Yes, surely the incentives are different. I don't at all believe that the public-bureaucrat incentives are better. My wife is manager of budget & reimbursement

Yes, surely the incentives are different. I don't at all believe that the public-bureaucrat incentives are better. My wife is manager of budget & reimbursement at a hospital, which means that her primary task is working with Medicare and Medicaid officials. I don't think that a day goes by that she's not telling me about some inefficiency in the process. It might be the (literally) reams of paperwork they're required to produce, or unnecessary tests that are necessitated by Medicare rules, or the attitude she gets from the public employees she must talk to. But any time you hear that Medicare is more efficient, remember that because Medicare/Medicaid nearly comprise a monopsony, it's able to push many of its administrative chores onto the healthcare providers.