It's a hard problem, but I think it lies in great part with the "underpaid, incompetent [government] employees".
If you make sure that your government employees are educated, provided with good benefits, feel like they have an impact, etc., the outcomes will invariably be for the better.
A very good example of this is teachers. The OECD tells us:
"[...]in nearly all countries, when teachers perceive that appraisal and feedback lead to changes in their teaching practice, they also report greater job satisfaction. When teachers believe that appraisal and feedback is performed only for administrative purposes they report less job satisfaction. In addition, teachers who report that they participate in decision making at school also report greater job satisfaction. Indeed, although fewer than a third of teachers believe that teaching is a valued profession in their country, those teachers who report that they can contribute to school decisions are more likely to report that teaching is valued in their society."
In other words, much like regular companies, governments with happier employees tend to have better outcomes. This should be hardly surprising to most HN readers.
Government employees in Japan have excellent hours, pay, and benefits compared to working in the private sector. Becoming one is very competitive and requires passing difficult exams.
In 10 years of various levels of being a model citizen (or not), all of my dealings with the local and national government have been satisfactory, even when they were in a position where they could make me have a very, very bad day if they felt like it.
My one negative interaction with the police (coerced into accepting a search of my bag) was because I was doing something else illegal, listening to music while riding my bicycle, and I am smart enough to know the difference between beating the rap and beating the ride.
>>Becoming one is very competitive and requires passing difficult exams.
Same in India. Pay is very good(you also get to make a fortune through bribes), working hours are non-existent and you get other benefits like a lot of holidays, health care and fat pensions after retirement.
They aren't always government employees. For lots of programs the funding is awarded as a contract to a company to administer and fund the people in need.
It's not a hard problem, and it certainly isn't the fault of the individuals tasked with administering a broken and underfunded system. America's elites just aren't interested in solving it. They'd rather pass on indescribable fortunes to their children while the wretched masses beg for insulin online.
The American voting public has not the interest or attention span in tackling small complicated problems. The politicians they elect therefore has little interest or motivation to fix these small complicated problems because doing so usually involves spending political capital on compromises. Sometimes a few of them get big ideas about civic duty, but not very many people vote for that. They just vote for whomever yells the loudest about their set of pet issues which are usually red herrings erected to distract the population from actual issues. (abortion, gun control, immigration, etc. not that this issues are _unimportant_ but politicians use them to secure power on both sides and keep up the yelling because if they actually solved them, they would have to tackle the sorts of issues that threaten the powerful)
If you make sure that your government employees are educated, provided with good benefits, feel like they have an impact, etc., the outcomes will invariably be for the better.
A very good example of this is teachers. The OECD tells us:
"[...]in nearly all countries, when teachers perceive that appraisal and feedback lead to changes in their teaching practice, they also report greater job satisfaction. When teachers believe that appraisal and feedback is performed only for administrative purposes they report less job satisfaction. In addition, teachers who report that they participate in decision making at school also report greater job satisfaction. Indeed, although fewer than a third of teachers believe that teaching is a valued profession in their country, those teachers who report that they can contribute to school decisions are more likely to report that teaching is valued in their society."
http://www.oecd.org/edu/school/TALIS-2013-Executive-Summary....
And other sources tell us that satisfied teachers tend to lead to better outcomes.
"TN teachers’ job satisfaction linked to performance scores"
https://news.vanderbilt.edu/2017/02/01/tn-teachers-job-satis...
In other words, much like regular companies, governments with happier employees tend to have better outcomes. This should be hardly surprising to most HN readers.