Here is some of what happened during COVID, according to Patrick McKenzie (patio11) [1] :

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I want to both be polite about the fact and be honest about it. We, the United States of America, through our elected representatives and through civil servants who represent our interests, committed monstrous crimes in 2021, which are against the laws, traditions, and constitution of the United States of America, including aggressively redlining the provision of life-saving medical care in a way which was designed to cause racially discriminatory outcomes with the provision of medical care.

Just throwing that out there as a statement. With that caveat, one of the things that we spent tens of millions of dollars on was that we want your consultancy to write a website which will enforce residency restrictions. A residency restriction is essentially, when we are under a supply constraint, there must be some method to decide which people get it, and some people don’t. We have, in our infinite wisdom as the government, decided that equity, equity, equity is one primary thing that we are focusing on. A thing that we think would be contrary to equity is allowing anyone who shows up at the clinic to receive the life-saving medication.

The thing that we are specifically worried about is relatively well-resourced people from advantaged demographics will use their superior access to transportation and information to travel to clinics which have the vaccine available and take that instead of that vaccine being used by someone in the local community who we intend the vaccine to go to. Therefore, to get an appointment to go to the vaccine, you will need to go to the county’s website, which is delivered by Accenture or similar, and prove to the website that you reside within one of the zip codes that we have allocated for those vaccine doses. Only then will you get the ticket, virtual or otherwise, which allows you to go to the pharmacy and get the vaccine. We spent tens of millions of dollars on that, targeting essentially a four-month window where we were acutely supply constrained. But we did not turn off residency restrictions on the websites after that four month window because we physically had no way to do that because that was not in the bid documents in some cases. ...

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Just one of the many ways that rigid institutions that behave more like stupid robots than things capable of dynamic decision-making cause immense harm. This is not a rant against equity btw, only against insanity.

[1] https://alethios.substack.com/p/patrick-mckenzie-vaccinateca

This is real and there's no way to get these problems down to zero. However I do believe that the best first step is to make sure the government has more employees and fewer contractors. It will cost more year to year but the delivery will be much closer to what the constituents want and over time I would expect it to save money as well. With that said it's not a silver bullet as that group of people needs to be properly motivated, they still will need specialist help from consultancies, and there may be institutional capture anyway.