I don't think scale is really the problem here. If so it is the scale of health care costs primarily. Since those tend to explode easily, workers are expected t

I don't think scale is really the problem here. If so it is the scale of health care costs primarily. Since those tend to explode easily, workers are expected to document every little step they take. And if a nurse spends 10 minutes to console somebody, she is in need to justify that time towards her superiors, who in turn need to justify the cost of health care to insurers, who in turn need to justify their expenses to patients or government. It is a self-reinforcing circle of hell and fully behaves that way because wrong decisions are taken at multiple steps. It isn't even that complicated, just short sighted incentives that fail to get a system under control. The case for Google is another one. The incentives of the company slowly changed as it moved onto the path many corporations took before. It isn't a necessity, but the drive to growth put them there where they are today. They wanted money, the problems of software logistics were already solved when they were a smaller company. In fact only when they were successful more and more people wanted an in on the profit. Of course problems are often more complicated in detail, but I don't think too many people looking at the larger picture are really the problem. > Naive ideological purity That is just a rant, I don't think there is any evidence of that happening anywhere.