Medicare Meets Mephistopheles

by David A. Hyman

Let's say you're the devil, and you want to corrupt the American republic. How would you go about it? According to David Hyman, you might create something like Medicare, the federal health care program for the elderly. Hyman submits that Medicare may be the greatest trick the devil ever played. Medicare feeds on the avarice of doctors and other providers, turns seniors into health care gluttons, and makes regions of the United States green with envy over the dollars showered on other regions. The program exploits the sloth of government officials to increase the tax burden on workers and drag down the quality of care for seniors. Medicare makes Democrats lust for socialized medicine, while its imperviousness to reform makes Republicans angrier and angrier. Most of all, Medicare allows its ideological supporters to bleat and preen their way to the heights of moral vanity. In the style of C.S. Lewis' The Screwtape Letters, Hyman writes that Medicare has freed the self-interest of these mortals from its natural restraints. As a result, the seven deadly sins have blossomed. With epic political battles over Medicare and the future of limited government looming just over the horizon, Hyman uses satire to cast a critical eye on this mediocre government program.

Hardcover

First published August 10, 2006

Reviews

[Steven H · Rating 3 out of 5]

A CRITIQUE OF MEDICARE, IN THE FORM OF LETTERS FROM A DEMON

David Hyman wrote in the Preface to this 2006 book, "Given Medicare's centrality to health care and health policy, it is not surprising that it has attracted considerable attention---including a 2003 conference ... on 'The Future of Medicare, Post-Great Society and Post-Plus Choice: Legal and Policy Issues.' I was invited to speak at the conference... the Cato Institute (where I am an adjunct scholar) read my contribution ... and invited me to turn it into a short book, in the hope that my satirical take on Medicare would be of interest to a larger audience." (Pg. xvii)

He intersperses his serious discussion with an allegory (a la C.S. Lewis's 'Screwtape Letters') in the form of letters from 'Underling Demon 666' to 'Lucifer, Prince of Darkness.'

He notes that "Medicare does not cover long-term nursing care. Overall, Medicare pays for roughly 45 percent of the health care expenditures of its beneficiaries." (Pg. 15) He observes, "Medicare's proponents routinely brag about its low administrative overhead. Of course, the figure is artificially low because Medicare has no marketing expenses, and its uses employers, the Internal Revenue Service, and the Social Security Administration to collect and process its premiums." (Pg. 25)

He asserts that "Medicare is only 'affordable' because of the infusion of hundreds of billions of dollars in subsidies from the rest of the population. There has been no popular uprising in favor of a one-payer system, despite periodic attempts to package it as 'Medicare for all.'" (Pg. 49) Later, he adds, "Everyone knows that Medicare spending is increasing dramatically, in both relative and absolute terms. Demographic projections and the ever-increasing cost of health care ensure that the program's economics are simply unsustainable." (Pg. 73)

He concludes, "Medicare is NOT a sacred bond between the generations. It's just a program and a pretty mediocre one at that." (Pg. 105)

Hyman's analysis is interesting, although his "letters" between the demon and Lucifer are a very pale imitation of Lewis's sparkling satirical prose.

[Anthony D · Rating 5 out of 5]

Medicare Meets Mephistopheles by David Hyman is the most honest and clear-eyed diagnosis of the U.S. healthcare system I’ve ever read.

It’s a book about incentives, arithmetic, and political reality—and that’s exactly why it’s so devastating. Hyman dismantles the comforting fiction that Medicare is “earned,” prepaid insurance and replaces it with what it actually is: an intergenerational transfer program sold to the public under assumptions that quietly stopped being true decades ago. The brilliance of the book is that it doesn’t rely on ideology or outrage. It relies on math.

What makes this book exceptional is its refusal to indulge in magical thinking. Every supposed “solution” to Medicare’s problems—cost controls, payment cuts, non-interference clauses, value-based care—is shown to be either politically impossible, economically incoherent, or quietly abandoned once it collides with reality. Rather than confronting the tradeoffs honestly, policymakers choose the path of least resistance: squeezing providers, shifting costs, and pretending tomorrow will somehow be richer, healthier, and more numerous than today.

Hyman’s writing is sharp, often dryly funny, and relentlessly precise. He doesn’t tell you what to think—but by the end, it’s impossible to unsee how structurally unsound the system is.

If you care about healthcare policy, Medicare, or public finance—and especially if you’ve been told the system just needs “better management”—this book is essential reading.

[Momdad]

Very thought provoking application of the seven deadly sins to various players participation in the Social Security bureaurcy, and impacts on the elderly, medical process, and economy.

[Lindsay McAllister · Rating 3 out of 5]

Easy to read and gives a basic overview of Medicare - and why the author thinks it is terrible. I can't wait to be done with my thesis...then it's back to reading fun stuff.

[John · Rating 3 out of 5]

A satirical look at the destructive Medicare program, showing how it fosters the 7 deadly sins and undermines American virtues.