A small dictatorship like NK can be controlled by a handful of people, often relatives. The family model also works for mafias, up to a certain size. But grow your association of lawlessness beyond a point and you’ll find yourself in desperate need for the protection of the law.
This is an interesting observation because it is the opposite of Alexis de Tocqueville‘s observation that democracy was well-suited to small states like Athens and Britain but large states like Russia needed autocracy.
Consider USA where there is a mismanagement problem with healthcare -- onerous regulations, rent-seeking, gatekeepers, state capitalism, crony capitalism, corrupt bureaucracies, anti-trust issues, and insufficient investment in training and development.
If healthcare is unnecessarily expensive by 10% -- then that's 2% of the American economy misallocated. Also, the lost human potential because of worse healthcare outcomes is another drain.
Now imagine if that was par for the course everywhere you look.