> The joke is that it's gotten so progressive that no one gets better
I don't think that's the reason. Public health systems in Canada/France/Belgium have (had?) a very good reputation because they were in fact really good until the neoliberal turn on the 80s/90s. When you have health workers running the show with a fair budget, wait times are low and results are good, and everyone is happy. Now introduce some managerial feudalism (see David Greaber's talk at CCC last year) and micro-management/benchmarking and things start to degrade.
Add to this mix that big corporations don't pay their dues and the government keeps reducing budgets and pretending they don't know why there's no more money flowing in and suddenly you've got health crisis on a wide scale and most people you know working in hospitals are depressive, either quitting or on the verge of suicide due to contradicting objectives: they want to help people but they're not given the means to do so. Social dues fraud is dozens of billions of euros every year in France, it's well-known and well-flagged and no government wants to do something about it.
If you're working in IT, think about it this way: management is benchmarking how many functions you write per day and does not care about the state of things as a whole. You are incentivized not to produce tests (which would indicate failure from your team specifically) but rather to ship away at once. Are you gonna produce good code?
EDIT: I should make it clear when i talk about social dues fraud, i don't mean individuals gaming the system to gain funds they're not owed (which is < 1% of fraud), and i'm not talking about small companies not paying their dues (the State is really good at harassing those until money flows in), i'm talking about CAC40 corporations who make billions of profit every year. They are the ones responsible for the social security hole ("trou de la sécu") and that's public knowledge.