Fantasy Despot Syndrome

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In this essay, I offer a deeper diagnosis of the problems with healthcare.gov.

Cutler’s memo strikes me as shallow and self-serving. He is shocked, shocked to find that when his pet health care reforms are passed through the political process, their implementation is hampered by politics. In that sense, Cutler suffers from Fantasy Despot Syndrome.

I go on to contrast people who try to solve problems and undertake reforms by starting businesses with people who try to impose solutions through the political process.

Meanwhile, I’m seeing reports of progress on fixing the web site. It is impressive that the tech folks have been able to improve the performance of the system without any major setbacks (data losses or multi-day outages). They must have a pretty robust release process in place.

Getting the front-end enrollment process functioning should give them time to iron out the remaining technical problems. However, other business issues remain with this startup-without-a-CEO. Will individuals who are not experienced health insurance shoppers be able to figure out how to choose?. Do the insurance plans have enough doctors willing to participate to sustain consumer satisfaction? etc.

8 thoughts on “Fantasy Despot Syndrome”

  1. I had a similar take on Cutler. His memo is astute as it applies to the immediate technical problems with Healthcare.gov, but seems to ignore the larger implication – what reason was there ever to believe that you could find the perfect regulators to write 1000+ perfect regulations to make the ACA meet all its nominal goals?

    Cutler actually hit upon this larger issue when he wrote “You can’t change the culture by piling new responsibilities onto a broken system.”; but that is precisely what the ACA does, yet Cutler’s memo seems to think that the White House just needs to take a better management approach to solve everything.

    I wrote about this, as well as my sister’s experience in getting her cancellation notice for a policy she was very pleased with, here: http://havechanged.blogspot.com/2013/11/is-healthcaregov-problem-or-is-there.html

  2. given how many posts you’ve written on healthcare.gov…. you might want to actually use it at some point lol. 😉

    • I tried early on, but I live in Maryland, which is one of the states where the computer system (last I heard) it still not working.

  4. Just remember all those justifiable reforms blocked by the political process, Despots all around.

  5. I enjoyed the content, but do you have a phrase that is more palatable than “fantasy despot syndrome”? This is not the essay that will open the minds of people who happen to be along a different political axis

    • A more general (but no more palatable) diagnosis could be “self deception”. As Tyler says in a recent MR post:

      “When in doubt, self-deception about helping is the next best thing to helping itself, and cheaper to produce”.
      http://marginalrevolution.com/marginalrevolution/2013/11/a-theory-of-good-intentions.html

      A charitable way to phrase that:
      “Your brain wants to help so badly it’s tricking you into thinking your ideas will work. Turns out, reality is harsh and actually helping is really, really hard. Don’t feel bad about it. Just set your sights a little lower.”

      I don’t have a short, catchy version yet 🙂

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