The lab of ideas = advantages the rich e.g. Steve Jobs. "In 2009, Steve Jobs received a liver transplant—not in northern California where he lived, but across the country in Memphis, Tennessee. Given the general complications of both travel and a transplant, Jobs’ decision may seem like an odd choice. But it was a strategic move that almost certainly got him a liver much more quickly than if Jobs had just waited for a liver to become available in California." https://arstechnica.com/science/2017/03/live-death-math-and-...

The challenge is maintaining the multiple independent systems when faced with pressures like "hey, if we consolidated systems, the the % of waiting list patients who die within 6 months of enrolling goes from 8% to 4%, and the % who receive a transplant go from 60% to 65%".

The UK system undoubtedly had a bad outcome, but the reasoning behind consolidation was sound, and the benefits real and ACTUALLY achieved (just not dispersed justly). Maintaining independent systems would mitigate against some of these failures, but would long-term be out performed by a responsive consolidated system (which I think is ultimately what the article is arguing for - not against algorithms, but against black-box algorithms that are not responsive or amendable to public scrutiny and feedback).

There are definitely times and places with independent implementations provide a strong benefits, but I think this is a much more borderline scenario.

And btw, the US has a unified organ matching system.

I think the advantage of the laboratory of ideas these days is mostly that it prevents knuckledraggers in other states from hindering progress in mine, but with a strong federal govt it’s looking less and less realistic