Never understood why – according to captitalist ideology – a manager managing a controller controlling an administrator administrating a squadron of minimum-wage workers in the private sector is productive (and therefore “good”) as long as their company can somehow extract the needed revenue from their customers, while a teacher, a nurse, or a firefighter are deemed non-productive if they are paid by tax money. Also leading to the even more absurd result that, e.g., a nurse working in a public hospital serving all people is not productive, while a nurse working in a private hospital only serving people who can afford it is very productive.
It all comes back to incentives and who is spending the money on who. Since you raised nurses, let’s use a medical example.
Patient comes in with skin cancer to see general practitioner doctor. Doctor says that is a skin cancer, let’s cut that out. Nurse prepares equipment while doctor sees another patient in another room to be efficient. Doctor comes back and puts in local anaesthetic, washes hands while local takes effect, then cuts out skin cancer and sutures the wound. Nurse cleans up patient, dresses wound and instructs patient about wound care / suture removal while doctor sees another patient. Patient pays a gap fee of $100 and rest covered by social security medicare, which is around another $200 depending on cancer. $300 total cost to the system. (Ignoring histopathology costs which is mostly identical for both examples.)
Patient sees hospital clinic, gets triaged by a nurse or several and eventually sees doctor who diagnoses skin cancer. Doctor and nurse organise for patient to come back and be seen at pre-admission clinic. Months later, at pre-admission clinic, patient sees anaesthetic doctor as well as another “surgical team” doctor, plus another nurse or two to get weighed, blood pressure, and whatever other mostly useless stats for record system. Patient then gets booked for theatre time. Another month or more later patient turns up to theatre and sees often different doctors again: surgical doctor + anaesthetic doctor + anaesthetic training doctor + surgical training doctor + anaesthetic nurse + scrub nurse + recovery nurse + another training nurse, are all in the theatre. Skin cancer is cut out and sutured. Patient was likely given a “light general anaesthetic”, which was unnecessary, but done “for patient comfort”. By the way, amortised depreciation of the theatre space in a public hospital is very expensive compared to depreciation costs of the private general practice room. Total cost greater than $3000. Literally 10 times higher, easily.
Anything the private system can do should be done by the private system. Sure, regulate things to mandate certain standards of care, but the private system will remove all unnecessary wasted costs.
You might argue that the public hospital system provides other advantages like junior doctor training etc. and this is true. But still, there is so much wastage in many government funded hospital systems.
Furthermore, it is important to realise that the doctor in the private general practice is being paid for what he does. In this example, per skin cancer treated. Whereas the doctors and nurses in the public hospital are on salaries and are paid irrespective of how many cancers they actually treat. There is no incentive for them to work harder or faster.
The doctors in the public hospital are spending other people’s money on people other than themselves. Using the terminology in Eric Basmajian’s video, this is category 4 money which is the most poorly allocated.
Maybe the intuitive solution to redistribute wealth from the rich through taxation is not the proper solution? Maybe the problem stems from the reserve banks not doing their jobs properly and allowing growth of the real economy to reduce below 2%. These brainiacs then deliberately targeted increasing asset prices by lowering interest rates.
Maybe we need less political manipulation of the economy and less political manipulators? It seems to me that the bigger government is, the more everyone is dependent and focused on it, and then the more everyone pushes for government to manipulate the economy.