Great point. And if you fire all the insurance middlemen, but don’t get rid of the legal requirements which spawned those middlemen in the first place, you end up with medical professionals swamped with paperwork they shouldn’t have to deal with it.

What legal requirements spawned insurance middlemen?

  The problem is if you want lower bureaucracy you have to change laws and not fire people.

Not every excessive process is the result of legislation. Some of these processes arise gradually and unnecessarily, because, in an organization without competition, there's no pressure to be efficient (i.e. focus on increasing output).

A business can become more efficient by focusing on the most profitable customers. The government is not a business, nor should it be.

There is plenty of pressure on the organizations to be efficient, the American people never saw a tax cut they didn't like.

  There is plenty of pressure on the organizations to be efficient

What you say may be true in certain parts of the US. But we're talking about San Francisco. I've lived here for over 5 years, and my observations during that time do not tell me there's any pressure on governmental organizations here to be efficient, let alone 'plenty of pressure'.

Efficiency isn't the number one goal of a democracy. You want pure efficiency, dictatorships are the way to go.

But for the most part, the things I expect the SF city government to do, get done. The roads are paved, the schools function, crime is kept in check, elections are held, permits are issued, inspections get done, etc. All to varying degrees of course. And the people get to change leadership if they feel things aren't going well (as they did in the last election).

I didn't say I want pure efficiency.

I don't know what you mean about crime being kept in check. Right now there are several cars on my street with expired registration. Two of them have no license plates at all. I doubt they are insured. I have been the victim of crime in my home.

There are people openly selling illegal drugs on the street, with no fear of arrest or prosecution.

The schools spent $27k per student per year (i.e. $500k per classroom), and FEWER THAN HALF of students meet grade level standards in math and English.

It takes many many permits to open a restaurant, and many would-be restaurant owners give up part way through the ordeal. 'Permits are issued' doesn't indicate efficiency when the number of permits required is beyond what's reasonable.

The expectations we have of the government have to be related, to some extent, to the resources it takes from us.

If you spend $27k per student per year, yes I expect schools to run efficiently enough such that students graduate high school able to read and write.

You want better govt, that's great, so do I. I don't think randomly firing workers like it's a video game will accomplish that, however.

Are you looking in the right places? I'm sure all the big tech leaders put pressure on? But their definition of "efficient" may not align with yours or mine.

> . The government is not a business, nor should it be.

And it's not a charity either. So get rid of these wasteful programs that redistribute other peoples money that don't even work.

If not working is so lucrative why don't you try it? I'll tell you this, it's not nearly as pleasant as you think.

For insurance companies? Yes doctors can be fired. They do not provide treatment.

You most definitely have to fire people. After all, their number one aim is to make sure their job still exists in a decade.

But their job doesn't exist for another month of you fire them. They aren't replacing "unproductive" workers.