Our paper (with Frans Birrer), Constituting the “good patient“, was published in the proceedings of the 2010 conference of the International Society for the Study of Argumentation (ISSA). Also here, the question is how innovation is related to the subjectivity of the patient, as Michel Foucault would put. The Dutch Personal Healthcare Budget – receiving “cash-for-care” instead of a treatment “in kind” – is presented as a scheme that ought to enhance innovation. By getting patients to control the budget, they are expected to become rational consumers who only spend their money on innovative care providers. This way of reasoning is often criticised. However, the discussion is built up around a large number of arguments, which make up a cluster that is hard to penetrate. Effectively, criticism is often evaded in these types of debates, as we show in the paper. The question is how this relates to political accountability. With respect to the patient, we may wonder if (s)he wil really turn out to be a “good patient”:
‘Is (s)he indeed a cash-supported, rational sovereign, who constantly shuffles elations with care givers and is putting pressure to break rigid healthcare institutions? On the basis of the problems that participants in the policy discussion raised, another image of the patient-subject appears. It could also be an overburdened individual, constantly involved in unequal power relations, suspect in the eyes of government and society, and, therefore, increasingly constrained. This points at an entirely different type of subject, a “problematised subject”, so to say’.