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" ... Finally, higher-income, better-educated people are almost always more successful at navigating bureaucratic systems. The British NHS is not like Walmart, which continuously monitors its sales in order to make sure it always has in stock whatever its customers want, when they want it. It’s more like a Department of Motor Vehicles, where the lives of employees are improved if the customers get tired of waiting and go home. Rationing by waiting is as much an obstacle to care as rationing by price. It seems that the talents and skills that allow people to earn high incomes in the economic marketplace are similar to the talents and skills that are useful in successfully circumventing bureaucratically managed waiting lines. ... "
" ... I've seen two kinds of approaches to creating a sandbox engine, both using a separate firm. A large health insurer wanted to disrupt itself, so it launched an innovation sprint within the main business. It then encouraged four members of the winning sprint team to take a two-year transfer to a startup firm that the company had invested in, to make their idea a reality. Startups and sandbox engines often suffer from a lack of exceptional talent – either they get pure innovators who don't understand the nuances of how mature companies work, or they get corporate types who think incrementally and bureaucratically. This approach elegantly solved the problem and kept some restless employees from leaving entirely. ... "
" ... “Is there any reason to think that this time will be different? The safe bet is no. Existing institutions were born out of, thus reinforce, the paradigm of bureaucratically organized control of schools. To make the changes outlined above would ask states and districts to release power, authority, and control; it would ask unions to move away from industrial-style bargaining and toward a professional-style reform unionism; it would ask practitioners, commercial designers, and university researchers to assume new roles and work in different forms of collaboration. All of these changes run against the grain of the institutions in which these people work; even if individuals are on board with the ideas outlined above, the orientation of the institutions in which they are housed is not. History does not suggest we should be optimistic about the fundamental changes called for here, precisely because they seek to dismantle many of the institutional pillars on which the modern school system was built. ... "