It would still be bad and a failure but it would be cheaper so why not

Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you! The fact that the costs are coming from your taxes and in the form of more expensive goods and services and decreases wages due to inflation makes the costs hidden, not lower.

>Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you!

Personally, I've come to the following conclusion after dealing with the American health care system far to much in the last three years and several encounters with corporate America throughout my adult life:

There is no difference in the potential for waste, inefficiency, fraud, corruption, laziness, and outright stupidity between government and private systems. There is a difference in (1) my (and my fellow citizens) ability to influence between that two and (2) not having to pay for profit and the costs to me resulting from necessary profit on top of the rest of the shit sundae.

there's no private healthcare system in the US, except for maybe the individual mom & pop doctor's offices.

Every other player is

- getting handouts from govt (hospital non-profit statuses from all taxes incl property taxes, payouts for invented"losses"; payor premium subsidies),

- protections from competition (PBM "discounts", Pharma IP evergreening rules, hospital requirements to approve new local competitors, payor lobbying for regs to prevent "lite" plans )

- and are very much flirting with antitrust action (payor & pharmacy vertical integration, cutting off contracts of any remaining independent doctor/vendor holdouts etc).

Just think about it abstractly. Variation decreases as n count increases. Large organizations will tend to be similar. As you note most large private systems end up behaving similarly to large public systems in terms of corruption, inefficiency etc….

But notice that it’s driven by the n size. If you look across smaller systems, you’ll notice they are more diverse. Like startups. Smaller n means more variation. Occasionally a small variation or mutation will push evolution forward. Public systems are generally to large and risk averse for that sort of evolutionary adaptation. At least at present. Maybe we can make public sector more like startups by changing how tax dollars are spent, not necessarily changing the amount spent, but the way it’s spent? I don’t think we’re there yet.

As someone who has actually worked for both the US government and the private sector - this isn't true:

> There is no difference in the potential for waste, inefficiency, fraud, corruption, laziness, and outright stupidity between government and private systems.

The inefficiency that I saw in the government was far greater than that of the private sector.

To some extent, it had to be - the government has to be extremely reliable and accessible (while most companies content themselves with 99.99% website uptime, or only serving people with a mailing address, or whatever - the government has to serve everyone and be available as much as possible), and that's a good thing.

But beyond that, factors such as extreme risk aversion (which generally grows with the size of an organization), gross incompetence, and outright corruption made the government far less efficient than what I experienced in industry - to the point where it was an old-and-not-funny-anymore running joke among my government colleagues.

Moreover, the government also holds massive influence over your life that corporations do not and cannot: taxes, monopoly on violence, control of the legal system, ability to enact and enforce regulation, and many more.

It should be pretty clear that separation of powers is a good thing, and only an idiot would decide that it's better to consolidate as many things as possible into a single central entity that also uniquely holds all of those powers.

> There is a difference in (1) my (and my fellow citizens) ability to influence between that two

Ability to influence? Yes, you have ability - but the amount of actual influence exerted on government in the US is minimal. Public opinion in the US has almost zero correlation on the law[1]. The political process is overwhelmingly dominated by a small amount of wealthy and powerful individuals and special interest groups.

It's absolute insanity to take this mess and put more things in control of it.

> (2) not having to pay for profit and the costs to me resulting from necessary profit on top of the rest of the shit sundae

Well, as we've already established, the government is significantly less efficient than industry - and even if it wasn't, the extra margin that you have to pay is a trivial price to the utterly insane alternative of the government controlling all private industry.

[1] https://act.represent.us/sign/problempoll-fba

The solution to bad government is better government not less government

The vast majority of the time less government is better government. If it’s not going to be less, it’s better when it’s local.

Block grants federate and localize solutions, limit the damage of poor choices, and force answers to tough choices.

Federal programs with centralized oversight end up spending too much for too little results and will never be able to efficiently solve these problems.

And also: the solution to bad government is better government, not more government.

Yes. I wish we'd move on from the tired more/less government debate and focused on better government. But neither party seems to care.

Does better government imply current government employees losing or having to change jobs? That’s sort of not possible at scale.

Not sure what you're implying but in my mind getting rid of government unions would be priority #1.

The government is controlled by the government, not voters. The government has incentives to stay the course. Every single government employee wants to keep their job, managers want to keep their teams/projects/products. The government downsizing itself amounts to hundreds of thousands of individuals collectively deciding to act against their own interests on behalf of some abstract notion of what’s best for hypothesized future citizens. Not going to happen. Workers are workers. The government is first and foremost a workforce.

You're implying that less government should be the goal. I don't care about the size, i want better government.

I didn’t connect the dots, sorry. Say a government agency needs to be better, like DoT for instance. How will you make DoT better? Every president puts a new leader in, buttgieg has some authority, but most DoT staff have been there forever. He can bring in some of his own people, maybe “manage out” (bully till they resign) those who don’t adopt his agenda or conflict with the people he brought in. But for the most part, DoT is going to keep doing what it does, same managers managing the people, doing the same work, protected from firing by American labor laws, and so how do you “make it better” without firing a lot of people, or moving them around, all at once?