Friction & Medicare

Medicare & "Friction"

I'm going to take another stab at saying what I was trying to say below. Sovay is furious because she is shocked and angry that the government's screwups are causing human suffering -- sickness and, perhaps, death, due to something that should have been avoidable. I am angry at the obvious corruption, but I'm not at all shocked, and so I can't muster the same level of outrage. I don't think the government could have done better than it did, because of the flaws native to giant Federal bureaucracies.

People often make the mistake of trying to point fingers at specific mistakes in cases like this. I don't doubt that we will soon see documentation that shows particular administration officials made particular mistakes; and it's easy, in the face of such data, to believe that the mistakes could and should have been avoided. The response I often get to this fatalistic attitude about government incompetence is, "How can you say the government couldn't have done better? Here's ten things it did wrong. If it had done those things right instead, there would have been a much better result." Obviously, that is true on its face: if the Bush administration officials hadn't made the mistakes we will soon be told that they did, things would have been better.

The problem is that it's not possible to run a giant Federal agency without making mistakes. Nor, in fact, am I convinced that the mistakes made at the top are more important than the compilation of mistakes made by the 99.5% of any Federal bureaucracy who aren't at the top -- the civil servant class, which doesn't change from administration to administration except through natural hiring and retirement.

A lot of the problems that appear that arise in these efforts come of that great force impeding human design: friction. I'm no expert on health care, although as you can see I have some opinions about it. I do know a thing or two about military science, and history, and it seems to me that there's a very useful concept we need to bring across to this kind of discussion.

Probably the single greatest military scientist was von Clausewitz; and among the things that earned him that title was the recognition of the problem of friction in war. Clausewitz wrote about "friction in war," but it is obvious that friction exists outside of war as well -- it is just that war exaggerates and worsens its effects. Part of the reason that armies make the mistakes they do is the pressure of blood and fire; but a large part of it is that they are also large bureaucracies, and much of friction arises from the failures that are natural to that form of social organization.

For example, Clausewitz speaks of generals bedeviled by "reports both true and false; by errors arising from fear or negligence or hastiness; by disobedience born of right or wrong interpretations, of ill will, of a proper or mistaken sense of duty, of laziness, or of exhaustion; and by accidents that nobody could have foreseen." Well, and so are bureaucrats; and not only the top level bureaucrats, but bureaucrats at every level. The top level are getting their reports from the field filtered through multiple lower levels, each one blurring the picture; the middle levels can hardly compile the next set of reports from the top level before new directives come down for additional reports, all the while those middle-level bureaucrats must also try to direct operations below them; and the people below are separated from the ones above by these multiple levels, so that they cannot really know what they should be preparing to do or when, or why, or how. No sooner do they think they understand the plan of action and start to prepare, then down filters a new report from on high that tells them that last plan was abandoned weeks ago, and they're only just finding out about the change now. So they must begin again; and the report begins to make its way back to the top that they have had to start preparations over, and so they are not nearly so far advanced along as previous reports had indicated.

This is the nature of bureaucracy. War makes them worse; but so do any matters of life and death, such as health care.

This is not to say that brilliance is impossible, or that no 'general' is capable of better results than another. We celebrate Ulysses S. Grant's Vicksburg campaign because it was brilliant -- but not because it was flawless. A general has to make do with the reality of friction.

I thus regard it as essentially inevitable that, of the 3.6 million new prescription drug beneficiaries, 2.6 million were signed up within the last 30 days. Of course they were. Everything is done at the last minute. That is the nature of things. The bureaucracy designed for day to day operations couldn't handle the surge of the sudden crisis caused by having to institute a major change; it never can.

Where the Bush administration is culpable (aside from their participation in the corruption attendant to the law-writing) is in not having realized that a crisis was inevitable, and prepared accordingly. They should have warned people that major disruptions in basic, life-sustaining services were all but inevitable, and to prepare themselves as best they could. They should have been ready to delay the roll-out until the crisis of late registrations could be minimized. They should have been had excesses of money set aside to address the inevitable collapse.

Really, they should never have done this at all. Yet they insisted. Well. Every major change in a massive Federal bureaucracy must be approached as if it were war: and that means expecting casualties. For major changes to a bureaucracy of any size are always a crisis, just like a battle is a crisis. If anyone's life depends on that bureaucracy, some people will die. That truth, the truth of friction, is a law of nature as immutable as gravity.

So no, I am not shocked, nor surprised, only sad to see it. It is somewhat like receiving news of a distant battle, and mourning the dead -- but we are not surprised that there were dead in a battle. Nor should we be surprised if dead come from this -- not surprised, nor given over to fervent belief that if only this or that mistake had not been made, if only someone better had been in charge...

No, probably not even then. Even Grant made mistakes, and he was a genius in his day.