The trouble is that blame doesn’t address the problem either. We want the government to make wiser, less gameable policy. We want businesses to act ethically. How do we acheive those? It’s not blame.
I think the answer is incentives. The government had the incentive to “help the poor” - so they did. The clinics had the incentive to “fix teeth for people in need” - so they did.
Just like in software development, so much rests on properly defining the desired outcome.
The problem is also that in the game of "helping people afford all their needs", governments will rarely construct solutions that involve less government. Which might well be the right answer.
Examples are impossible: governments are too complex. Any government that does this (however it is done), that government is also doing other things that are confounding factors.
The idea is simple: a government that does less costs less, so it needs to collect less taxes. That means people just over the edge could pay for their dental work instead of the government and all the overhead of having a third party involved.
It doesn't help those completely unable to care for themselves, but those who are close are no longer pushed over the edge.
That may have helped, but you can't ignore other factors such as relatively stable inflation adjusted fuel costs, combined with better fuel efficiency, lowering operating costs, or the trend towards eliminating amenities and increasing passenger density. Or the continued increase in airline safety while overseen by the not deregulated role of the FAA. Deregulation was only part of the picture.
"less gameable policy" -> clinics do not get a blank check, for good or bad, they have to comply with government's bureaucracy requirements, i.e., explicitly take action that attests that the clinic considers the procedure to be necessary and covered under that particular government aid. That is, if the clinic does the bureaucratic 'work' when the procedure would not have been recommended otherwise, their actions border: fraud and healthcare crime.
"The clinics had the incentive to “fix teeth for people in need” - so they did", in the case at hand, being the procedures unnecessary, the incentive was not "fix teeth for people in need", but "increase profits".
I agree completely that “increase profits” was a goal for the clinics, but I mean something a little different by incentive. I mean “a behavior that is being encouraged or rewarded by others.”
You are asserting that the government’s policy was sufficiently specific regarding “medical necessity” that would clearly show these claims would not qualify. If that were the case, then the government itself should not have paid out those claims in the first place. The fact that they did pay the claims (at least until someone blew a whistle) suggests either that their policy was vague enough to not be so enforceable, or that their review and enforcement was lax (or both).
That’s my point - if the policy and enforcement had been clear from the get go this wouldn’t have been so big a deal. One or two bad apples try something and get sanctioned and the whole thing stops being an incentive to bad actors.
We agree that something changed in the situation such that this is no longer occurring, right? What was that change, and why was it not so in the first place?
I think the answer is incentives. The government had the incentive to “help the poor” - so they did. The clinics had the incentive to “fix teeth for people in need” - so they did.
Just like in software development, so much rests on properly defining the desired outcome.