I post this now because the author (Balaji Srinivasan) has recently been named as a contender for heading the FDA: https://www.statnews.com/2017/01/12/fda-trump-oneil-srinivas...

Note that "exit" here is not synonymous with "secession", but instead refers to Albert Hirschman's contrast of "exit" and "voice" as two complementary approaches that individuals can use to influence the society around them: http://peterlevine.ws/?p=11887.

In this context, the option of "voice" includes the approach of reforming institutions from within, while "exit" leaves them broken and bypasses them with new alternatives. Given Srinivasan's embrace of "exit", this makes him an intriguing candidate for overhauling a massive federal bureaucracy.