This is exactly what happens in hea

This is exactly what happens in health care today. For-profit hospitals turn away patients who have no insurance, sending them to overcrowded public hospitals. The consequences, of this practice, known as patient dumping, can be severe. In one six-month study of a public hospitals in Dallas,77 percent of those patients transferred in from other hospitals had no insurance. In other words, private hospitals routinely turned away patients without insurance, sending them to a public hospitals that would take them. Eleven of them died on the way in.
A different form of inequity can threaten those who work for competitive service providers. Careful studies indicate that wages paid by governments and private contractors are, on average, fairly comparable. But some studies suggest that contractors offer fewer benefits, such as health insurance. Governments also tend to be more aggressive than private contractors about hiring and promoting minorities and women.
Competition that is structured carefully, however, can produce more equitable results than service delivery by a public monopoly. Contractors can be required to provide comparable wages and benefits and to promote affirmative action, for example. This is important, if the values we embrace through our governments are not to be lost when those governments use competitive contracts.
Contractors can also be required to serve all segments of the market, to keep from creaming off the most profitable customers. During the National Science Foundation study on garbage collection,
E. S. Savas found that competition actually heightened the equity of service delivery-because public agencies were, in effect, creaming. When city forces encountered delays and did not want to pay overtime, they would simply skip some areas that day-often the poorest areas, because they had the least political clout. With a contractor that didn’t happen, because the contractor had no choice but to fulfill his contract. “It’s a job to be done, rather than a set of neighborhoods to be differentially placated, depending upon their political strength,” Savas says.

A different form of inequity can threaten those who work for competitive service providers. Careful studies indicate that wages paid by governments and private contractors are, on average, fairly comparable. But some studies suggest that contractors offer fewer benefits, such as health insurance. Governments also tend to be more aggressive than private contractors about hiring and promoting minorities and women.
Competition that is structured carefully, however, can produce more equitable results than service delivery by a public monopoly. Contractors can be required to provide comparable wages and benefits and to promote affirmative action, for example. This is important, if the values we embrace through our governments are not to be lost when those governments use competitive contracts.
Contractors can also be required to serve all segments of the market, to keep from creaming off the most profitable customers. During the National Science Foundation study on garbage collection,
E. S. Savas found that competition actually heightened the equity of service delivery-because public agencies were, in effect, creaming. When city forces encountered delays and did not want to pay overtime, they would simply skip some areas that day-often the poorest areas, because they had the least political clout. With a contractor that didn’t happen, because the contractor had no choice but to fulfill his contract. “It’s a job to be done, rather than a set of neighborhoods to be differentially placated, depending upon their political strength,” Savas says.

If not carefully structured, markets that look competitive
Also succumb to monopolistic power. In both contracting
Procurement systems, for example, some projects are so
Sive that for all practical purposes it is impossible to switch
Viders once the job has begun. Defense contractors who
Submarines and ships enjoy this protection; it explains why
Get away with endless cost overruns and seem impervious
Sanctions. A similar problem is emerging with private corpor
Tions that contract to operate prisons, many of which demar
20-to 30-year contracts. “There is some reason to fear that in
Stead of being competitive like the trash collection industry
John D. Donahue wrote in The Privatization Decision, prise
Management “will be competitive like the nuclear-submarin
Industry-which is to say, not at all.”
Even when private firms do not have monopolies, they times develop enough political power to stifle competition.
Mass transit, private bus companies spend considerable sums
Influence legislatures, to get and keep their contracts. In garba
Collection, large private firms use their power to lobby again
Policies that would reduce the volume of garbage, such as
Cycling and source reduction. Even in day care, private firms to
To restrict the competition.
This pattern suggests that governments would be wise to der
Firms with which they do large volumes of business the right
Lobby or make campaign contributions. Such prohibitions
Have constitutional problems when applied by law to all priva
Firms, but they can certainly be written into specific contracts.
A company wants the public sector’s business, it simply agree
To forgot any effort to influence public policy in related area
The conflict of interest is obvious.
None of this is to say that public monopolies don’t requie
The same careful oversight. Oversight. The postmasters sent enormo
Volumes of free mail to lobby Congress for a rate hike in 199
School principals in Chicago used to eliminate the refrom pro
Gram that took away their lifetime job security. A public employee union in Michigan sued to block the state from
Contracting out job training for welfare recipients. Rural Metr
A private firm that operates fire departments in some 30 con

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Competitive Government
Munities, has been threatened so often by unions that it will no
Longer bid against a unionized fire department. The threat usually goes something like this: “If you come in here, we’re going to raise money from every union in the country and make trouble in your backyard.” Unions may have less money to spend than large corporations, but public employees vote at twice the rates of the general public.

Competition is here to stay, regardless of what our governments do. In today’s fast-moving marketplace, the private sector is rapidly taking market share away from public organizations. Public schools are losing ground to private schools. The Postal Service is losing ground to Federal Express and UPS. Public police forces are losing ground to private security firms, which now employ two-thirds of all security personnel in the nation.
We can ignore this trend and continue with business as usual, watching fewer and fewer people use public institutions. We can sit idly by as a vicious cycle unwinds in which the less people depend on government the less they are willing to finance it, the less they finance it the worse it gets, and the worse it gets the less they depend on it. Or we can wake up – as entrepreneurial leaders from Phoenix to East Harlem to Minnesota have-and embrace competition as a tool to revitalize our public institutions.
The choice is not quite as stark as it would be in a competitive marketplace: compete or die. But it is stark enough. Our public sector can learn to compete, or it can stagnate and shrink, until the only customers who use public services are those who cannot afford an alternative.

ผลลัพธ์ (แอฟริกา) 1:

Dit is presies wat gebeur in gesondheidsorg vandag winsgewende hospitale wegdraai pasiënte wat geen versekering het nie, om hulle te oorvol openbare hospitale stuur. Die gevolge van hierdie praktyk, wat bekend staan ​​as die pasiënt te stort, kan ernstig wees.. In een van ses maande. studie van 'n openbare hospitale in Dallas, 77 persent van die pasiënte oorgedra in ander hospitale het geen versekering. Met ander woorde, private hospitale gereeld weggewys pasiënte sonder versekering, hulle na 'n openbare hospitale wat hulle sou neem stuur. Elf van hulle gesterf het. op die pad in.
Kan 'n ander vorm van onbillikheid dreig diegene wat werk vir 'n kompetisie diensverskaffers. Sorgvuldige Studies dui daarop dat Lone betaal deur regerings en ​​private kontrakteurs is, gemiddeld, regverdig vergelykbaar. Maar sommige studies dui daarop dat kontrakteurs bied minder voordele, soos. As Health Insurance. Regerings is ook geneig om meer aggressief as private kontrakteurs oor die verhuring en die bevordering van minderhede en vroue.
Kompetisie gestruktureerde versigtig, kan egter meer regverdige resultate as dienslewering deur 'n openbare Monopoly Produseer. Kontrakteurs vereis kan word Vergelykbare te voorsien. lone en voordele en regstellende aksie te bevorder, byvoorbeeld. Dit is belangrik, as die waardes wat ons gryp deur ons regerings is nie verlore te wees wanneer daardie regerings Gebruik Competitive kontrakte.
Kontrakteurs Kan ook verwag word om al die segmente van die mark te dien, te. Hou van verroom af die mees winsgewende kliënte. Gedurende die National Science Foundation Studie oor vullisverwydering,
ES Savas gevind dat die kompetisie eintlik verhoogde Die Equity van dienslewering-Omdat openbare agentskappe was, in effek, verroom. Wanneer City Kragte teëgekom vertragings en ​​het nie. wil om oortyd te betaal, sal hulle eenvoudig slaan sommige gebiede wat die dag-dikwels die armste gebiede, want hulle het die minste politieke invloed. Met 'n kontrakteur wat nie gebeur het nie, want die kontrakteur het geen keuse nie, maar sy kontrak na te kom. "Dit is. 'n Job gedoen moet word, eerder as om 'n Stel woonbuurte te differensieel gepaai word, afhangende van hul politieke krag, "Savas sê. 'n ander vorm van onbillikheid kan dreig diegene wat werk vir 'n kompetisie diensverskaffers. Sorgvuldige Studies dui daarop dat Lone betaal deur regerings. en private kontrakteurs is, gemiddeld, regverdig vergelykbaar. Maar sommige studies dui daarop dat kontrakteurs bied minder voordele, soos gesondheid versekering. Regerings is ook geneig om meer aggressief as private kontrakteurs oor die verhuring en die bevordering van minderhede en vroue. kompetisie wat noukeurig gestruktureer word ,. egter kan produseer meer billike resultate as dienslewering deur 'n openbare monopolie. Kontrakteurs kan verwag word om vergelykbaar lone en voordele te voorsien en regstellende aksie te bevorder, byvoorbeeld. Dit is belangrik, as die waardes wat ons omhels deur ons regerings is nie om te wees. verloor toe die regerings Gebruik Competitive kontrakte. Kontrakteurs Kan ook verwag word om al die segmente van die mark te dien, te hou van verroom af die mees winsgewende kliënte. Gedurende die National Science Foundation Studie oor vullisverwydering, ES Savas gevind dat die kompetisie eintlik verhoogde Die Equity. van dienslewering-omdat openbare agentskappe was, in effek, verroom. Wanneer stad magte teëgekom vertragings en ​​wou nie oortyd te betaal, sou hulle eenvoudig slaan sommige gebiede wat die dag-dikwels die armste gebiede, want hulle het die minste politieke invloed. Met. 'n Kontrakteur wat nie gebeur het nie, want die Kontrakteur het geen keuse nie, maar sy kontrak na te kom. "Dit is 'n werk wat gedoen word, eerder as om 'n Stel woonbuurte te differensieel gepaai word, afhangende van hul politieke krag," sê Savas. As. nie noukeurig gestruktureer, markte wat lyk Competitive swig ook na monopolistiese Power. In beide Kontrakterende Verkryging Systems, byvoorbeeld, 'n paar projekte is so Sive wat vir alle praktiese doeleindes is dit onmoontlik om te skakel viders wanneer die werk begin het. verdediging kontrakteurs wat duikbote en. skepe Geniet hierdie beskerming, dit verduidelik waarom wegkom met eindelose koste overschrijdingen en lyk ondeurdringbare Sanksies 'n soortgelyke probleem is opkomende met Private Corpor. sies wat kontrak Gevangenisse, baie van wat Demar bedryf 20-tot 30-jaar-kontrakte "Daar is 'n paar.. rede het om te vrees in plaas van om soos die asblik Versameling Industry Competitive John D. Donahue geskryf in die privatisering besluit, Prise Management "sal soos die Nuclear-Submarin Competitive Industry-wat is om te sê, glad nie. " Selfs Wanneer Private. maatskappye het nie monopolieë, hulle Times Ontwikkel Genoeg politieke mag Kompetisie. te onderdruk Mass Transit, Private Bus maatskappye bestee aansienlike somme Invloed wetgewers, te kry en te behou hul kontrakte. In Garba Collection, groot private maatskappye hul mag gebruik om Weereens werf Beleid wat. sou die vermindering van die volume van vullis, soos Fietsry en Bron Vermindering. Selfs in Day Care, Private firmas om die kompetisie te beperk. Hierdie patroon Stel dat regerings Wise sou wees om der Firmas met wat hulle doen groot volumes besigheid The Right Lobby of. Maak veldtog bydraes. Sulke verbod Het Grondwetlike probleme wanneer dit toegepas word volgens Wet al Priva Firmas, maar hulle kan seker in spesifieke kontrakte geskryf word. 'n maatskappy wil die openbare sektor se besigheid, is dit eenvoudig Stem te vergeet enige poging openbare beleid in Verwante Area te beïnvloed. Die konflik van belange is duidelik. Nie een van hierdie is om te sê dat die openbare monopolieë nie requie Nie Die Dieselfde Sorgvuldige toesig. toesig. Die posmeesters gestuur Enormo Volumes van gratis e-pos Kongres om steun te werf vir 'n rentekoersverhoging in 199 Skoolhoofde in Chicago gewoond is. elimineer die Refrom Pro Gram wat weggeneem hul leeftyd Werksekerheid n openbare Werknemer Unie in Michigan gedagvaar om die staat te verhoed. Uitkontraktering Job Opleiding vir die ontvangers van welsyn. Landelike Metr n private firma wat werk Vuur departemente in 'n 30-con Page 106 Page 107. mededingende Regering skappe, is bedreig deur Unies So dikwels dat dit sal nie meer 'n vakbond bie teen Fire Department Die bedreiging Iets gaan gewoonlik soos volg:. "As jy hier, ons gaan geld in te samel in die Unie van elke. Land en maak moeilikheid in jou agterplaas. "Vakbonde Mag minder geld te spandeer as groot korporasies, maar openbare werknemers teen twee keer die koers van die algemene publiek stem. Die kompetisie is hier om te bly, ongeag van wat ons regerings doen. In vandag se snel. beweeg die mark, die private sektor is vinnig besig om markaandeel weg van openbare organisasies. Openbare skole word verloor grond aan private skole. Die Postal Service verloor grond te Federal Express en UPS. Openbare polisie verloor grond aan private sekuriteitsmaatskappye, wat nou. diens Twee-derdes van alle sekuriteitspersoneel in die land. Ons kan dit Trend ignoreer en voortgaan met business as usual, kyk hoe minder mense gebruik openbare instellings. Ons Kan ledig sit as 'n bose kringloop draai los waarin die minder mense afhanklik. regering om die minder hulle bereid is om dit te finansier, hoe minder hulle finansier die erger dit kry, en die erger raak dit die minder hulle afhanklik is Of ons kan wakker -. as entrepreneuriese leiers van Phoenix na Oos Harlem te Minnesota have-. en omhels Kompetisie as 'n instrument om ons openbare instellings te vernuwe. Die keuse is nie heeltemal so STARK As dit sou wees in 'n mededingende mark. Kompeteer of sterf Maar dit is STARK Genoeg Ons openbare sektor kan leer om te kompeteer, of dit kan stagneer.. en krimp totdat die enigste kliënte wat openbare dienste gebruik is diegene wat nie 'n alternatief kan bekostig.