what does it mean for the US healthcare system to be “bureaucratic in nature”
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We can start our answer by breaking down the word itself. The word “bureaucracy” comes to us from France in the mid-18th century.. From their own language, they took “bureau,” meaning a desk or office. From Greek, “kratos,” meaning rule or political power. “Bureaucracy” in its most literal sense is “rule by offices.”
Modern bureaucracy has four components. First, there’s a hierarchy. Each worker has a defined job, and a boss who oversees their work. That boss also has a defined job, and a boss who oversees their work. Second, there is continuity. Each worker is in that job full-time, and gets paid a salary. Third, each worker is impersonal. Their decisions are based on codified rules and procedures, and not personal feelings. Fourth, each worker has expertise. They are trained in a specific set of tasks, and know the rules they’re supposed to follow.
For a practical example, look to everyone’s favorite bureaucracy: the DMV. You go to the DMV to get your driver’s license. You go to the counter and give them all your identity documents. There is a defined list of which documents you can use to prove your identity. The clerk has been trained to know which documents are okay, what the rules for expiration are, and so on.
Then you sit down and take a written test, with a defined set of questions and a defined passing score. That test was written by an expert, and scored according to a universal set of rules. After that, you go out into the parking lot and get into a car with an examiner. That worker has been trained in how to administer the driving test, and asks you to perform a defined list of tasks. At the end, they compare your results to a defined passing score.
That’s bureaucracy. It doesn’t matter who you are, or who the worker is. Everyone who tries to get a driver’s license goes through the same process, following the same rules, and is judged by the same criteria. Whether or not you get a driver’s license will be the same no matter who is working at the counter, no matter who is administering the written test, and no matter who your driving examiner is.
When someone says, “U.S healthcare is bureaucratic in nature,” that’s what they mean. Medical care is governed mostly by trained employees who follow defined procedures and make decisions based on codified rules. Sometimes that employee is a doctor, following the hospital’s rules. Sometimes they’re an insurance negotiator, following the insurance companies rules. Sometimes they’re a hospital administrator, following the government’s rules.
But, like the DMV, decisions about your healthcare shouldn’t change based on who you are, which doctor you see, which insurance company you use, or which hospital you go to. Obviously the system *doesn’t* work that way all the time, but the *goal* of bureaucracy is to minimize those differences. Bureaucracy as a concept is rather different than bureaucracy as a thing that exists in the real world.
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