John Goodman, in a post that is good throughout:
In general, a bureaucratic system is one in which normal market forces have been systematically suppressed. In such an environment, there tends to be a sea of (relative) mediocrity, sometimes punctuated by little islands of excellence. Further, the islands of excellence tend to be randomly distributed. They do not correlate with much of anything.
This picture not only describes most public school systems around the world, it also describes most health care systems. (In fact, I can’t think of a single exception.)
He points out that in health care as in education, no matter how you slice it, results don't seem to be correlated well with anything you can transplant. Higher spending as often leads to worse results as better. Interventions into schools by well-meaning judges, city governments, etc. seem to have no statistically significant impact. Adding IT or changing the way hospitals are paid likewise has no consistent impact on health care.
Needless to say, I am sympathetic to the point that bureaucracy tends to lead to random results. I think it may be one of the reasons there is a wide discrepancy between the left and right on the use of government. I suspect most people can't mentally handle the notion that things are random. So what they do to resolve such situations is ignore one half of the results. If you ignore the part where the government is doing well, you are a conservative; if you ignore the part where the government fails, you are a progressive. It's the only way that two intelligent people can look at the same series of events and see the policy implications as 180° off from each other.
H/T Arnold Kling
Comments