"An institution which is financed by a budget - or which enjoys a monopoly which the customer cannot escape - is rewarded for what it deserves rather than what it earns. It is paid for 'good intentions' and 'programs'. It is paid for not alienating important constituents rather than satisfying any one group. It is misdirected by the way it is being paid into defining performance and results as what will produce the budget rather than as what will produce contribution."