At the end of 2014, medical researchers published a shocking discovery: that outcomes for high risk cardiac patients at hospitals were better during periods when the top cardiologists were away from the hospitals for national cardiology meetings. The researchers dug deeper, conducting a more in-depth study, and in 2018 published that follow-up study which came to the same conclusion: more patients admitted with cardiac arrest or high-risk heart failure survived longer when the so-called top doctors were absent from the hospital. Which brings us to the question of the day: does meritocracy exist? In the above example, if meritocracy were real, who should be getting paid more? The top doctors, or the replacements who had better outcomes? Should the so-called top doctors be fired and replaced by their underlings, for “efficiency’s sake?” Or should they have to at least switch positions? There has been a lot of political fervor over workforce “merit” lately, and claims that the private sector is more “efficient” than the government because government decisions aren’t merit based while the private sector is some sort of pure meritocracy. A recent executive order even demanded the restoration of merit to government service. Which supposedly the DOGE Bros and their groupies insist can only be done by outside minds like theirs, from the non-governmental world meritocracy reigns supreme, are needed to restore balance to the force. Which, of course, anyone who has experienced rampant private sector nepotism and waste knows is complete BS. But it begs an examination of what meritocracy really is and if we find it in the competitive world outside of government or if, in fact, we might find it in the least likely place imaginable given all the rhetoric floating around: a government entity. Back to our original cardiologist example, if a meritocracy should exist in any widespread field of business, it would be in medicine. Patient outcomes are tracked on a wide scale and the data is voluminous, both for physicians and for hospital systems. Not only that, but private health insurers, at least according to themselves, oversee the whole process by providing capital-based pressure and incentives that would necessitate merit-based decisions and drive efficiency and improved outcomes. Capitalist efficiencies on top of capitalist efficiencies! It’s everything that the efficiency experts could dream up for creating a pure private sector meritocracy. So, does it work? Do the doctors with the best outcomes get paid the most and are positive outcomes maximized? We can see from the study on cardiologists that it doesn’t seem like they do in that particular instance. But what if we took it broader? Around the same time that the cardiologist studies were being conducted, medical researchers discovered that patients treated by female physicians have significantly lower mortality rates and readmission rates than those cared for by male physicians. Follow-up research, just like it did with the cardiologists, came to the same conclusion. In short, patients treated by female physicians experienced 1 fewer death per 417 hospitalizations and 1 fewer readmission per 208 hospitalizations. With about 35 million hospitalizations in the US every year, that’s a big deal. Obviously, because of the vast amount of data available in medicine, the capital pressure from an entire insurance and industry, and the rapid consolidation of healthcare firms through mergers and acquisitions—something that CEOs and DOGE types constantly tout as increasing efficiency—there must be a significant difference in pay between male and female physicians. Market efficiency makes no other result possible, particularly at such a large scale, according to their science-y market religion. And they are right, there is a difference! A pretty big one, in fact. Female physicians make approximately 24.6% less than their male counterparts during their careers. And that’s after adjusting for things like specialty, hours worked, years of experience, age, marital status, family structure, and research and clinical productivity. Hmmm… Thank God for market based meritocracy. But then again, if you’re an efficiency expert I suppose you can always look at it through a different lens: the hospitals are getting a cut-throat rate on the better performing doctors! Seriously, though, if pay doesn’t match up with performance in a field full of educated professionals with easily accessible metrics, does anyone really believe that it matches up in more nebulous fields where insiders give their favorites non-stop hook-ups without an accountability system whatsoever? There is no better example of accountability-free hook-ups than the board of Boeing hiring one of its own, Dave Calhoun, to “clean things up” as CEO when its planes were falling out of the sky. Which of course, he failed to do, yet still raked in around $90 million. Ah, the sweet meritocracy of rewarding failure, of which ample CEO’s give us great examples. How about the former CEO of Merrill Lynch, who was rewarded with $159 million for losing billions of dollars and costing his company millions in fines for playing around with subprime mortgages and plunging our country into the great recession. For all the recent talk about private sector efficiency and accountability and complaints about how hard it is to fire a federal employee who is failing, I would bet it’s a lot harder to fire a CEO than one of those federal employees. If these guys were serious about merit and accountability, ironically, there might not be a better place to look than a section of the federal workplace: the US Military. In the Marine Corps everyone is rated, all the time, both on subjective and objective performance metrics. Everyone is also moved around from boss to boss and job to job so that you can’t get screwed or hooked up by just one supervisor. As for accountability, as a commanding officer in the Naval Service, you are held responsible for everything that happens in your command, oftentimes whether it was your fault or not. 16 Navy commanders were relieved of command in 2023, for example. That doesn’t mean it’s perfect, every system has hook-ups, but it certainly paints a clearer picture than anything I’ve seen for professional advancement proposed by the incoming private sector crowd. Except, I should say, what they have implemented in aggressive service jobs like being an Amazon truck driver. They have a very intense solution there that I’m sure is quite effective: tracking every second of your time, watching you on camera, forcing you to poop in bags in order to meet quotas, and turning AI systems into your overlords. That’s the actual endgame of all of this. Efficiency for these guys isn’t about merit, no matter how many times they say it. There are thousands of federal employees that would welcome better and more meritorious systems. But so far it doesn’t seem like that’s what we are going to get. Instead, what we have seen is a bunch of tech bros looking to instill fear, turn workers against one another, break unions, and extract every last drop of sweat and blood from those of us who work for a living in order to support the lifestyle and whims of an ownership class that is tired of government getting in its way. Until they’ve succeeded in accomplishing that, I hope the worst thing that happens to you down at work is the bro who got his job because his dad was in the same frat as the boss explaining how important it is to bring private sector merit and efficiency to the jacked up government while he’s placing his FanDuel bets and updating his fantasy roster. Lucas Invite your friends and earn rewardsIf you enjoy Lucas’s Substack, share it with your friends and earn rewards when they subscribe.
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Friday, February 14, 2025
The Myth of Meritocracy
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