>“People will say to me, ‘Why are MTA construction costs so high?’ And the answer is ‘Everything,’ ” says Julia Vitullo-Martin, a senior fellow at the RPA and c

>“People will say to me, ‘Why are MTA construction costs so high?’ And the answer is ‘Everything,’ ” says Julia Vitullo-Martin, a senior fellow at the RPA and co-author of its 2018 report comparing New York’s construction costs to those in peer cities. “Every factor you look at is flawed the way the MTA does business, from the first step to the end.” >When you’re doing everything wrong, the best way to fix the problem isn’t usually to go through the list of things you’re doing wrong and fix them one by one. It’s best to step back and ask why you’re so bad at everything, whether a systemic problem is causing you to make so many separate mistakes. And in the case of the MTA, the root cause of its capital-construction failures is usually diagnosed as unaccountability: Nobody knows who’s in charge, so nobody has to be terrified of taking the blame for obscene costs and endless delays. This is very similar to the explanation for the American healthcare system's turmoil given by David Goldhill (founder of https://sesamecare.com/ https://sesamecare.com/) in his book Catastrophic Care. Even for those that disagree with his recommendations, he delivers a great analysis of the perverse incentives that gave rise to the broken healthcare system.