"It doesn't feel planned."

This made me think of a noteworthy corollary: airport control towers.

In the United States air traffic control is heavily regulated, and as a consequence the technology used is straight out of the 1970s - moving about little scraps of paper. In Canada, on the other hand (apparently we're more economically free than the US? http://www.heritage.org/index/ ) there is less regulation, and the entire process is computerized.

For those of you who watch Breaking Bad, the disaster at the end of Season 3 probably wouldn't have happened if the US adopted a similar system.

I think that 'planned' is a fallacy; systems as complex as Hospitals and Airports resist central planning, allowing the troops with their feet on the ground to design their own solutions often leads to a better result. I'm reminded of the time I worked at Bell Mobility's Engineering dept - the only rule I had to follow, expenses wise, was "You cost the company twice what you're paid per hour - if hiring outside is more efficient, go ahead and do it." The entire office was loose and deregulated, and gosh darn, did we ever get things done!

Distributed decision making will occasionally result in 100 different researchers using $12.50/hour temps when pooling their resources would give them a computer programmer for less, but the hours spent in coordination would be expensive. On the other hand, the inefficient paper/electronic organization you bring up feels like the hallmark of over-regulation.

To quote Robbie Hanson, "Coordination is hard!"