I used to think government involvement in health care, in order to fix the current system, would be a no-brainer. Of course the government can do it just fine. I know the government manages Medicare, and I for one am gratefull. But my own life as a contractor has forced me to rethink my support.
The government gets its work accomplished largely through the management of contracts, and their favorite contractors. The government, DOD, everyone uses contractors. So why does the government use so many contractors? Easy access to high quality expertise, convenience and competition. As a government entity, I can ask for contractors to bid on my work, and I get to choose the one I want. I can get bids, and select the lowest bidder with the best approach and save the tax payer money. Sounds great, right? It would be great, if it worked that way.
As the government, I can pick expertise from a waiting pool of contractors, and escape all the messy management of my own workforce. However, every few years, as the government, I get paranoid and swell with positions to keep expertise. Then, years later, I cut them to save money like I never knew them. Other than these organized purges, it’s hard to remove a government employee. Not so with a contractor. All a government manager has to say is “I am not comfortable with Joe” and they are on their way out. The government can terminate whole contracts fairly easily.
Contractors are much more agile that the government. Filling a government position takes months. The president still doesn’t have all his people seated. It’s not his fault: it’s the system. And this is during the biggest financial emergency in our history. A contractor has bodies staged to place into work. I can hire and have someone in place in two weeks. I know other contractors that have shortened that down to a day.
The government wants us to think they are the honest brokers of everything, including contracts. I certainly wish they were above it all, but this seems rare in practice. It is more frequently based on who you know, who you will hire, and who has just retired into your company, from the inside of the government organization immediately before your bid.
Longevity plays negatively into the government personnel system. I can say many of the people I deal with in government have figured out where the “autopilot” button is for their job, and have pressed the button years ago. And, in my workplace, if a General has bright ideas about how to do something innovative, the civilian leadership will just wait him out. He will rotate in 3 years or so. This is the scale at which they think.
Government folks have their favorite contractors, and they will take their word over any one else, right or wrong. You also have people in government who worked on a previous job as a contractor. Now the ones in government have an informal alliance with those who remained as a contractor. This funnels work to the contractor, despite competition. You would think there would be too many checks and balances in the system. In practice, the system insulates the government from all but the loudest contractor calls for fairness and fair consideration.
Contractors have their warts too. If the government wants an elevator to Mars, every contractor will bid, and all their energy will go into winning the bid. Only after they win, will they actually figure out how to do the job. Also, some contractors hold the government hostage by promising to deliver, while costs go ever upward. Seldom does the government realize this.
So back to health care. I don’t fear government involvement because of privacy issues, or cost issues, or difficulty in getting care.
I fear the magnitude of the unmeasurable bias, favoritism and lack of visibility that is possible.