[wpietri]

I'm sure that IBM Federal is as bad as you suggest. But part of that is due to how government works, which is in turn due to how citizens react to things.

Think about it like a government employee. If you do your job perfectly well, nobody notices. Despite the bureaucracy, despite unclear success criteria, despite insane budgeting. Nobody notices. That's just what's expected.

When something goes wrong, though, you get hammered. God help you if something comes to the attention of the public or makes the news. Nobody will take the time to understand the context; everybody just looks for the most plausible person to blame. If that's you, then you've got a black mark for the rest of your career. Welcome to the basement!

It's the total opposite of a startup context. And in some ways it should be. But it does mean that government projects drown in red tape and politics and procedures up the wazoo. Which is absolutely a recipe for shitty software and overpriced contracts, whether you're in government or a megacorp.

I'm in startups for a reason, and I have a lot of sympathy and respect for the good people who keep plugging away in government despite the fucked-up incentives.

[cleaver]

That paralleled my brief career in government. Managers are not promoted for efficient decision making—they are promoted for not having been associated with an unsuccessful initiative.

[mathattack]

Is it "not having been associated" or "not being blamed due to misfollowed procedures"?

[wpietri]

My impression was "associated".

[mathattack]

Given all the failed government projects, I feel like that people say, "As long as you can't prove it wasn't my fault" (as opposed to "my project") they won't get fired. After all nobody got fired from Big Government for following the rules... (Sarcasm intended)

[wpietri]

Fired isn't the problem. If you're smart and ambitious and believe in public service, you don't want to spend the rest of your life in a basement cubicle re-verifying the presence of the new cover sheet on the TPS reports.

[briandear]

Exactly why I fear government managed healthcare.

[wpietri]

I think there's less reason to fear that. Some of the best parts of government are the science- and data-driven ones, and evidence-based medicine provides a lot of data. Plus, doctors are notoriously independent.

Personally, I'd feel much better about government-run healthcare than for-profit-insurer-run healthcare. At least with the government option, everybody works for me, either directly or indirectly. Plus, a bureaucrat's natural fear works in my favor.

[MBCook]

I really like single payer in theory, but I'm with briandear on this one. There is already enough monkeying with what Medicare should and shouldn't pay for. My fear is the more money is involved, the less science/data/evidence based the decisions will be.

That's why I'm torn on the whole thing. I think for-profit should be able to do it better, but the current system clearly isn't structured in a way that encourages it. I have no idea whether the devil I know is better or not, and it's a big decision.

[redcap]

If (most of) the rest of the developed world can do "socialized" medicine reasonably well, then what's so special about the US that would prevent this? Just the size and scale for fuckups?

There are occasional health system scandals in Australia and the UK, for example, but even with this everyone gets coverage. So why the US needs to drag its heels in this is beyond me.

But if you do think the public service will make a dog's breakfast over the whole thing, I'm all ears.

[MBCook]

My concern is the size of the entrenched interests would prevent things from being setup reasonably. If the government could truly start over, I would have more confidence. Instead I would think we'd get all sorts of pressure that, for example, treatments proven not to beat placebos (or do worse) should still be paid for because people want them, and unless it's so dangerous the FDA bans it.

[nateabele]

Okay, to be clear though, exactly which segment(s) of the developed world are doing socialized medicine and not going bankrupt (or on the verge of going bankrupt) in spectacular fashion?

[grassclip]

If your a government employee and something goes wrong you just claim that you didn't have enough money or resources to do the job. At least that's what everyone seems to do and they get away with it.

[wpietri]

Agencies can claim that. Because we never fire or sideline agencies.

But individuals don't have the same out. Somebody who took a risk and failed may never get fired, but for somebody with ambition and vision, getting demoted to a pointless job with no power is worse than getting fired.

[luriel]

Just look at the TSA.