I'm going to risk a political statement and say that this is why I'm mostly hopeful about DOGE, even if parts of it are a shit show.
Building civilization comes with a hefty dose of institutional entropy, which keeps accumulating, despite (or often because) good intentions and competence. Everybody is improving their piece of the map, but this means you get stuck in a lot of spots of local maxima. Some can be fixed from a level above, but some need a round of creative destruction every 10 years or so.
I've read this yesterday: https://unchartedterritories.tomaspueyo.com/p/why-japan-succ...
It's a good read and a good blog for many reasons, but the relevant part to this conversation: Japan managed to keep a very high level of living even through decades of economic stagnation and aging population in large part by having a sane zoning system. Yes, that simple. They have 12, nation-wide, mostly inclusive zoning types. This means the permitted building types carry over as you move up the categories, allowing mixed-use development by default.
And indeed, you can actually go to Japan and buy a house for about the price of a decent car - which coincidently used to be the case in most of the world, before the double pressure of zoning/coding on one hand, and migration towards urban centers on the other squeezed the housing pricing way above what actual costs would have it be.
For instance, would you fire doctors to reduce bureaucracy in medical services?
The problem is if you want lower bureaucracy you have to change laws and not fire people.
There is plenty of pressure on the organizations to be efficient, the American people never saw a tax cut they didn't like.
There is plenty of pressure on the organizations to be efficient
But for the most part, the things I expect the SF city government to do, get done. The roads are paved, the schools function, crime is kept in check, elections are held, permits are issued, inspections get done, etc. All to varying degrees of course. And the people get to change leadership if they feel things aren't going well (as they did in the last election).
I don't know what you mean about crime being kept in check. Right now there are several cars on my street with expired registration. Two of them have no license plates at all. I doubt they are insured. I have been the victim of crime in my home.
There are people openly selling illegal drugs on the street, with no fear of arrest or prosecution.
The schools spent $27k per student per year (i.e. $500k per classroom), and FEWER THAN HALF of students meet grade level standards in math and English.
It takes many many permits to open a restaurant, and many would-be restaurant owners give up part way through the ordeal. 'Permits are issued' doesn't indicate efficiency when the number of permits required is beyond what's reasonable.
The expectations we have of the government have to be related, to some extent, to the resources it takes from us.
If you spend $27k per student per year, yes I expect schools to run efficiently enough such that students graduate high school able to read and write.