Competitive service districts II

   The process of competitive service districts can be applied to health care.  The manager would be responsible for creating operating agreements with medical providers.  This would allow for premium care, but those institutions who wish to provide premium care would have to give something in return.  The availability of premium care would make some consumers happy and would help the manager in terms of rating but the manger could withhold an operating license unless they provide some general service as well.  It is a system of mutual blackmail.  There does need to be auditing to ensure there is only limited abuse.
   Any fees assessed by the manage, such as five dollars for an appointment would also be included in the rating.
   The rating does not have to be by only the consumers, it can also have ratings by doctors, nurses, other medical staff and pharmacists.  They can be weighted in the rating in different ways.  The manager would have to determine the best way of keeping them all relatively happy.
   In addition to the ratings an additional factor could be actual outcomes.  There would have to be thorough auditing of medical records for the ratings to be meaningful and to avoid fraud.
   By holding managers responsible for both cost and outcome money can be saved.  Studies have shown that performing a high rate of any given operation, such as heart transplants, increases the success rate of those operations.  Currently there are too many heart transplant centers.  Each center adds its fixed cost to the national health bill while actually killing patients through lowering success rates, because too many of the centers are performing too few operations to have the highest success rates.  Under competitive service districts, there is no bonus given for vanity, each district must reduce costs, which means consolidating certain procedures with other districts benefits the manager through reduction in costs and improvement in outcomes.
   Nationally, there is the question of adjusting costs between largely rural and largely urban districts.  It would probably be sensible to do so, but any adjustment will produce an anomaly somewhere, the rules will have a poor match with reality in some area.
   The other advantage is that by just taxing and setting up competitive districts nationally there is a workable system that provides effective service and is not unconstitutional by doing something like having the government order people to buy health insurance from private business, which is the kind of abuse the constitution was specifically written to prevent.
    In government services, the service has to be one with which people have constant enough contact that they can actually accurately state the quality of service provided.  Road repair, sanitation, street lighting, parks and policing may fall within those limits; schools and courts do not, since most people have no idea of the amount of nonsense occurring in either of the last two.  People just do not see enough of them to have a legitimate opinion.
Parks, too, are problematic because unlike street maintenance and policing , they are not evenly distributed.  Parks are often large facilities spaced at random and do not admit of smoothly divided boundaries of responsibility.
   In sanitation an additional rating can be made of recycling, encouraging managers to experiment and try to find the best means of encouraging people to cooperate in recycling.  In policing, it forces the police to respond to the people of the district, if the police are viewed as abusive, the manager will be gone.
   Positively electing people, as is done in commission forms of government which Louisiana used to have, are disasters because as soon as political parties are introduced, people get stupid and crazy and will actually defend the incompetent to  prevent the opposing party from winning.  Competitive service districts rate people after they have actual performance so there is no question of promoting one group over another.  And, once again, it removes the perverse incentive to spend the full budget, instead promoting people who manage savings.
    With private sector utilities, there is the need to arrange for capital transfer in on orderly yet quick manner, it may bog down legally.  Cell phone companies recently agreed to notify customers when excess charges are initiated.  If they had been under threat of being fired, they would have done it years ago.  The setting up of two cell phone companies in each area doubled the capital costs without improving service.  Companies only actively compete when there is a high enough introduction of new businesses to threaten their profits.  Established companies eventually inevitably come to accept their market share and make no effort to compete, which would entail at least a short term loss of profits.  With the district system they have to compete against their customers expectations and are under threat of losing their entire profit base, it promotes companies who improve management even if they do it accidentally or at random because anyone with bad management will be removed.
    Wire phones, cable and internet are best consolidated into a single wire company.  No one knows haw cable companies got their franchises anyway.  The three separate wires represent three sets of capital costs, it is wasteful. The company would have three ratings which can be combined.  There could be one rating of multiplying all three ratings together, three of combing the ratings two at a time, and three individual ratings.  The triple rating could have a limit of 1.5 standard deviations, the doubles 1.75 deviations and the singles 2 deviations or something like that.
    In private utilities there would be no distribution of equal budgets, the costs they charge would be part of the ratings.
   Banks and credit cards could be separated.  In urban areas, the proliferation of bank branches does not improve economic production.  Each branch drives up overall banking costs without improving service, certainly not in an area where there are five banks in three blocks.  Having one bank per district would eliminate that.  If banks want to impose nuisance charges people can fire them, the costs and services will equilibrate at some point, although it might not be ideal for the customers.  Credit cards would be a separate entity from the banks and would be held accountable by the failure rate of payments.  The credit card company would have to be a little more selective in issuing credit cards, which could reduce some abuse.
   Airports would constitute competitive districts.  They would be responsible for scheduling and pricing between airports, the origin airport would be held accountable.  The airlines would be service providers.  An airport would order a two hundred fifty seat airplane with a fifteen hundred  mile range every weekday morning at eight o'clock, an airline would provide it.  It is the rare person who cares what airline they fly on, they want to, on a given day, fly from one city to another.  By making the airports the units of competition that service can be improved.  Instead of ten airplanes from six different airlines each of two hundred fifty passengers flying form New York to LA every morning between  eight and ten o'clock, the airport could schedule five five hundred seat aircraft.  The flight could be more comfortable, having fewer aircraft would reduce delays and costs could be less.  Similarly, there might be a market for two hundred fifty people to fly between New York and Kansas city every day, but because it is divided among airlines there are no direct flights and passengers have to fly into Dallas or Chicago and wait around and accumulate before there are enough passengers to fly on to Kansas City.  It can improve customer service.
  The airports would rate each other to prevent one duping its problems on another.  It would  encourage coordination on aircraft usage, a five hundred seat aircraft might make sense for the origin airport, but there might be no use for it at the destination.
   Passengers can down rate for any reason, such as uncomfortable seats,lost luggage or bad peanuts.  To encourage people filling in the rating card a deposit between twenty and fifty dollars could be paid.  After arrival the passenger would fill out the card and insert it into what would b e similar to an ATM.  After the card is inserted, the deposit would be repaid.
   Air traffic control would be handed over to the airports to run, but strong government oversight should be maintained.  Pilots could also rate the airport on scheduling and control.