Mona Charen

Even if Obama were the best manager in the world, the problems with efficient service delivery by government would continue -- because the government is too large, too unwieldy and too lacking in incentives for efficiency to yield much, if at all, to management. A business that fails to deliver services will be crushed by its competitors. Government can never go out of business.

At the Veterans Affairs, bureaucrats lied and cooked the books regarding the care they were providing veterans. Eight cardiologists at the Albuquerque, New Mexico, facility, The Daily Beast reports, saw the same number of patients in a week that a single cardiologist in private practice sees in two days. According to the inspector general's report, long wait times, poor service and deceit are "systemic" throughout the system. Some veterans may have died for lack of timely treatment.

Care for another headline guaranteed to recur? "Senate Chair: Fix Dysfunctional Indian Health." That's an Associated Press story about the Indian Health Service, tasked since 1955 with delivering free medical care to 2 million Native Americans. Former Sen. Byron Dorgan found that a "chronic state of crisis" plagued the service, featuring "a lack of providers, hospitals at risk of losing their accreditation, improperly licensed staff, and missing or stolen narcotics." A spokesman for the Assiniboine and Sioux tribes of northeast Montana's Fort Peck Indian Reservation told the Journal Gazette: "All too often, tribal members complain of ailments but get sent home from the Indian Health Service with cough medicine or pain killers. Later we learn the situation is much more serious, like cancer."

Progressives respond that the IHS is simply underfunded -- as they regard every federal program except the military. But even Democratic Sen. Jon Tester of Montana found when he examined problems with the IHS that at least one provider was seeing only one patient per day.

It isn't management; it's a matter of incentives. No central authority can make a system like the VA or the IHS or Britain's National Health Service run efficiently. Competition is the only system that gives the power to consumers to reward good service and punish bad. But progressives cannot shed their faith that more government is the answer to bad government, so this story is sure to be repeated.

Mona Charen

Mona Charen is a syndicated columnist, political analyst and author of Do-Gooders: How Liberals Hurt Those They Claim to Help .
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