It has become fashionable to lament the high cost of health care and college tuition to name but two services provided to the American public. Both were never designed to become cottage industries, and yet both have become sprawling masses of inefficiency. This we know. This is something politicians have latched onto and incorporated in their stump speeches, but hardly anyone ever addresses the reasons for the increased cost.
Doing so would force us to confront a few unpleasant realities about these fields, their impact in our daily lives, and just how unruly and undisciplined these industries have become. It would be wonderful to see a politician speak the truth about these problems, rather than merely reiterating our grumbling without proposing an adequate solution to fix it.
A major reason why is that supposed non-profit organizations, specifically institutions of higher learning and medical centers, have made money hand over fist in the last several decades. Charity hospitals or colleges/universities have then established largely unnecessary administrative positions within positions, departments within departments, and factions within factions that make little to no rational sense. Since these fields were never designed to turn a profit, yet ended up making money hand over fist, each overbuilt, both in an architectural and staffing sense.
Most students and most patients do not directly deal with half of these departments, and yet they exist to give jobs to middle management. Certain cities, of which my home of Birmingham, Alabama, is a notable example, are utterly sustained by medical centers and public universities as the predominant employer of the entire town. When the steel mills went away and were among the first jobs to be outsourced overseas, back in the 1970s, banking, health care, and higher education stepped in to fill the void. Birmingham was not the only city for whom this kind of response was a godsend.
But back to the issue at hand--slashing jobs to the bone is no real solution, since doing so would increase unemployment and leave many people with no place to go. Judiciously pruning unnecessary departments and administrative staff is the most sensible resolution, combined, of course, with reducing the pay of those who remain. Unchecked, unregulated bureaucracy fosters inefficiency, keeps cost unnaturally high, and slows down the process. If we want to put our money where our mouth is, this kind of necessary regulation is where we'll put our efforts.