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Bureacracies tend to be bad at new things, get better over time if given stable goals. That's what has happened with the ACA. Huge new task, bad rollout, but learning led to improvement. But hard to get better if org leaders want policy to fail & actively create problems 1/
This is one basic difference between public and private organizations. Sometimes public organizations are led by people who oppose the underlying mission. As Terry Moe has put it, public orgs rely on political rationality, not technical rationality 2/
There are some basic norms about how far executive branch political leadership can undermine public goals. Basically, you can't violate statutory goals. But that is precisely what Trump admin has been doing with ACA 3/
