What does this have to do with "government's bloated and inefficient bureaucracy"? The only government failure I see in this story is that they allowed the sale of the small company to the big one, or that they allowed the big company to get out of the contract.

If the government had done it in house they could have succeeded.

The problem here was the profit motive. Cheep ventilators endanger profits.

It is a side effect of free markets (I like free markets) that big firms get bigger, get more market power, kill off competition then price gouge. Health is a bad bad place to have free markets as the incentives are almost all wrong (exceptions: E.g. running clinics as a service for state run health systems turns out to work well here in Aotearoa - but even that is under pressure from consolidation)

Nationalise the whole ball of wax. Use waiting lists not wealth to ration access. FFS the richest country in the world is heading to a health catastrophe. What a bunch of idiots!

Ok, so how do we get the government to do it in house, and stick to it long enough so that the stockpile is there when the next disease crisis happens, which might not be for another 10 years? That's five Congressional elections and at least two changes of Presidential administration.

Ok, so your plan for solving the ventilator issue is to change the entire system of government. Good luck with that.

The civil servants work on what Congress and the President set as priorities. They cannot execute plans that span multiple Congresses and Presidential administrations unless every single Congress and Administration over that time period agrees to support the plan.

They built a horrifying arsenal.

I really do not see why they cannot build a health system. They have done so here.

Yes, because three successive Presidential administrations and six successive Congresses supported it.

More precisely, two successive administrations and about four successive Congresses supported it. The third administration began to back off, as did the fifth Congress; then the sixth Congress, along with the administration, stopped supporting it--and the moon missions stopped. Despite the fact that a large number of civil servants were making cogent arguments for why they should continue.

> They built a horrifying arsenal.

Yes, because every President and every Congress since 1945 has supported it.

Ok, so how do we keep the government from being corrupted? Nobody has yet solved that problem, and people have been trying for centuries.

> Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking.

The money supply is not the same as the economy. Government spending as a percentage of GDP, which is the closest estimate we have to "the size of the economy", has been growing, not shrinking.

What? No it hasn't. It has kept pace with GDP since the end of WWII (prior to WWII it was much smaller), and the rate of GDP growth is higher than the rate of inflation. The size of government in the US has been growing continuously in real terms since before Eisenhower.

Really not even for this particular crisis. We can build more of something on a short timescale, it just costs more then. You have to build facilities you know are only going to run for six months and then be decommissioned, so you have to amortize their construction cost over half a year instead of 30 years. You have to build them on the double, which means paying a lot of overtime and buying land and raw materials without taking a lot of time to negotiate on price or worry about efficiency. But we could do it.

And then the ventilators would cost ten times more than they ordinarily do and idiots would accuse anybody trying to do this of price gouging. But it could be done. (Unless the idiots pass a law against charging more than the regular price during an emergency.)

Well, of course. That's what we're talking about, right? Somebody has to do the long-term planning for emergencies like this one.

I understand that most of us thought it was the government's job to do this long-term planning so individual facilities wouldn't have to, but this article shows that the government failed at that job. Unless we have some reason to think the government wouldn't fail next time, it seems like the only alternative is for private entities to do it.

Private entities don't have to be subject to the market. Someone like Bill Gates or Elon Musk could set up a privately owned company, not publicly traded, that would not be subject to investors' demands for consistent quarterly growth. Matter of fact, maybe that's what Bill Gates should switch his attention to from malaria.

The fact is, a private individual, or a small group of them, can have a longer time horizon than the government does, and a longer time horizon is exactly what is needed for something like this.