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Tom Coburn needs to read Dilbert

So, Senator Tom Coburn (R-OK) has decided to stop bashing Healthcare.gov. “It will eventually work and work well,” he said.

But Coburn warned that the law would still have problems, thanks to the “centralized management” of the federal government, which is “inefficient, most of the time ineffective, oftentimes complicated by fraud or incompetence.”

All of this is of course true. Government is a very inefficient way to get anything done. But we don’t buy our health insurance from old Hank down on the corner, who stays up late every night making sure that he’s squeezed all the waste from his health-insurance business. We buy it from giant corporations. Which are *also* centralized, also inefficient, also complicated by fraud or incompetence. And worse, they’re not even trying to help us and failing–their business plan is to take as much from us as they can, and pay out as little as they can. Regulation–even clumsy, inefficient regulation–can fix that.
(Yes, in theory competition should keep private industry honest because if one insurer charges too much we can go somewhere else, but health insurance is a “naturally” concentrated industry. If you’re not big you can’t manage risk properly or negotiate with providers. And the industry, like many industries, is in fact so concentrated that competition doesn’t operate like it “should”.)
In other words, the choice isn’t between giant, inefficient government and dynamic private industry. It’s between giant, inefficient government and giant, inefficient private industry.
I’m not the first to note that giant corporations tend to resemble government departments; here’s John Stuart Mill, in Principles of Political Economy, all the way back in freaking 1848:
Government management is, indeed, proverbially jobbing, careless, and ineffective, but so likewise has generally been joint-stock management.
Okay, maybe I can’t expect Tom Coburn to be familiar with John Stuart Mill. And Coburn’s bio states that he’s never had a corporate job, so he may never have had a chance to see, firsthand, how slow and stupid big corporations can be.
But at least he could read the comic pages. Dilbert doesn’t work in the government.

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