Rethinking the Welfare State: The prospects for ... - e-Library

Conclusion 217
whether justified or not, whereas an hourly tariff, even if limited, creates incentives to
protract matters unjustifiably, perhaps arguing for a fixed hourly tariff per class of matter
up to some capped limit, although recognizing that this will still create incentives to
attenuate effort once this limit has been reached, even though the complexity of the
matter in question may genuinely require more time and effort on the part of the supplier.
Extra billing (topping up)
With fixed-sum or capped voucher systems, the question of whether suppliers should be
permitted to “extra bill” consumers on top of the value of the voucher raises highly
problematic issues. With respect to child care and primary/secondary education, allowing
day-care centres and schools to extra bill on top of vouchers is likely to violate
distributive justice, social solidarity and equality of opportunity concerns in that it will
permit families with greater private resources to acquire a better quality of education than
families with fewer private endowments. We recognize, of course, that wealthier families
always have the option of sending their children to private schools entirely at their own
expense—an option that we would not, of course, foreclose—but to permit extra billing
may seriously exacerbate existing inequalities of educational opportunities as well as
compromising citizenship values that emphasize the importance of all children
inculcating norms of equal and effective citizenship. Hence we favour a prohibition or at
least a tax on extra billing or “top-up” payments. With respect to post-secondary
education and classroom job-training, citizenship concerns have less salience, given that
participation in post-secondary programs is not mandatory. Hence, efficiency
considerations should be given more weight by allowing institutions offering a superior
service to price it accordingly, with the price system serving as both a signal of and
reward for superior quality, leaving distributional concerns to be addressed through
income-contingent loan schemes coupled with means-tested grants. With respect to
health care services, which like primary/secondary education, can be viewed as an
essential service for all members of the population (and hence a primary good in
Rawlsian terms), extra billing poses the same threat to universal access to similar quality
essential health care services as means-tested entitlements and is quickly likely to lead to
a two-tier or multi-tier health care system in terms of quality. Thus, for essential health
care services covered by the entitlement system, we favour a prohibition or at least a tax
on extra billing, although we would not foreclose complete opt-out from the entitlement
system at the individual’s own expense. With respect to legal aid, given the means-tested
nature of the entitlement, it seems inappropriate, and largely pointless, if eligibility
criteria are designed to identify recipients lacking capacity to pay for legal services, that
lawyers providing legal aid services should be able to attempt to extra bill clients
presumptively lacking the means to be able to afford the services in the first place,
although in order to induce lawyers in private practice to provide legal aid services, legal
aid fees will need to be highly sensitive to commercial fee levels. If eligibility criteria
were more relaxed, then it may be more appropriate for legal services to be paid for, in
some cases, through a combination of vouchers and personal means of the recipient. With
respect to food stamps and rent vouchers, eligibility criteria take account of the financial
capacity of recipients in setting the value of the voucher, given prevailing market prices