One of the whole points of Government always has been … to raise money for Government.

Which, as the wonderful book Seeing Like a State explains, is why we have surnames and agreed weights and so on. To raise its money easily Government needs to measure, and it is much easier to measure things in neat compartments – hence state-imposed standardisation. And ever-more state-imposed control.

The problem is that the greater the central standardisation and control, the less room there is for experimentation and innovation.

And in any case the paradigms for thinking about all these issues come from earlier times when the very ‘information technology’ tools available for measurement required cumbersome data aggregation and associated centralisation.

Sprawling systems have emerged (the UK NHS and state education are classic examples) which depend upon formalised information management methods which are now obsolete.

Hence the problems with Obamacare, which seems to be all about creating dozens of complex new ponderous state-run arrangements for control over US healthcare, rather than tackling systemic weaknesses in the existing schemes to loosen things up.

Can things be done differently, empowering both doctors and patients through clever use of new technology?

Yes:

Mr. Bush thinks the main benefit is the “collective intelligence” that he is starting to weave together from the 87% of American physicians who practice solo or in groups of five doctors or fewer. “We found one of the last few remaining crowds in health care, which are these independent practices. Now you can argue that this decentralization is not the best thing in the world,” but what’s most important, he argues, is that “they’re still allowed to go and make their own decisions.”

In effect, as the network gets bigger, it gets smarter, while opening the space for innovations to feed off one another and spread. There really can be “radical improvement” in health care, Mr. Bush says, but only if there are “radical improvers” able to set themselves apart and lead the forward advance. “No one ever says, ‘Here’s to the average,'” he declares pointedly.

The point of today’s IT is that it allows private and public sector organisations alike to do something which was literally impossible: to capture the benefits of centralisation and the benefits of decentralisation simultaneously.

Alas we’ll get to those benefits only by the existing behemothic systems crashing under the weight of their own incompetence. Which will be unpleasant.