This quote offers a nuanced commentary on the dynamics of control and influence within complex systems like healthcare. Clark's statement highlights the importance of empowering key stakeholders—doctors and patients—and removing unnecessary barriers that hinder effective decision-making and care. It resonates with broader themes of decentralization and democratization, emphasizing that the ultimate goal is to facilitate better outcomes by enabling those directly involved in the process. However, the humorous twist reveals an acknowledgment of human nature; even as we strive for openness and collaboration, there remains an unavoidable 'asshole'—a metaphor for those who may impede progress or act selfishly—who resides at the center of the system. This self-awareness underscores the challenge of designing systems that are fair and efficient, given that imperfect individuals will inevitably influence outcomes. The quote also touches on the paradox of leadership and influence—the very individuals attempting to improve processes may sometimes become the bottleneck themselves. The humor and honesty serve as a reminder that systemic change is complex and iterative, requiring humility and continuous effort. In the context of the book '(The New New Thing: A Silicon Valley Story)', it reflects the innovation culture that thrives on challenging traditional hierarchies and fostering empowerment, yet always contends with human imperfections. Recognizing that no system is perfect allows us to set more realistic expectations and focus on incremental improvements. Ultimately, the quote stands as a candid reflection on human nature within progress, emphasizing that while systems aim to reduce adversarial forces, certain centralized influences—whether leaders, key stakeholders, or persistent individuals—inevitably shape the landscape.