I don’t think it’s accurate to make that blanket statement without the qualification that his options were precluded by his political alignment. For example, Me

I don’t think it’s accurate to make that blanket statement without the qualification that his options were precluded by his political alignment. For example, Medicare cost reduction hits the broader problem of the American medical system being so much less efficient than everywhere else, but since both drug companies and doctors are key constituencies he couldn’t propose anything significant. Similarly, hiring civil servants instead of contractors would avoid several massive sources of inefficiency but that’d involve boosting pay scales, hiring more people, and shifting from saying the government is inherently inefficient to discussing realistic changes to incentives and oversight – all of which would have been political suicide.