My job requires me to interact with HHS basically weekly and everyone I talk to has no idea what the heck is going on and constantly sends me over to someone who also knows nothing. And this department is the one who makes the rules for healthcare, scary I know. As for the ratio given you can see it in in the increase of federal workers over the years. Government is the only sector that didnt have a plateau effect with the birth of technology. Now the 5:1 ratio is completely arbitrary but the point still stands.