Note that bureaucracies are not about outputs. They are about process. And it's been known since Weber's time that bureaucracies take on lives of their own. They're like one-celled organisms. Their only objective is survival. And survival in a bureaucracy is not about output but about process.
He's writing about national health care, but it applies to other fields, as well. I'm reminded me of my classmate, who's been on a "research rotation" in radiology. But it took him weeks to set it up, get the clearances, sign the waivers, and get the permission to view the films. Two and a half weeks into the four-week rotation, he could finally get underway. Doc Shazam has blogged about a similar experience.
Contrast this to my elective, out-of-state ED rotation, which involved some minor paperwork and mailings a month beforehand. When the time came to start, I just walked into the hospital with my white coat, introduced myself, and asked if I could help. Someone handed me a long needle, and told me to get some spinal fluid from the patient in room 14. I was off and running within minutes! (though the screams still haunt me)
I'm grappling with a branch of the research bureacracy now. I've been trying to submit this case for publication, and the process of adapting my writeup to the journal's standards has been mind-numbing. There's actually a 17-part checklist with instructions like:
In the cover letter include (1) statement on authorship responsibility, (2) statement on financial disclosure, (3) 1 of the 2 statements on copyright or federal employment, and (4) a statement of acknowledgment. Each of the first 3 statements must be read and signed by all authors. The corresponding author must sign the acknowledgment statement. (See the form at the end of these Instructions.)
After I collect the signatures I'm required to snail-mail the journal a floppy, like our brave forefathers did in 1989. And don't get me started about the formatting of legends and figures, which must "be in a CMYK color space." It sounds like Dianetics.
Contributing to the scientific literature shouldn't be effortless, but it's not like this byzantine process eliminates fraud. Because the output of research rotations and case writeups isn't as easily quantified as the output from spinal taps, more emphasis is placed on bureaucratic "process" and administration.
With the proliferation of scientific journals, increased funding, and growing armies of administrators, it should be getting easier to conduct and publish research. But I've been doing this for ten years now and, if anything, it's gotten harder.