Almost everybody in Pakistan and that includes TV anchors, Op-Ed writers, drawing room analysts and members of the general public seem to know what the Pakistan Tehreek-e-Insaf (PTI) government is flawed. And all of them know what really needs to be done. But then if everybody and their aunts know what needs to be done and how to do it then why don’t the members of the PTI government know that to do as well?The question is whether Imran Khan and his band of merry men and women are entirely clueless or are they just trying to do the best they can? It is my opinion that they do know what needs to be done and really truly want to do it too. If we look at what Imran Khan wants to accomplish, I don’t think that many people will disagree with his aims. He wants better education, better health care, inexpensive housing, jobs for all, and things. And also lower energy costs, cheaper food and other necessities and of course law and order. All perfectly acceptable aims. So then why is he not able to get most of this stuff done or at least get started on getting these things done? I think there are three major reasons for that.The first reason is money. The government just does not have enough money to pay for all things like better health care, better schools and jobs for all those that want jobs. The primary reason why the government has no money is because people don’t pay taxes. Here is an important point, everybody talks about the rich not paying taxes but there are just not enough rich people that avoid taxes. If all of them did pay up, it will not make a major difference. It is the so called ‘middle class’ that now runs into tens of millions that needs to be brought into the tax net. However, the salaried middle class is already a part of the tax net. Who exactly belongs in this untaxed ‘middle class’? The list of this group is long. Most small shopkeepers don’t pay any income tax and they also do not charge or pay any sales tax. My favourite example of somebody that should pay taxes but never will is the roadside push-cart vendor. During more than six years I worked as a professor and head of cardiac surgery in King Edward Medical University/Mayo Hospital I often ordered food for my co-workers after a long day in the operating theatre.The primary reason why the government has no money is because people don’t pay taxes. Here is an important point, everybody talks about the rich not paying taxes but there are just not enough rich people that avoid taxes. If all of them did pay up, it will not make a major difference. It is the so called ‘middle class’ that now runs into tens of millions that needs to be brought into the tax netOne of the major sources for food was a push-cart ‘biryani’ seller located just outside the Gawalmandi gate of Mayo Hospital. Without going into too many details, this vendor easily made a profit on his sales of more than five thousand rupees a day. That comes close to one hundred and fifty thousand rupees in a month. My salary including all ‘allowances’ after six years of service in grade-20 came to less than a hundred thousand rupees a month and that before tax deduction. The biryani vendor made more than I did, but he would never even think of paying any income tax, let alone charging a sales tax from his customers. Why can’t such small shopkeepers and vendors come into the tax net? The answer is that the person responsible for bringing these people into the tax net is a low level ‘official’. This person walks into a small bazaar with maybe twenty shops and pushcart vendors. He collects a hundred rupees a day from each for not reporting them to tax authorities. In a month, he has already doubled his monthly income. It would be a major loss of income for him to force all these people to pay taxes. This problem goes all the way up the food chain with the amount of tax being avoided going up almost exponentially.The other major problem in getting things done is of course a matter of ‘governance’. Much is written and discussed about who rules Pakistan. The important question however is who ‘governs’ Pakistan? The answer is the bureaucracy, from the lowest to the highest positions. The bureaucracy also includes the police as well as the lower judiciary. Unless members of these three branches of government are willing to cooperate with the political government, nothing much can be accomplished. And that in my opinion is the main reason why the PTI government is facing such problems with governance.A bit more than thirty years ago, I had a chance to take care of a visiting senior Pakistani bureaucrat while I was practicing cardiac surgery in the United States. During a chat with him, he told me an interesting story about Zulfiqar Ali Bhutto, and when he took over as the prime minister of Pakistan. Bhutto called in all the senior bureaucrats and told them that most of his ministers were new to the government so it was the bureaucracy’s job to ‘guide’ them about how to govern effectively. The implied threat was that if the ministers did not perform well, Bhutto would hold the bureaucrats responsible.At present I believe that most of the bureaucracy all the way up has become so dependent on corruption to add to their incomes that any pressure to give up corrupt practices is contrary to their best self-interests. As such it is not in their interests for Imran Khan and the PTI government at the centre and in Punjab to succeed. This in my opinion is the major problem that Imran Khan has to face as far as governance is concerned. How to make bureaucrats work effectively when they see themselves being ‘impoverished’ by the policies of this government?Finally about the possible lack of political will. Here I do not think that Imran Khan lacks the will but he and his party have relatively weak coalition governments at the centre and in the Punjab. Essentially in both places he then has to adhere to the idea that politics is the art of the possible.The writer is a former editor of the Journal of Association of Pakistani descent Physicians of North AmericaPublished in Daily Times, January 30th 2019.