I continue to be impressed by the depth of the insight found in Thomas Sowell's "Knowledge and Decisions".
Here is my attempt to discuss some part of it that.
One of the major constraints facing human is lack of knowledge for making the many decisions they have to make in the business of living and just getting by.But decisions have to made and analysis of how and where these decisions are made offer meaningful insight into a lot of which transpires.
We can speak of decision making units (DMU) ( my abbreviation) and attempt to examine the processes involved .Much can be learned about that by looking at the incentives and constraints under which the DMUs operate and the extent to which their (its?)decisions and actions are subject to feedback.The DMUs also may vary in the extent to which they engage in incremental trade offs as opposed to categorical solutions.Sowell correctly emphasis that for analytic purposes one should not look at an organization's purported "mission statement" but rather at their incentives and constraints
Sowell contends that over time in the United States there has been a shift in the locus of the decision making.There has been a shift from decisions traditionally made in the home to the school, from businesses to various governmental agencies and to the courts. Further, within government there has been a major shift from decisions made by the legislative branch,concerning which voters have at least the chance of influencing the decisions, to the executive branch with its too numerous to list agencies and departments which are much more immune to the power of the vote and more insulated from public feedback and often given much difference by the courts.
These administrative entities have " .... political initiatives and its own external constituencies developed as a results of initial mandate, constantly pushing for an expansion of its activities and benefits." ( from page 318 Sowell, "Knowledge and Decisions" Basic Books, 1980,)
Medical decision making has also migrated from the decisions made by the individual patient physician "dyad" to more central decision making directly and/or indirectly by insurance companies,large medical practices, pharmacy management companies and HHS.