Abstract

America's dim view of the bureaucrat needs reassessment because professional standards review organizations (PSROs) and national health insurance will increase the amount of contact between physician and bureaucrat. Inevitable conflict between The Organization and the physician is aggravated by the government-business adversary relationship based on constitutionalism. With more public funds, the budget-based health institution may acquire more of the characteristics of bureaucracy. For better understanding, the bureaucrat is described, and his main types and natural history outlined. Contrasts between business and government as revealed by interchange of executives are reported. Remedies for better interaction are suggested, including liaison groups and use of the apolitical, career bureaucrat. Rules for dealing with bureaucracies are listed, including The Constituent's Letter.

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