This article is so on point. It's about IT in government but it applies to healthcare just as well.

"Unintended consequences of outsourcing for government

Outsourcing software means outsourcing knowledge. This may not be obvious, because the people doing the human portion of the service provided are still employed by the agency, yet that's only a superficial assurance. When no true software specialists are available in government IT procurement, gullible career bureaucrats will go with the most charming vendor. Too many hugely consequential technical decisions are made by administrators with superficial knowledge. Even if one refrains from the cynical position that government employees operate under loose financial restrictions, how could one expect them to accurately assess the potential or monetary value of a piece of software?

When a big company comes to a real software professional with an estimate of $200,000 for what is otherwise conservatively estimated as two weeks of work, they will get called on it. When they do that to a glorified Excel clerk promoted to decision-maker as a reward for their dedication, critical assessment cannot be expected. Because all technical expertise and a substantial portion of the business knowledge is essentially deferred to the outsourcing entity, they act as the ultimate authority on the subject matter. This is not about demonizing the private, profit-oriented enterprises. There is nothing inherently ill-intentioned in vendors' behavior. However, the dynamics in this public vs. private relationship are skewed."

I feel like there is constantly asbestos in my building needing to be remediated. considering how much everything else seems to get messed up, it terrifies me.

Before and after. I look like a totally different person. I kind of prefer the before.

Don't run and jump onto slippery wooden stairs with sandals on.

Look at that pot hole. I feel like baby Jessica could be down there. This winter killed it. This winter killed everywhere. I think the entire city is going to have to be repaved.