAM, commission à l'informatique and supervising ministries.</td><td>Centralized decision-making, "vertical" computer groupings in CETELICs</td></tr><tr><td>Trade unions: the Confédération Générale du Travail (CGT), Force Ouvrière (FO)</td><td>CGT: improving beneficiaries' access and work conditions, maintaining the unity of the Sécurité sociale.</td><td>Distributed treatment, grouped files</td><td>Caisses and inter-caisse groupings</td><td>« horizontal » grouping of equipment across "branches", at regional/departmental basis, to ensure the unity of the Sécurité sociale</td></tr><tr><td></td><td>FO: controlling medical practitioners and establishing health statistics to coordinate health policy at the level of each branch</td><td>Regional solution</td><td>Caisses and inter-caisse groupings</td><td>Centralized decision-making, « vertical » computer groupings in CETELICs</td></tr></table>
In computer science, the term “configuration” typically refers to the composition of a
system in terms of nature, number and essential characteristics of its constitutive
elements. Here, however, it allows for a more expansive description of the articulation
between computing, its intended institutional objectives and the corresponding
distribution of managerial authority. In our case, consulting report by the engineering
school École des Mines, invokes the term “configuration” to detail the various computer
systems operating in the healthcare branch in the late 1960s<sup>xii</sup>.

Amongst the models identified, the so-called “medium” configuration entails the
construction of a model computing system including “homogeneous software, a
standardized definition of hardware, a standard organizational chart for processing
centers, as well as all operational procedures concerning the processing centers, their
relations with the *caisses nationales*, and their administrative organization<sup>xiii</sup>”. This
specific configuration (in bold in Table 1), defended both by the *Caisse nationale* and its
supervising ministries, implied a significant centralization of decision-making power
within the French healthcare fund. In this context, the term “configuration” emphasizes
the articulation of technological and political interests. The issue at stake is not only the
definition of computerization or its technical specifications, but also the ability of certain
actors to advance a technical definition alongside a particular state of institutional
power relations. Each line in Table 1 thus reflects competing attempts to articulate
technical and institutional objectives in the definition of computerization.

## 2. A forceful transition to the “medium configuration”

By the start of 1971, although multiple configurations existed, only two competed to be
generalized at national level: the “medium configuration” and the “integrated
configuration” experimented in Lyon. Although some *caisses*, with the support of CGT
union, reclaimed their independence and the possibility to maintain autonomy in their
computing choices, the indeterminacy of the computerization policy was quickly
resolved in favor of the “medium configuration”, which centralized information
processing and decision-making power. Despite important limitations and significant
malfunctioning, it was forcefully imposed as the backbone of the institution’s “National
Plan”.
## 2.1 Experimenting with the “medium configuration”

Technologically, the “medium” configuration consisted of a national software developed by STERIA, which enabled access to the “historical files” of each beneficiary recorded on magnetic tapes, along with a query system for generating medical statistics. This system operated on a 64K central unit - either the C.I.I.’s IRIS 50, an IBM 370/135, or a Phillips 1175 - equipped with magnetic disks and readers, punch card readers, and printers<sup>xiv</sup>. Unlike the integrated configuration deployed in Lyon, it was based on a quasi-mechanographic conception of computing, oriented towards mass information processing (Neumann 2013). While it aimed to automate certain claims processing tasks (such as eligibility determination, reimbursements, statement printing for archiving), it continued to struggle with providing complete statistics on medical consumption and benefits<sup>xv</sup>.

Both industrial and political factors played into the decision to deploy this “rustic” configuration on a national scale. Following its experimentation in five *caisses* across France in 1971 (Melun, Toulouse, Évreux, Nancy, Rouen) it was extended to five more in 1972 (Limoges, Bordeaux, Nancy, Nantes, Tours) and six additional ones in 1973 (Caen, Dijon, Marseille, Metz, Troyes et Valenciennes). The *Caisse Nationale* and its supervising ministries supported it because of the lack of technicians in the *caisse primaires*<sup>xvi</sup>. Furthermore, reports indicate that proponents of the *Plan Calcul* preferred it because computers produced by the newly founded and state-backed *Compagnie Internationale pour l'Informatique* (C.I.I.), the IRIS 80, conveniently offered the necessary processing power for a “medium system<sup>xvii</sup>”. Ultimately, this configuration also facilitated the consolidation of institutional control by centralizing technological decision-making authority.

Indeed, the medium configuration enabled the creation of CETELICs (CEntre de Traitement Electronique Inter-Caisses, or inter-caisse electronic processing centers), which involved the pooling of equipment, expertise and technical decision-making for data-entry, claims processing, etc. across *caisses* within the health branch. Designed “to keep computing within acceptable dimensions for the *caisses primaires*,” the CETELICs signaled the end of the *caisses’s* autonomy regarding information processing. Notably, the distinctive administrative status of these technological groupings granted them with
limited workers' unions representation. This shift exposed them to the influence of the
employers' union and aligned them more closely with ministerial strategies aimed at
promoting the C.I.I.<sup>xviii</sup>.

## 2.2 The levers of the imposition

The employers' unions and the ministries rallied in support of the "medium configuration". The principal lever for its promotion was the control of purchasing authorizations. By endorsing this configuration, these actors effectively established it as the only viable configuration, eliminating all other options.

Although the *caisses* formally retained some autonomy in their choice of equipment, purchasing power was distributed vertically in the institution. The local *caisses* depended on the *Caisse Nationale* which, in turn, required approval from its supervising ministries, and notably the *Commission Ministérielle à l'informatique* of the ministry of Social Affairs and the *Délégation à l'informatique* established in 1966 by the *Plan Calcul*<sup>xix</sup>. While this process was supposed to improve the *Caisse Nationale*'s bargaining position with computer manufacturers, it often generated tensions between the *caisses primaires* and the *caisse nationale*, as well with the ministries<sup>xx</sup>. In practice, purchasing authorization soon became a way for halting ongoing experiments with alternative computer configurations in the *caisses*. The best-documented example of this dynamic is the case of the *Caisse Primaire Centrale Parisienne* (CPC), which features extensively in the archives.

The CPC, responsible for processing benefits in the Paris region, was an early experimenter in automation, much like the *caisse primaire* in Lyon. In 1964, it acquired a SEA 3900 for the daily processing of payment orders and transfers, and a Bull Gamma 30 for managing in-kind benefits. In 1965, the CPC requested to implement an automated processing system using a UNIVAC 1108 computer. Although the CNAM approved the proposed leasing arrangement, it was rejected by the *Délégation à l'informatique*. Subsequent negotiations led to the development of an entirely new configuration the following year.
The revised configuration involved retaining the old SEA 3900 computers, leasing two
Burroughs computers, and, most notably, establishing a research contract between the
CPC and C.I.I. to explore the "complete integration of claims processing on a C.I.I. 10070
computer, scheduled for delivery in May 1970<sup>xxi</sup>". Trade unions publicly denounced the
industrial interests influencing the decision, claiming that "the C.I.I. 10070 computer
was not offered based on the characteristics defined to address the CPC's problems but
because, at the time of this contract, it was the only computer in C.I.I.'s catalog that could
potentially meet its needs<sup>xxii</sup>". In other words, the new configuration not only required
the *caisse* to change its equipment but also to plan for an additional transition one or
two years later to a C.I.I. computer which was not yet ready for deployment. This came
at the cost of three successive transfers of processing programs across different
hardware systems, with substantial expenses related to equipment and training.

Despite its impracticality, and despite the opposition from the CPC, the *Délégation à l'informatique* ultimately imposed the adoption of the "medium configuration<sup>xxiii</sup>". This top-down enforcement, driven by political and industrial considerations, can be understood as the administrative equivalent of the use of force. In this instance, the resolution of technological indeterminacy - what constructivist STS scholars would refer to as technological "closure" or "stabilization" (Bijker et al. 1987) - occurred not through consensus, functionality, or negotiation, but through the forceful imposition of a configuration over all others. This came at the expense of pursuing a policy that was not only inefficient but also inconsistent, both in terms of organization and allocation of financial resources. Its success, however, proved to be short-lived and the resistance it provoked at the level of the *caisses* underscores the peremptory character of the decision.

## 2.3 Resistance to the imposition of the "medium configuration"

Compared to the computing configurations developed by certain *caisses primaires*, the national rollout of the "medium configuration" was largely unsuccessful. Its deployment led to significant dysfunction in *caisses* that had already implemented autonomous computing systems. By 1973, initial evaluations revealed that although the system had begun to operate, it failed to meet expectations. Despite substantial investments in its
deployment, only 1.6% of claims were automated in *caisses* equipped with the STERIA packages by the end of 1973, compared to 28% in those using programs developed with the computing systems of Paris, Angers, and Lyon. Due both to its malfunctioning and to the abrupt changes it imposed in the *caisses*, computerization came to be widely perceived as “traumatizing<sup>xxiv</sup>”.

In the *caisse* of Le Mans, integration into the national system extended reimbursement times to nearly six weeks, requiring mandatory overtime for workers, while the addition of temporary workers failed to resolve the issue<sup>xxv</sup>. In Limoges, where an IRIS 10 computer had been operating for five years, the transition to the "medium configuration" caused delays in reimbursements and resulted in queues lasting several hours at the counters, drawing the attention of the press<sup>xxvi</sup>. Concerned about institutional credibility, unions such as *Force Ouvrière* (FO) chose to speak out publicly, denouncing the heavy-handed implementation of a policy imposed by the supervisory ministries, favoring the C.I.I., at the expense of any other broader consideration for the effective functioning of the *Sécurité sociale*<sup>xxvii</sup>.

The abruptness of the changes experienced by the workers of the Social Security offices is highlighted by the union documents and press clippings collected by director Christian Prieur in his archive. One article reporting on the delays in Limoges links the "brutal" implementation of the Plan to a deterioration in working conditions:

> One might also worry to see a wonderful tool designed to simplify the work and assist men in their tasks, achieving exactly the opposite result: a delay like we've never known... and a degradation of the work. Writing all day long on pale-colored cards, entering numbers strictly according to a standard - neither too far right nor too far left, in their little box with no other responsibility or interest - makes you doubt the quality of life<sup>xxviii</sup>.

This criticism highlights the difficulties inherent to the forceful implementation of the medium configuration – particularly its impact on workers’ conditions. As discussion commenced in 1974 regarding the second Computerization Plan, despite the dysfunctions and mounting controversy, the policy was meant to continue, albeit with
slight adjustments. However, the national system proved fragile: the death of Prime
Minister Georges Pompidou and the abandonment of the *Plan Calcul* were enough to
disrupt the trajectory of the National Plan's "medium configuration".

2.4 The reversal of 1974: the recast version

The accession to power of liberal candidate Valéry Giscard d'Estaing in 1974 marked the end of political backing for the C.I.I., which was sold the following year to Honeywell-Bull. The *Plan Calcul* was not renewed. Archival records indicate that this moment coincides with a reversal in computer policy doctrine at the CNAM. On February 10, 1975, the Minister of Finance unilaterally suspended the authorization for any new purchase or lease of information processing and entry equipment. Additionally, he entrusted a private company, CAP SOGETI, with the decision to either continue or halt the second Computerization Plan. As a result, years of discussion and negotiation regarding the national plan were left unresolved.

CAP SOGETI then conducted an audit that criticized the limited results of the first Computerization Plan. The report described the computerization process as "stumbling" due to the "rustic" configuration chosen and underscored the absurdity of a contradictory and inefficient equipment policy. Instead, it promoted promoted the type of automated system developed in Lyon, a model grounded in a vision of computing oriented towards the analysis of complex systems and management control, which had previously been systematically opposed by the *caisse nationale*. From this point onward, a new configuration, called the "Recast Version" - recast because it combined elements of the "National Plan" with aspects of the Lyon experiment - began to be developed at the national level and imposed on all the *caisses*. This shift marked both the culmination of centralization of the Computerization Plan and the definitive end of any further local experimentation within the institution.

Initially, the CNAM resisted this new version, arguing that "it would be much easier to
evolve the existing system than to replace it with another^xxix^". However, lacking better
alternatives and qualified technicians, it was soon forced to comply. Unlike the previous
attempt, this version resulted in a definitive "closure" of CNAM's computer
configuration. As we have seen, this was not a happy compromise resulting from an
agreement between the parties, but rather a decision imposed by the ministry in its full
verticality. Unlike the "medium" configuration, this new one functioned well, which
contributed to sediment it as the dominant configuration in the institution.

This case highlights the forceful levers behind technological “closure” of welfare
computerization in France. The imposition of a centralized configuration was achieved
at the expense of the *caisses* and their workers, by authoritative administrative means.
However, it also suggests that dominance alone is not sufficient for technological
closure: a configuration must also function effectively, progressively displacing
competing alternatives, and emerging as the only viable option. If power traditionally
consists of two components - coercion and consent - then the process of defining
computing at the CNAM during his period leaned heavily on the former. The attempt to
impose the “medium configuration”, along with the resistance it provoked, frames this
conflict as a power struggle, weighing the actions taken and resources deployed to
enforce and maintain each position. However, once the “recast version” was finalized,
power shed its coercive dimension and came instead to rest on consent.

3. The national configuration naturalized: technical hegemony
   as the consensual face of power

Despite difficulties in getting teams to collaborate on a national scale, the “scaling up” of
the “recast version” was successful, and the *Commission à l'informatique* already praised
it in 1977xxx. By 1979, the automation rate for benefit processing reached 90%xxx. The
smooth functioning of this new version, unlike the previous one, helped to stabilize the
dominance of such a centralized configuration, under the leadership of the CNAM.

3.1 The recast version: from force to consent

Unlike its predecessor, this “recast” version adopted a systematic view of computers,
conceived as components of an information system characterized by “the consideration
of information as the primary wealth in a global but static vision of the institution”
(Folliet 2001). It also embodied an imaginary of integrated management promoted by
the computing industry, wherein the institution is envisioned as a unified, manageable
entity whose components can be subjected to a centralized control. This conception
contributed to the naturalization of centralized computing at national level. Once this
“recast” version was consolidated, even CETELICs came to be regarded merely as sites
for implementing national software.

By the late 1970s, all alternative computing configurations had been eliminated in the
institution and the enhanced performance of the “recast version” contributed to its
acceptance. One could argue that this centralized, integrated configuration began to
function as a standard: the system’s efficiency, feeding back into its operational context,
validated it as a good technical option and established it as the default choice. This
conception influenced subsequent computing choices, which continued to evolve
towards further centralization. This trajectory culminated in 1980 with the introduction
of the “unique model” known as LASER: a fully centralized, increasingly integrated
production system managed by the *Caisse Nationale*.

The gradual naturalization of this configuration is evident in the evolving positions of
labor unions. While all unions initially opposed the “National Plan” in 1974, *Force
Ouvrière* began to stand behind the promises of LASER just a few years later, praising
“its clear coherence with the future developments of the national system<sup>xxxii</sup>”. This shift
reflects the emergence of a consensus around a centralized model of computing for
welfare and signals the decline of alternative conceptions that *caisses* and unions had
defended for over a decade. Although the CGT union continued to resist the shift, this
centralized configuration came to be naturalized and, through its operation, provided
material validation for the institution’s centralization. This mutually reinforcing
dynamic between technological arrangements and institutional relations reflects the
consolidation of what philosopher Andrew Feenberg terms “technological hegemony”.
## 3.2 Technological hegemony

According to Feenberg, technological hegemony designates “the way in which the concrete functioning of technology participates in the distribution and maintenance of power in a given context.” (Feenberg 1999) In the history of the CNAM, the imposition of the centralized configuration weaves together technological development and institutional relations: the selection of one option over others advances specific conceptions of computing as much as it secures institutional positions for its proponents, which came to be accepted and naturalized.

For Feenberg, technological hegemony operates at two distinct, yet intertwined levels. It occurs at the level of technological “design”, as dominant designs come to be naturalized and understood as a neutral, as well as at ontological level, when a given mode of appearance of technology solidifies the very conception of what technology is, what it can do in the world (Feenberg 2023). The first aspect is easily identifiable in the case of the CNAM’s computerization, in which the medium configuration and its recast version eliminated all other existing, small-scale, decentralized understandings of computing. This dominant version additionally upheld a conception of computing as a unified task, subjected to centralized control, incompatible with local *caisses’* autonomy and initiative, and impenetrable to the intervention of *Sécurité sociale* workers. In just about ten years, it came to be seen as the only viable conception of computing in French welfare institutions.

In contrast with the accounts of the politics of technology offered by STS, which emphasize the multiple, conflicting forces presiding to the *shaping* of artefacts (Bijker et al. 1987; Joerges 1999; Akrich 1987), Feenberg’s approach situates technological reflection within a broader critical theory of technology. The notion of technological hegemony functions as a critical concept to denaturalize a given state of technological development and to examine how technological functioning sustains and entrenches the values and positions of its proponents, as part of broader power and class dynamics at play.
3.3 The agency of the configuration

For Feenberg, hegemony is a close conceptual relative of the idea of reification : it
implies the fact that a given orientation in technological development comes to "be
maintained by a sheen of neutrality that ensures it comes to appear as necessary",
influencing further technological development (Kirkpatrick 2020:70). Without resorting
to the neo-materialist notion of "agency" – which Feenberg criticizes in *Questioning
technology* (1999) – technology can be seen to offer a seemingly neutral "material
validation" to a given political horizon. Technological designs, once stabilized, "invisibly
sediment values and interests (...) that routinize the pursuit of power and advantage by
dominant hegemony (sic)" (Feenberg 1995:14).

In a way, the notion can be likened to that of technological “lock in”, according to which
specific technologies and technological systems follow constrained paths in their
development, which are costly to escape (Perkins 2003). Unlike “lock in” or path
dependency, however, the forces that constrain technological development can be
ascribed to a complex and conflictual power struggle, rather than mere economic or
cognitive constraints. A similar idea can be found in Nick Srniček and Alex Williams’
*Accelerationist Manifesto*, as they invoke the possibility to reappropriate technology and
to institute a “left-wing socio-technical hegemony” (Srnicek and Williams 2017).
Interrogated on the notion, Srniček explained that:

Traditionally, the study of hegemony focuses on its social and discursive
aspects within the system, on ideology, and on all the incentive systems
that convince people to remain loyal to an existing social system. The
sociotechnical aspect of hegemony, by contrast, concerns its material and
technical dimension, the way in which infrastructures, tools, and
technologies construct a social order around us. To give a very simple
example: the individual family home builds the nuclear family unit by
naturalizing it. It divides people into small single-family homes, effectively
separating them into nuclear households. xxxiii

In this regard, technological hegemony can be understood as a way to perpetuate power
relations by other, technological, more consensual means. This interpretation is close to
Gramsci's understanding of hegemony, for whom it designates the "predominance obtained by consent rather than force of one class or group over other classes" (Femia 2010:24). Here, technological hegemony refers to the materiality of power, how technology sustains social relations in its own distinctive manner, according to its specific technological and material properties.

While Feenberg and some of his commentators have insisted on how artefacts "embody" and "perpetuate" "values", "norms" or "interests" (see Flanagin et al. 2010; Kirkpatrick 2020), it should be recalled that a Gramscian understanding of hegemony primarily concerns social relations across classes and within the dominant class. As a strategic notion anchored in the political sphere, it is less concerned with the realm of values and their critique than with social and class relations in the conquest of power. Importantly, such a reading allows us to redefine the politics of technology not as intrinsic properties of artefacts, but rather as a relational, emergent properties deriving from the interaction between technological development and its institutional context, traversed by its own social dynamics.

In the case of the CNAM's computerization, the focal point of conflict only partly concerned the definition of potential and capacity of computers for the institution. Computerization unfolded amid a contentious reform aimed at centralizing welfare institutions under state control and dismantling the decentralized model of workers' self-management in place since 1945. The struggle surrounding the choice of "configurations", which the notion of technological hegemony helps us describe and analyze, unfolded as much around control over information processing as around managerial authority within the institution. As the CNAM's centralized "recast version" was imposed and began to operate, it became increasingly difficult to reverse to – or to even envision – an alternative division of institutional power other than a centralized one.

In the following years, the institution's information system evolved towards a fully integrated and centralized configuration. As a result, decentralized decision-making at the caisse level gradually vanished from institutional discourse, along with ideals of workers' self-management. This transformation significantly constrained the capacity of
opponents to the “recast version” – particularly trade unions – to devise and pursue
alternative technological configurations.

4. New perspectives for technological democracy

Very much like for Gramsci, for whom hegemony is not just a tool of historical and
political analysis, but a guiding concept for political practice and strategy, Feenberg’s
reflections are grounded in the perspective of emancipatory technological
transformation. This understanding distinguishes him from many other thinkers in line
with the tradition of the Frankfurt school: technology, for Feenberg, must be understood
as an essential site of politics – if not its privileged site - and can be opened to the
realization of human potential by popular intervention in technology design (Feenberg
1999).

This view resonates with trade unions' appeals throughout the 1970s to democratize technological design in the *Sécurité sociale*. The CGT union, for instance, advocated in favor more “democratic” conceptions of technology in the institution, developed in a more inclusive fashion. In 1975, the union published its plan “Towards a Social Computing System at the Service of a Democratic Management of *Sécurité sociale*”, which proposed to redesign the computer system “at the service of the user”, with workers in the *caisses* “capable of identifying problems, imagining solutions, and testing them<sup>xxxiv</sup>”. While this proposal challenged the established consensus around the National Plan, its recommendations stood in stark contrast to its authors' ability to implement them, shedding a new light on the constraints of technological democracy.

4.1 Radical technological democracy

Over the years, political-philosophical reflection on the role of technology has
elaborated multiple readings technological democracy, generally understood as the
possibility for participation of a technology's "publics" to deliberative processes
concerning technology design, usage, or experimentation (see notably Callon,
Lascoumes, and Barthe 2001; Latour 2004; Marres 2012). Contrary to these approaches,
often grounded in a liberal understanding of politics, oblivious of conflict and power,
Feenberg predicates his conception of technological democracy on a more radical understanding of politics and democracy.

For Feenberg, technological democracy consists in the “possibility for individuals directly involved in technologized activities to actualize the potentialities excluded by existing technical rationality” (Kirkpatrick 2020:79). If radical democracy, as described by its theorists Laclau and Mouffe, consists in the permanent struggle to challenge prevailing conceptions of what gets to be included in politics and what gets to count as possible or realistic, radical technological democracy refers to the capacity to reopen technological possibilities and horizons constrained by technological hegemony, by challenging the *status quo* and by including those subjected to power in the active shaping of technology. That is, in our case, minority voices involved in the shaping of computerization of the CNAM, such as its workers, as well as its beneficiaries.

Although this democratic intervention primarily occurs at the level of technology design, Feenberg’s hope is that subsequent transformations will challenge establish hegemony and occasion an ontological transformation, giving rise to a novel and more progressive understanding of what technology *is* and of what purposes it can serve - bringing technology “more in line with society’s needs and interests” (Kirkpatrick:84). This hopeful propounding, however, stands in stark contrast to the history of the CNAM’s computerization, which highlights the practical impediments encountered by technological democracy.

## 4.2 Union's plans "Towards a Social Computing System"

In 1975, the CGT published its plan “Towards a Social Computing System”, a document that summarized years of efforts to influence the trajectory of computerization at the CNAM. As the predominant union within the *Sécurité sociale*, the CGT had been actively involved in all early computing initiatives and its power was significantly diminished by the 1967 reform. The document thus served both an exercise of critique and as a proposal to restore workers’ power over computing – and over the institution. It traced the contentious history of computerization, emphasizing that “computers impose neither a greater centralization of structures nor a greater decentralization a priori; they
enable both, depending on the political choices made by the responsible authorities<sup>xxxv</sup>. The union condemned the "control over computing, as well as the management of the *Sécurité sociale*, placed in the hands of the CNPF (the National Council of French Employers) and the Government." This, it argued, resulted in the "gradual elimination of the autonomy of the [...] *caisses* under the pretext that the standardization of procedures is an imperative due to computing itself.<sup>xxxvi</sup>

In addition to critical analysis, the CGT put forward an alternative computerization plan, as part of a new and "comprehensive political project" for the institution. Seeking the cooperation of all interested parties, it envisioned a "highly decentralized" computing configuration in which local, multi-purpose agencies – akin to the *caisses* – would be equipped with lightweight terminals managed by a departmental IT Center (*centre informatique départemental*). These terminals would allow for online updates of files, queries, and limited printing functions. At the regional level, a dedicated center would manage regional databases and historical files, with the capacity to freely program and execute bulk processing, provided that the programs and their documentation were "presented in a standard format to the *Caisse Nationale*<sup>xxxvii</sup>". The role of the *Caisse Nationale*, in turn, would be curtailed to focus on national oversight, documentation, and the harmonization of software and interfaces when necessary. With respect to the benefit-processing software, the union advocated for a redesign of computing systems through the active involvement of different categories of staff, users and beneficiaries – a participatory approach reminiscent of the Scandinavian tradition of workplace "participatory invention" (Ehn 1989) and aligned with participatory design principles later promoted by Feenberg.

## 4.3 Material and institutional components of technological democracy

Although the CGT's plan kept alternative conceptions concerning the use of computers in the institution alive, it failed to translate them into technological design. This failure calls attention to the significance of the role of broader institutional power relations for technological democracy.
The CGT's hope "that another [computer] policy is possible" occurred at a time when the union had lost any prospect of holding a majority in the institution's boards. Moreover, as we have seen, the decision-making centers regarding information technology had gradually been removed from the *caisses* and transferred to the CETELICs, more permeable to the influence of supervising ministries and of the employers' union. Within the *caisses*, the progressive disqualification of management and IT functions reduced the staff to an execution role for the national program. Consequently, the criticism and alternative computing proposals confronted the stark reality of lacking institutional levers, which increasingly marginalized unions and workers from technology design and decision-making.

Significantly, the CGT itself conditioned the realization of its alternative computerization proposal to the electoral success of alliance of the communist and the socialist parties. If the Common Front of the Left came to power, computing at the *Sécurité sociale* could be "freed from the constraints that currently paralyze its development. The managing organizations [would] have the freedom to choose hardware; the responsibility for initiatives, program design, and the role of national organizations in this area will change profoundlyxxxviii". Pending more favorable institutional circumstances, the prospect of democratic computing remained a possibility to preserve. However, lacking capacity to effectively influence technological design, counterproposals failed to challenge the hegemonic centralized configurations, and to open avenues for transforming both information processing and managerial relations in the institution.

Despite left-wing candidate François Mitterrand's rise to power in 1981, the *ordonnances* were not abolished. Aside from the brief reintroduction of elections for the boards of directors, which had been suppressed by the 1967 reform, the institutional reorganization of French welfare remained unchallenged. In the realm of computing, the established consensus was never subsequently contested, and the centralization of the decision-making on this matter was further reinforced when the "recast version" was replaced by the "unique model", LASER, managed by the CNAM from its Paris headquarters. Today, the system is entirely managed by the *Caisse Nationale's* Information Systems Direction, which operates its national platform. The history of the imposition and the contestation of the CNAM's computerization serves as reminder that,
although they may now seem inevitable, both computing and institutional management
might have evolved along alternative trajectories.

Conclusion: towards an empirically informed political philosophy
of technology

Despite its unfavorable outcome, this history attests to the existence - both historical
and potential - of an alternative technological path for computing in the *Sécurité sociale*.
The early computerization of the *caisses* in the 1960s, carried out at the level of each
caisse under the directives of workers' representatives, as well as later union programs
such as "For a Social Computing System," establish the perspective of alternative
approaches to computing. In contrast to the configuration promoted by the central
administration and industry, these experiences illustrate the possibility of devising a
computing system managed as close as possible to welfare beneficiaries, its workers,
and placed at their service. More broadly, this account makes it possible to examine the
drivers behind the constitution of technological hegemony in French welfare,
iluminating the interplay between the political shaping of technology and its
consequences on institutional power relations, in light of Andrew Feenberg's critical
theory of technology.

Constructivist STS have extensively shown that the social shaping of artefacts is the
scene of a political conflict. The notion of "configuration" emerging from the CNAM
archives, however, allows us to shift the focal point of contention from an artefact itself
to a more relational ensemble that articulates technological specifications, institutional
objectives and social relations. Contrary to most of the literature on the politics of
technology that leaves the question of "closure" of artefacts indeterminate, this case
additionally shows that the triumph of one configuration over others is indeed the result
of a power play and open confrontation between actors, but that the stabilization of such
dominance is in fact a long and gradual process which requires a given configuration to
function efficiently. Only then can a given technological configuration be naturalized,
acquiring a consensual dimension and shaping further technological evolutions, thereby
constituting a form of technological hegemony.
The notion of technological hegemony emerges from this inquiry as dual. First, hegemony represents the consensual face of technological conflict: it is achieved when conflict over technological configuration gives way to a pacified and naturalized acceptance of a particular one. Second, such a configuration perpetuates the consensual exercise of power *by technological means*, legitimizing it by virtue of efficient technological functioning and thereby curtailing alternative conceptions of technology. Technological hegemony is thus both a descriptive and a critical concept: it enables us to describe how dominant expressions of technology come to appear as seemingly immutable, while also reopening the conflictual process of their shaping. Within this critical framing, the prospect of technological democracy is to permit the cultivation and expression of currently neglected technological potentials. It is neither a deliberative nor a merely critical notion; rather, it demands effective technological transformation. Yet, as our historical case study shows, technological transformation is profoundly dependent upon broader political dynamics. Understanding the "politics" of technology as their extrinsic properties arising from interaction with its institutional context, requires that we situate technological struggles within wider social and institutional power relations, rather than at the level of individual artefacts.

This conclusion represents one of the most original contributions of this empirically grounded inquiry into the computerization of the French National Healthcare Fund (1963-1979). Although it requires further inquiry and elaboration, it marks a clear departure from philosophy of technology's prevailing "artefactual" focus, present in much reflection on the politics of technology. As this study has shown, power and politics are not intrinsic properties of an artefact but emerge from the encounter between technological development and its context of deployment and use, each marked by their own dynamics, and can be thought of as emergent properties of a technopolitical settings. In a time of growing concern around the power of technology (Crawford 2021; Posada, Miceli, and Yang 2022), this research aims to offer conceptual tools and critical perspectives for engaging with the question of the politics of technology.
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<footnote>i Reference to archival materials is provided in the endnotes. Unless otherwise mentioned, the documents are part of the « Caisse nationale d'assurance maladie : dossiers de Christian Prieur, directeur de 1967 à 1979 (1951-1979) », French National Archives (Archives Nationales), Pierrefitte-sur-Seine (inv. 20080146/6-20080146-8).</footnote>

<footnote>ii 1971. « Dépenses Informatiques des Caisses Primaires. Exercice 1971», *Informatisation des organismes 1971, 20081046/6*.</footnote>

<footnote>iii Note that this autonomy mostly concerned work management, rather than social insurance, whose orientations and rights were determined uniformly at national level.</footnote>

<footnote>iv In French, they have retained the name of *caisse*, referring to the till and the cash register used to compute and administer social benefits. Interestingly, the informational labor at the heart of each *caisse*'s functioning is internally referred to as "production", which allows to realize the institutional goal of "concretization of social rights" (Basso-Fattori 2013).</footnote>

<footnote>v CGT Secteur social. 1975. « Pour une informatique sociale au service d'une gestion démocratique de la sécurité sociale. » « Informatisation des organismes 1er semestre 1975 ». 20081046/7.</footnote>
vi 1971. « Exécution du programme général de développement de l'informatique dans les Caisses Primaires d'Assurance Maladie ». 24 March 1971. « Informatisation des organismes 1971 ». 20081046/6.

vii 1972. « Note d'information sur l'automatisation de la Caisse Primaire d'Assurance Maladie de Lyon : bilan, perspectives et enseignements au 1 October 1972. » 20081046/8.

viii *Ibid*.

ix 1972. « Note d'information sur l'automatisation de la Caisse Primaire d'Assurance Maladie de Lyon ». op. cit.

x 1973. « Note d'information sur le développement du système national de traitement des prestations de l'assurance maladie » 4 July 1973. 20080146/6.

xi CGT Secteur Social. 1973. « Informatique à la Sécurité sociale ». 20080146/6.

xii École des Mines. 1973. « Développement de l'automatisation à la CPCAMRP : Mesures préparatoires à l'implantation d'un ordinateur du plan calcul français en 1975 ». 1973. « Informatisation des organismes 1973 ». 20081046/6.

xiii Exécution du programme général de développement de l'informatique dans les Caisses Primaires d'Assurance Maladie, 1971. Op. cit.

xiv 1973. « Compte rendu de la réunion de la commission ministérielle de l'informatique du 19 juin 1973 ». 19 June 1973. « Informatisation des organismes 1973 ». 20081046/6.

xv École des Mines, op. cit. p. 36.

xvi « Compte rendu de la réunion de la commission ministérielle de l'informatique ». op. cit.

xvii École des Mines. op. cit.

xviii 1971. « CETELIC : Arrêté du 23 August 1971 ». 20081046/6.

xix 1973. Letter of the 8th of August 1973 from Christian Prieur to the directors of the *caisses*. 8 August 1973. 20081046/6.

xx 1973. Letter of the 6th of September by M. Piketty (Vice-Président CNAMTS) to Minister Poniatowski. 6 September 1973.

xxi 1973. « Rapport sur la situation du programme d'automatisation de la Caisse Primaire de la Région Parisienne » 1973. 20081046/6.

xxii CGT Secteur Social, 1975. op. cit.

xxiii 1973. « Rapport sur la situation du programme d'automatisation de la Caisse Primaire de la Région Parisienne », op. cit.

xxiv 1973. « Note d'information sur le Développement du Système National de traitement des prestations de l'assurance maladie. » 4 July 1973. 20081046/6.

xxv 1974. Press cutting. « 82000 dossiers sociaux à la traine : l'électronique en cause ou symptôme d'un malaise qui dure... ? » « Informatisation des organismes 1974 ». 20081046/7.

xxvi 1974. Press cutting. Coupure de presse. « 30,000 dossiers en retard à la Caisse maladie de la Sécurité sociale de Limoges. Un nouvel ordinateur en accusation. » 1974 « Informatisation des organismes 1974 » 20081046/7.

xxvii Force Ouvrière. 1974. « Informatique et Sécurité sociale ». 1974. « Informatisation des organismes 1974 ». 20081046/6.

xxviii « 30,000 dossiers en retard à la Caisse maladie de la Sécurité sociale de Limoges », op. cit.

xxix Correspondence between Christian Prieur and the *Cour des Comptes* regarding the deployment of the « Version refondue » (the recast version) in Nantes. « Informatisation des organismes 1979 ». 20081046/7.

xxx 1977. « Commission Ministérielle de l'Informatique 17/11/1977 : Bilan informatique à moyen terme de la CNAM ». 17 November 1977. 20080146/8.

xxxI 1979. Letter from M. Derlin to M. Prieur. « Version refondue du système national d'automatisation des C.P.A.M. 1979 ». 23 May 1979. 20081046/8.

xxxii R. Picard. 1977. « L'informatique de demain », *Les faits du mois FO*, n°182. 1977. 20081046/8.

xxxiii Maud Barret Bertelloni, "On peut imaginer un agenda radical en matière de nouvelles technologies. Entretien avec Nick Srniček", *AOC Media*, 14/07/2023.

xxxiv 1975. CGT Secteur Social, op. cit.

xxxv 1975. CGT Secteur Social, op. cit. p. 32.

xxxvi *Ibid*.

xxxvii *Ibid*. p. 35.

xxxviii *Ibid*. p. 33.