The bureaucratic mindset
|

As I reflect on the PPACA (Patient Protection and Affordable Care Act) legislation on the Supreme Court's docket - all 2700 pages of it - it occurs to me that it's a perfect example of the bureaucratic mindset, and why that kind of thinking can't work.

One defining characteristic of the bureaucratic mindset is an extraordinary level of obsessive compulsiveness. In this world view, the solution to a complex problem is to anticipate every possible contingency and write down what the response should be in each and every case. Of course, this approach is hopeless and self-defeating, and even worse, sets the stage for the regulated to eschew responsibility for compliance, and for abuse by agents of the bureaucracy itself.

It's a hopeless approach because you can't possibly anticipate all the contingencies, and it's self-defeating because to the extent that you even try, you create an impenetrable wall of regulation that defies mastery by any individual. That's why, for example, we have a whole industry that's evolved to help citizens with their taxes. The tax code - all 70,000-plus pages of it, is another exemplar of what the bureaucratic mindset produces.

Although it's virtually impossible to anticipate every possible contingency and prescribe the appropriate response, the attempt to do so, and the presumption that it's been done virtually eliminates the opportunity for individual judgment, and in doing so, eliminates any sense of personal responsibility. The truth is, very complex problems defy simplistic prescriptions. That's not to say that complex issues can't be regulated.

The FDA creates guidelines for an extraordinary range of complex issues involved in regulating and enforcing the Pure Food and Drug Act and its extensions. The agency has no shortage of detractors, but review of its regulatory output suggests that it attempts to avoid the bureaucratic mindset by offering guidelines, not prescriptions for managing the issues for which it is responsible.

For an example of the alternative, consider HIPAA - the Health Insurance Portability and Accountability Act of 1996. Intended to protect patients' rights to privacy of their health information, HIPAA's byzantine prescriptions and penalties have inspired an industry of healthcare providers largely clueless about the letter and the spirit of the law, who take no accountability for its accurate implementation, or responsibility for the inconvenience they create.

Finally, products of the bureaucratic mindset set the stage for abuse by the bureaucracy itself. To the extent that there is oversight, legislation like PPACA invites arbitrary and politicized action, because the requirements are so complicated and contradictory that ultimately they can be used to justify any decision. The tax code has been the "take-down" tool of last resort by law enforcement for many years. PPACA is only 2700 pages, but that's more than enough to serve the same purpose - and all the rules aren't out yet!

Implicit in the bureaucratic mindset are the following underlying assumptions:
1. people's judgments cannot be trusted.
2. bureaucrats who write regulations are sufficiently omnipotent to anticipate all contingencies and prescribe optimal responses to all of them.
3. people who genuinely want to do a good job will be satisfied following rules that others have laid out.

In short, the bureaucratic mindset is the outgrowth of a kind of terminal hubris that imagines those who create and enforce the rules as the only stakeholders worthy of any respect. We've had enough of that already. I, for one, would like to see more judgment and fewer rules. We'd all be better off for it. We might even get better health outcomes at lower cost ...

Related Entries:


keep in touch     Follow Us on Twitter  Facebook  Facebook


Our Research

Rhetoric and Reality—The Obamacare Evaluation Project: Cost
by Paul Howard, Yevgeniy Feyman, March 2013


Warning: mysql_connect(): Unknown MySQL server host 'tmiweb52.vwh.net' (2) in /home/medicalp/public_html/incs/reports_home.php on line 17
Unknown MySQL server host 'tmiweb52.vwh.net' (2)
Archives

Blogroll

American Council on Science and Health
in the Pipeline
Drugwonks
Pharmalot
Reason – Peter Suderman
WSJ Health Blog
The Hill’s Healthwatch
Forbes ScienceBiz
The Apothecary
EyeOnFDA
KevinMD
Marginal Revolution
Megan McArdle
LifeSci VC
Critical Condition
EconLog
In Vivo Blog
PharmaGossip
Pharma Strategy Blog
Drug Discovery Opinion