Found in 2 comments on Hacker News
specialist · 2017-02-21
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Interesting theory about corporation style bureaucracy taking over public (governmental) functions, leading to increased costs, among other side effects:
"The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy"
by David Graeber
Same economist who wrote Debt.
First theory for why public education has gotten so nutty. Like requiring K-12 teachers to have masters degrees and ongoing training (out of pocket) while paying them peanuts.
Frankly, this book blew my mind.
Two USPS workers. Package label says "Do not bend, fold, mutilate." One says to the other "Doesn't say anything about crumple!"
Har har har.
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I had high hopes for ACA. I believed the 15% medical loss ratio was the poison pill that would eventually drive insurers out of business, and therefore lead to Medicare for All. For comparison, Medicare's is under 5%, meaning 95 cents for every dollar spent goes to patient care, vs coke and prostitutes for the execs.
Silly me. There's no set of rules that can't be broken, gamed.
So now I'm for dozing it all down and rebuilding with universal coverage, single payer, using the capitation model (reward wellness vs fee for service). No more incrementalism. Just do it.
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Aside: Mid 2000s, my team created, implemented, supported 5 regional health information exchanges (eg BHIX). It was clear then, to everyone in healthcare IT, that we were pushing cooked noodles across hot pavement. Since then, it's only gotten worse. Overhead continues to grow geometrically, due to things like ICD-10 and meaningful care, without nudging the patient care (outcomes) needle one bit.
I can't explain it.
I just read about cost disease. It seems to explain rising costs, but I don't understand the mechanism, or what to do about it.
https://en.wikipedia.org/wiki/Baumol%27s_cost_disease
And this book blew my mind:
"The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy"
by David Graeber
http://amzn.to/2mi169U