[naasking]

> Government jobs are for life with little to no repercussions.

This is one of the main problems: without some kind of feedback mechanism, this means bureaucracy can only monotonically grow which means inefficiency can only increase. At some point that inefficiency starts making private healthcare look competitive.

[negamax]

That's pretty much it. Government jobs are lower paid because money comes from taxing private sector. Career growth there is all about how big of a team in numbers someone has reporting to them.