The American government has expanded through theinterweaving of public functions with private power

In the past five decades federal spending has continued to grow at a significant rate, and yet at the same time government employment has remained relatively flat. Donald F. Kettl takes a close look at this relationship, writing that much of the trend is down to the interweaving of federal programs with private organizations, such as the provision of Medicare by private health insurance companies. He argues that this interweaving is important, because the complex programs it produces can lead to more waste, fraud and mismanagement, and that they can also create challenges for improving public trust in government, as it becomes less directly connected to citizens.