When it comes to government and IT, my fear is less about efficiency than it is about how easily it seems to be that our adversaries are able to exploit rotting systems.
I think the comparison to healthcare is on point, as the single payer advocates on the left have no understanding of the technical and process debt that will not allow you to just wave a magic wand to bring about utopia.
I think part of the impossibility of upgrading the IT infrastructure is simply resistance to change. Certain stakeholders certainly like the status quo, for a variety of reasons (from relatively benign to borderline malicious). But the “this is The Way we’ve done it” mentality is strong.
I hired on with a DOE prime contractor a little over two years ago. When first shown some of the systems we have to use, my thought was “you’ve got to be kidding me.” The systems were obsolete well over a decade prior.
The reverse is also true. There are no shortage of contractors offering to upgrade "obsolete" systems with vastly more expensive platforms that don't maintain the functionality of the existing systems.
Even in the private sector, there is no shortage of examples of these kinds of efforts to reinvent the wheel ending in disaster. Stakeholders are right to be skeptical.
Electronic medical records: My wife has been struggling with this as an RN for over 40 years. The problem is rarely stated: There are many different proprietary medical records systems. They do not talk to each other. My wife for a time worked in a hospital in which the Emergency department had its own MR system, which didn't communicate with the main hospital system. So if a patient was admitted to the hospital from the ER, all the records had to be re-entered into the hospital system by hand.
Then there is the fact that for most senior citizens, for most of our lives medical records were on paper in files in discreet clinics and hospitals. In my case it would be impossible to find most of those records, spread across several states and cities. Most have almost certainly been destroyed.
So let's standardize! Yeah, right. Absolutely the worst thing that can happen to caregivers in a hospital or connected clinic is to switch MR systems. They barely have time to enter all the details now, much less to learn and navigate the new system, which is always more complex and less user friendly.
Giving the government better IT infrastructure would be bad, because it'd make them faster and more effective at stealing and tortiously interfering (with their magical cloaks of of protection created by libraries full of written laws and regulations) with everyone's lives. E.g. an IRS with a hypothetical AI hyper-computer could put everyone in federal prison from the skid row to the yahct club.
Actually, HIPAA could have done some good if it had not been stupidly paranoid about privacy. Can your doctor email you the results of a test? No but they can FAX it to you! Text you? No, they can call.
The budget deficit is not as important as reducing govt expenditures. An inflation tax, at less than around 5%, is less bad than high or higher taxes on production. A tax cut which increases production is better than reducing the budget deficit.
I favor a Balanced Budget Amendment, and ways to reduce govt increasing taxes or costs.
Buying out govt workers is a good idea. Fast 5-10% reduction ... maybe more?
Govt IT could be good, like in Estonia, but so far the USA hasn't shown it much. The Obamaware website roll-out was terrible. Medical info sharing remains elusive, and it doesn't seem to be getting better. Making a small program, for the DC folk only, at first, would be a better process.
8 year term limits should be tried for new hires -- as well as prioritizing total previous income taxes paid over the last 40 years. Those who have paid more in taxes, usually older & more experienced In Real Life, should be hired before recent college grads.
Anyone who thinks you can just easily do a bunch of IT system replacement at this scale with these sorts of stakeholders has never done IT system replacement.
With all of the break out energy and drama the new administration has unleashed, it’s tempting to feel a bit annoyed by Dr. Kling’s pessimism. However, even now the establishment is building a new Death Star with even more diabolical powers of immiseration than we can hardly even begin to comprehend. The prudent thing to do is to get out while you still can and build a home in some third world country without the infrastructure to engineer and impose a bug-eating, dormitory dwelling, battery powered, AI controlled social credit prison society. But for those few brave souls willing to risk the “I told you so” taunts of the defectors, the dream of an Argentine style revolution with substantive and sustainable reforms ennobling all citizens and bringing forth a great human flourishing will need to be enough to motivate endurance through the coming struggles and is really the only hope that the United States has for a brighter future.
So how do we dispel the doom and gloom of the “Disappointing Donald and the Limp Dick Republicans” nay-sayers and offer a compelling “Hold my beer, Milei” alternative vision? Well a lot of it is going to be propelled by people like @fentasyl (~~datahazard~~ on X) doing the hard work of going through the data and calling out the truth regardless of whose feelings it hurts. The administration’s feet needs to be held to the fire and the member of Congress need to be scrutinized and called out when it persists in their troglodytic ways. With this current last gasp of free speech there is great potential for great things to be accomplished. But will it be enough?
To understand Milei’s success it is necessary to understand the structural advantages he enjoys under the relatively enlightened constitution of Argentina. The most important of these are the blessings of the rule of low afforded by a jurisdictionally constrained supreme court and rationally distributed and non-redundant court system: Milei has an order of magnitude less arbitrary and irrational interference from the courts than Trump is faced with. The second of these are the checks and balances between the Minister of Defense and the Ministry of Security, that is between the national armed forces and the provincial security forces, the National Gendarmerie, a significant, militarily trained body used to guard borders and places of strategic importance, and the Naval Prefecture that protects inland water ways. In Argentina it is much more difficult to imagine military generals in open defiance of Milei than a replay of what we saw in the first Trump administration and Milei is at much less risk of a military coup.
The obvious and best solution is also the most difficult and it would be of course be to defenestrate the current constitution and reinstate the Articles of Confederation. (Reading between the lines here: https://www.supremecourt.gov/publicinfo/year-end/2024year-endreport.pdf , Chief Justice Roberts makes a great case for this). Short of this, a legislative program authorizing interstate compacts to assume the responsibilities for health, income security, law enforcement, immigration enforcement, domestic defense, agriculture, emergencies, transportation, energy, environment, and education currently vested in central government agencies is needed. Who will step up? Mike Lee, Rand Paul, a nation turns its lonely eyes to you. Unfortunately the easiest way, championed by nearly every economist, appears to be simply eliminating social security benefits and diverting social security tax receipts to funding discretionary government programs. Perhaps once the easy way to kick the can down the road becomes attached to specific person or party, a charismatic opponent will rise to the occasion and champion the more difficult and unpopular task of actually limiting the central government’s unconstitutional metastasis.
UHC dba Optum has been snapping up medical offices because Obamacare put a cap on their insurance revenue.
It's unlikely that the wonks writing that bill thought that limiting insurance companies revenue would therefore encourage them to get into the doctor business.
I was going to write something on DOGE but I think you wrote just about the clearest piece on the issue that I’ve read. Should be required reading for all reformers.
When it comes to government and IT, my fear is less about efficiency than it is about how easily it seems to be that our adversaries are able to exploit rotting systems.
I think the comparison to healthcare is on point, as the single payer advocates on the left have no understanding of the technical and process debt that will not allow you to just wave a magic wand to bring about utopia.
I think part of the impossibility of upgrading the IT infrastructure is simply resistance to change. Certain stakeholders certainly like the status quo, for a variety of reasons (from relatively benign to borderline malicious). But the “this is The Way we’ve done it” mentality is strong.
I hired on with a DOE prime contractor a little over two years ago. When first shown some of the systems we have to use, my thought was “you’ve got to be kidding me.” The systems were obsolete well over a decade prior.
The reverse is also true. There are no shortage of contractors offering to upgrade "obsolete" systems with vastly more expensive platforms that don't maintain the functionality of the existing systems.
Even in the private sector, there is no shortage of examples of these kinds of efforts to reinvent the wheel ending in disaster. Stakeholders are right to be skeptical.
Electronic medical records: My wife has been struggling with this as an RN for over 40 years. The problem is rarely stated: There are many different proprietary medical records systems. They do not talk to each other. My wife for a time worked in a hospital in which the Emergency department had its own MR system, which didn't communicate with the main hospital system. So if a patient was admitted to the hospital from the ER, all the records had to be re-entered into the hospital system by hand.
Then there is the fact that for most senior citizens, for most of our lives medical records were on paper in files in discreet clinics and hospitals. In my case it would be impossible to find most of those records, spread across several states and cities. Most have almost certainly been destroyed.
So let's standardize! Yeah, right. Absolutely the worst thing that can happen to caregivers in a hospital or connected clinic is to switch MR systems. They barely have time to enter all the details now, much less to learn and navigate the new system, which is always more complex and less user friendly.
Giving the government better IT infrastructure would be bad, because it'd make them faster and more effective at stealing and tortiously interfering (with their magical cloaks of of protection created by libraries full of written laws and regulations) with everyone's lives. E.g. an IRS with a hypothetical AI hyper-computer could put everyone in federal prison from the skid row to the yahct club.
Actually, HIPAA could have done some good if it had not been stupidly paranoid about privacy. Can your doctor email you the results of a test? No but they can FAX it to you! Text you? No, they can call.
Isn't DOGE, in theory at least, run by an empowered leader, pretty much what a COO/Chief Auditor would look like?
First step in reforming healthcare: Eliminate/suspend HIPAA.
That will streamline record sharing & portability.
The budget deficit is not as important as reducing govt expenditures. An inflation tax, at less than around 5%, is less bad than high or higher taxes on production. A tax cut which increases production is better than reducing the budget deficit.
I favor a Balanced Budget Amendment, and ways to reduce govt increasing taxes or costs.
Buying out govt workers is a good idea. Fast 5-10% reduction ... maybe more?
Govt IT could be good, like in Estonia, but so far the USA hasn't shown it much. The Obamaware website roll-out was terrible. Medical info sharing remains elusive, and it doesn't seem to be getting better. Making a small program, for the DC folk only, at first, would be a better process.
8 year term limits should be tried for new hires -- as well as prioritizing total previous income taxes paid over the last 40 years. Those who have paid more in taxes, usually older & more experienced In Real Life, should be hired before recent college grads.
But it can still fulfill the most important (to Trump) mission: Perform toughness.
Anyone who thinks you can just easily do a bunch of IT system replacement at this scale with these sorts of stakeholders has never done IT system replacement.
With all of the break out energy and drama the new administration has unleashed, it’s tempting to feel a bit annoyed by Dr. Kling’s pessimism. However, even now the establishment is building a new Death Star with even more diabolical powers of immiseration than we can hardly even begin to comprehend. The prudent thing to do is to get out while you still can and build a home in some third world country without the infrastructure to engineer and impose a bug-eating, dormitory dwelling, battery powered, AI controlled social credit prison society. But for those few brave souls willing to risk the “I told you so” taunts of the defectors, the dream of an Argentine style revolution with substantive and sustainable reforms ennobling all citizens and bringing forth a great human flourishing will need to be enough to motivate endurance through the coming struggles and is really the only hope that the United States has for a brighter future.
So how do we dispel the doom and gloom of the “Disappointing Donald and the Limp Dick Republicans” nay-sayers and offer a compelling “Hold my beer, Milei” alternative vision? Well a lot of it is going to be propelled by people like @fentasyl (~~datahazard~~ on X) doing the hard work of going through the data and calling out the truth regardless of whose feelings it hurts. The administration’s feet needs to be held to the fire and the member of Congress need to be scrutinized and called out when it persists in their troglodytic ways. With this current last gasp of free speech there is great potential for great things to be accomplished. But will it be enough?
To understand Milei’s success it is necessary to understand the structural advantages he enjoys under the relatively enlightened constitution of Argentina. The most important of these are the blessings of the rule of low afforded by a jurisdictionally constrained supreme court and rationally distributed and non-redundant court system: Milei has an order of magnitude less arbitrary and irrational interference from the courts than Trump is faced with. The second of these are the checks and balances between the Minister of Defense and the Ministry of Security, that is between the national armed forces and the provincial security forces, the National Gendarmerie, a significant, militarily trained body used to guard borders and places of strategic importance, and the Naval Prefecture that protects inland water ways. In Argentina it is much more difficult to imagine military generals in open defiance of Milei than a replay of what we saw in the first Trump administration and Milei is at much less risk of a military coup.
The obvious and best solution is also the most difficult and it would be of course be to defenestrate the current constitution and reinstate the Articles of Confederation. (Reading between the lines here: https://www.supremecourt.gov/publicinfo/year-end/2024year-endreport.pdf , Chief Justice Roberts makes a great case for this). Short of this, a legislative program authorizing interstate compacts to assume the responsibilities for health, income security, law enforcement, immigration enforcement, domestic defense, agriculture, emergencies, transportation, energy, environment, and education currently vested in central government agencies is needed. Who will step up? Mike Lee, Rand Paul, a nation turns its lonely eyes to you. Unfortunately the easiest way, championed by nearly every economist, appears to be simply eliminating social security benefits and diverting social security tax receipts to funding discretionary government programs. Perhaps once the easy way to kick the can down the road becomes attached to specific person or party, a charismatic opponent will rise to the occasion and champion the more difficult and unpopular task of actually limiting the central government’s unconstitutional metastasis.
Small medical practices being bought out by hospitals, hedge funds, & insurance companies is an unintended result of Obamacare.
What makes you think it wasn't intended? Don't Democrats always want to centralize?
UHC dba Optum has been snapping up medical offices because Obamacare put a cap on their insurance revenue.
It's unlikely that the wonks writing that bill thought that limiting insurance companies revenue would therefore encourage them to get into the doctor business.
I was going to write something on DOGE but I think you wrote just about the clearest piece on the issue that I’ve read. Should be required reading for all reformers.
Regarding the first mission. What if Trump just told the Treasury to stop writing checks.
It seems he did that already, but a judge already put an injunction on that memo to stop the "stop writing checks", so the checks keep going out.
Mailing out checks doesn't take so many people to keep the checks going out.