The same way decisions are made in large public (state owned*) or private firms as well as public service institutions in our systems. People get hired and do these kinds of decisions across such institutions all the time. All of these issues are tackled and there are imperfect solutions that with all the pitfalls and mistakes work alright.
* Actually I'm not sure if the US does state corporations but we do in Canada. For example in rail, air travel, nuclear power (design and implementation), telecom, housing, etc. Of course we've privatized many of them with not so great results for the public, just like the UK did. They've made a lot of money for their private shareholders though.