I see where you're coming from but none of the stuff related to the article is happening on that level. It isn't top down intentional negligence that's causing these sorts of incentive misalignment. It seems to be good old fashioned incompetence.

These doctors are shooting all the dogs (metaphorically speaking of course) but they're shooting all the dogs because the organization they work within has incentivized that behavior. It's not a top down policy to shoot (metaphorical) dogs. It just so happens that if your top down policy is to suck at everything then there's no motivation to stop the people at the leafs of the organizational tree from shooting dogs (denying disability wrongly as a matter of standard) practice. I think this is incompetence, not malice. The people actually misbehaving are too far removed from policy for this to be malice.

All of this stuff is happening at a high level. At the low level it’s all people responding to their incentives, it’s the high level that sets up the system.

Surely there are incentives at work at higher levels as well? That isn't "outside" the system.

People at the bottom can only change their own actions. So if 3/4 of them act well you still have a problem. However, if 3/4 at the top act directly they can change the rules.

Many of the incentives that act on higher levels are set in the Constitution or well-established law. The laws become a little bit worse from this perspective every year, as new forms of nest-feathering are introduced and entrenched. The system as it exists "incentivizes" this process. This will not be fixed by those whose own incentives lock them into this system, whatever level they inhabit.

The US is not in a steady downward spiral. Some years things improve and others they get worse, but it’s individuals that make the decisions shaping history.

Of course USA is not in a downward anything. USA government on the other hand is certainly circling the bowl. There is a difference between those! It may be that various states of America will eventually decide on a different way of organizing society. I'm hopeful, because when things change they often get better.

It's curious that you can see how incentives shape the behavior of some people, but not that of other people.

I am specifically saying the US government has been more and less corrupt in the past.

It’s not about people at the top responding differently it’s about the flow of influence. If 20% of the people at the bottom behave poorly the other people at the bottom have little influence. That changes at the top as it’s easyer to monitor a small group of people and their actions are more documented.

Ex: A cashier can fail to scan items for their friends at checkout and without any form of paper trail. The CFO can do more harm, but it’s harder for them to act in secret.