[majewsky]

> The amount of waste in terms of time and money were eye-watering, every time. The amount of politicking was immense.

Have you ever worked at a reasonably large private organization? It's exactly the same there. It's a complete fairy tale that large private organizations are somehow more efficient than large state-run ones.

[rdtsc]

Exactly. It is also interesting for as much as free market and competition is touted as the golden standard of organizing things, most large multinational companies are really run in hard line Communist style command economy: top down bureaucracy and planned allocation of resources.

[majewsky]

I wouldn't call it communist, it's more of a centralized dictatorship in practice [1]. Which is particularly interesting because of how it completely contradicts the general political mainstream that says that more democracy is always good.

[1] Although one that still, from time to time, listens to the people at the bottom who actually know their stuff.

[brightshiny]

Yes, I have, so no, it's not a complete fairytale. I was quite clear on my views.

[wildmusings]

The difference is that private organizations that don't perform eventually fail to turn a profit and go out of business.

[Osiris]

It's doesn't logically follow that every business that has internal inefficiencies will stop making a profit. They may make less profit than they could if they were more efficient. My father-in-law works for a very large corporation and he's always complaining about the wasted time to get simple tasks done, but they aren't going out of business any time soon.

Every company I've worked at with lots of red tape got there because they were actually trying to solve a problem due to the lack of "regulations" or rules.

[duncanawoods]

I think this is usually because their profit engine breaks rather than being overwhelmed by waste. All big orgs seem to have one part of the business printing money while the rest tries to burn it. So long long as the printer prints, the bonfires burn.

[wildmusings]

If your competitor can produce the same output with less waste, they can lower prices and take your customers.

This is especially true of health care where there's not much salient differentiation or other dynamics that would naturally produce monopolies.

[acdha]

That's a very simplistic view: it assumes that the product in question is an easily-compared commodity, the business has low barriers to entry, and that there aren't other factors (long-term contracts, regulatory requirements, natural monopolies, etc.) which would make switching hard.

In the case of healthcare, consider the cost of entering a competed space: nobody is better at everything so you won't have a clear advantage for many patients, the startup costs (time, money, permits, staff, etc.) are massive, people like to keep their existing doctor and won't change without cause, and the complexity of the problem defies simple solutions. You can't save on staff costs without losing in-demand professionals, things like billing are both intrinsically complex and disastrous if you get them wrong, and so are all of the safety and other regulatory compliance issues. You might be able to shave bits here and there but it'll take time, have indirect costs, and it's going to be a modest percentage over time.

[ZenoArrow]

Only if those competitors can arise. If the established players are all happy to keep their market share and increase profits by raising prices, you won't see the same race to the bottom.

Companies require capital to start. The level of capital to start a company differs depending on the industry. One of the main reasons you see far more startups in IT than in telecommunications (think Verizon, AT&T, etc...) is due to the difference in cost of entry into those markets.