The Cost of Bureaucracy

Posted on the 29 November 2013 by Markwadsworth @Mark_Wadsworth
There was an interesting comment by DBC Reed about bureaucracy and competition in an earlier post, that has triggered a memory of post that I intended to write:-
I know I have rehearsed King Gillette's argument that competition increases bureaucracy before and you have acknowledged the validity of some of it,but there are newer contributors on here who appear to be enemies of the Post War British state founded on a mixed economy so some continued resistance is in order.
I'm not disagreeing with DBC Reed here, but I've long wondered how much the cost of bureaucracy affected things like competition.
Let's imagine you're working as a GP in the 1930s. You've got a patient with an ingrowing toenail. How efficient would it be to have competing hospitals providing ingrowing toenail surgery? That GP would have to send each hospital a letter, written by hand, posted, wait for a response of a few days. Someone at that hospital would have to check the appointment book, see when they could fit someone in for an ingrowing toenail operation, write back and once the GP got all the quotes a few days later, he would then write to the particular hospital and book them in. The GP then has to send a letter to the patient.
That's not only slow, it also has lots of cost in people's time writing things to and fro.
Here's how you can do it today: A GP taps a request into a comparison system. It sends a message across the internet to the servers of each hospital, that check an online appointment book, find available slots, and report back a price and availability time in about 5 seconds. The GP then selects it, at which point the system books the slot at the hospital and sends an email to the patient.
The model for today costs a lot to set up, but once set up, the transaction costs are miniscule.
What I'm wondering is whether in the past, we suited more of a state-run model, with large, centralised organisations, because while competition would have lowered prices, the cost of the bureaucracy to run it would have been so huge as to wipe out the gains, but having dramatically lowered the cost of bureaucracy, we now suit more of a fragmented model.