From the politician's viewpoint, a national health care plan has nothing to do with health care. It's about power and control and patronage and all of the other wonders created by government officials who have no expertise in the program's subject matter.

Amtrak, the Post Office, SSA, VA, and the list goes on. What they all have in common is the inability to effectively reorganize to the times and customer base, as they all need a combination of approvals from various oversight groups, the Office of Management and Budget, and Congress itself. By the time all of this "coordination" is done, the opportunity and incentive is over. Also,, having to insure that no restructuring negatively affects any congressperson's pork delivery, the odds of any "normal" business adjustment is very slim.