I often find clients with horrendous legacy technology stacks—systems that are bug‐ridden, poorly‐written, undocumented, and that don’t even work for what they need to do.

It makes sense that people will end up with some technical debt. But in many cases, people in the organization who are trying to improve the situation are stymied by political blocks from other people who would rather protect a fief than try to improve the business process.

I’ve begun to wonder if it’s possible for such companies to actually have nice software, or if the organizational dysfunction is so fundamental that it will poison any development or acquisition process.

I was speaking to a friend of mine a bit ago, who is the IT manager of a hospital. We got on the subject of Electronic Medical Record systems, and he said that there’s little chance for anything good to come of them.

He said that problem is that American private hospitals already are highly computerized, it’s just that the computer systems are focused entirely billing and not at all on medical records management. The hospital considers it critical that you get charged for every tongue depressor used, but they’re significantly less enthusiastic about making sure your x‐ray gets to the right person.

He said that his hospital will end up turning to their billing software vendor to purchase their EMR system. This is a decision that has, pretty much already been made, and one over which he has no control.

While EMR systems like the Veterans Administration’s VistA program exist and are well‐liked by nurses and doctors, they provide no functionality to ensure that you get billed for that tongue depressor. Software that doesn’t integrate with the hospitals’ existing billing system has no chance of being chosen. This gives hospital billing system vendors the contract by default. And they have no incentive to actually make EMR software that works.

Western Europe has long defied economic growth models by remaining stubbornly poorer than the United States. In his 2002 paper Two Centuries of Economic Growth: Europe Chasing the American Frontier, Robert J. Gordon, an economist at Northwestern University, attempts to explain the paradox. His conclusion questions our assumptions about wealth, the wisdom of American post‐World War II urban development policies, the GDP as an accurate measure of wealth, and the future viability of the American way of life.