Can They Think Outside of the "Proverbial Federal Box?"

A couple of brief anecdotes illustrating what happens when large organizations run health care....
In Colorado, there is indignation over the Department of Veterans Affairs (VA) cancellation of plans to build a new hospital integrated with the University of Colorado medical center. Apparently, there was a lot of initial discussion about an innovative, cooperative building, but, as Lawrence Biro, director of the VA Rocky Mountain Health Care Network put it, VA architects are not used to designing integrated facilities. "That's the way VA hospitals are built." As for all the local discussions about the cooperative building, "This is out of my control. Planning of hospitals is driven from Washington." As Colorado Governor Bill Owens said, "apparently the VA can't think outside of the proverbial federal box."
In Florida, a fed-up physician is suing several managed care organizations (MCOs) about how they reimburse out of network physicians. Setting aside the merits of the suit, a telling remark was made by the spokesperson of Neighborhood Health, Bruce C. Rubin, "we've been paying a certain percentage of Medicare for years. It's standard procedure." Thus some Florida MCOs decide how to reimburse simply by paying a fixed proportion of what Medicare pays. So it seems they also can't think outside of the proverbial federal box.
Is it any surprise that large organizations don't make decisions outside of the box? But didn't a lot of people once argue that managed care innovation would reduce health costs while improving quality and access? And didn't others argue that the only way to save US health care is to nationalize health insurance? (The euphemism is "single-payer.")