ABSTRACT
Along with privatization, contracting out and “new” management techniques, one of the important, but less discussed, manifestations of the way neo-liberal ideology and policies have changed social services is through the requirement that individuals pay for those services – services that were once provided free of charge. A parallel method, which should be distinguished, includes the offer of “premium” services in a given sector at a prescribed cost. In the UK, for example, over 600 individual services impose user charges
(Bailey 1994a). It is interesting to note that “social democratic” countries, such as Norway, Finland and Denmark, which have proud public services, are also those with the wider and longer experience of user charges (Emmerson and Reed 2003). As an indication of the importance of the trend, the IMF has recently offered a definition of user charges which is relatively straightforward: “payments made by consumers to providers of government services” (IMF 2007, p132). While the literature has addressed the imposition of user charges in public
sectors, in general, with some focus on utilities, this chapter addresses user charges in the field of social services, with a particular emphasis on health and education. The fact that such charges have adverse effects on equal access to services (and thus on equality in general) seems straightforward: their imposition precludes those without the necessary means from accessing the services. But it will be argued that the charges have more profound effects as well. Through these relatively small charges, the relationship between the citizen and the state is transformed. The citizen, we are told, is now the “citizen-consumer”, who “expects improved standards from public services, in line with those supplied by the private sector” (Lister 2003, p438). Replicating free market services, such charges are seen as part of an overall strategy to “roll back the frontiers of the state” (Bailey 1994a, p366). Closely related is the role and, perhaps, the nature, of the relevant rights. This
chapter focuses on the relationship between user charges and the rights to health and to education. This may be referred to in two ways. First, the relevant rights should have a role to play when assessing the legitimacy and legality of user charges. Rights, after all, are “especially sturdy objects to stand upon, a most useful sort of moral
furniture” (Feinberg 1970, p252; also Holmes and Sunstein 2000). They have the potential, at the very least, to alter the confines of the debate that would have taken place in their absence. A world without the right to freedom of speech, we assume, would be different from a world in which such a right is granted and respected. Focusing on social services in general, and on health and education in particular, we therefore need to explore what impact social rights may have on the phenomenon of user charges and/or its effects. Second, the direction of the cause and effect may also be reversed. If the nature of services changes, and the relationship between the citizen and state becomes increasingly mediated through market norms, then our understanding of rights – or at least of social rights – should be revisited. But in doing so, we need to, first, understand the origins and breadth of the
trend; to come to terms with the rationales and justifications that drive it; and to offer a tentative typology of user charges in the fields of health and education. The chapter then moves on to inquire whether the right to education and the right to health can, and should, provide the analytical and pragmatic basis for bucking this trend. The chapter concludes with an assertion that social rights’ failure to serve as safeguards in the face of increased marketization of the services has consequences not only for the services and their clients, but also for the understanding of the rights themselves.
