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I’ve seen people in the US say things like:
“While the NHS works very well in many ways compared to the American health system, the British government isn’t the American government. The American government is much better at fucking things up”.
These arguments aren’t just made in the context of the NHS. They are made with regard to everything from excessive public-private partnerships, to regulation, to education.
Now if it is true that the American government is uniquely incompetent at certain sorts of things, then it seems to me that correcting this problem should be a first-order priority for Americans. Government around the world is expanding, it will probably continue expanding, and so you’d better make a government that is ready to wield greater powers because in dollar terms its likely to keep getting bigger.
It seems to me also that if you want to sharpen your capacity for government, the best way to do it is probably to take on big projects and work through the kinks.
Thus I think there’s an argument that if the US government is worse at running things than other governments, that actually gives us reason to try big and ambitious projects like public healthcare. How strong this argument is, I don’t know, but I certainly don’t think “our government is bad at managing things” is a fact you can afford to just fatalistically accept.
Maybe it can’t be fixed. Maybe the way the presidency and constitutional structure in the US works, things like an independent public service are impossible. However, under sufficient social need and pressure, things like constitutional structure can become remarkably flexible.
EDIT: Kieran Latty reminds me that Ha Joon Chan makes a similar point in relation to what he calls “state capacity”.