Medicare Book Informs and Amuses

Medicare Book Informs and Amuses
February 1, 2007

Medicare Meets Mephistopheles

By David Hyman

Washington, DC: Cato Institute Press, 2006

138 pages, paperback, ISBN: 1930865902, $9.95


The road to hell, we're told, is paved with good intentions. If this is true, one might well believe Medicare was designed by Satan himself.

That is the scenario David A. Hyman outlines in Medicare Meets Mephistopheles. In the spirit of C.S. Lewis' classic The Screwtape Letters, Hyman's satirical take on Medicare asks us to journey temporarily beyond our three-dimensional moral universe and see public policy through the eyes of the devil.

In Hyman's amusing book, the biggest social "safety net" in the United States--the paragon of good intentions, providing health coverage for 42 million of our most defenseless citizens--was in fact an elaborate trap designed by none other than the devil himself.

The journey is humorous, witty, efficiently written, and above all else, enlightening.



Seven Deadly Sins

Hyman's examination of Medicare takes the form of a memo from Underling Demon 666, a bureaucrat slaving away in the Department of Illness and Satanic Services (DISS) in Washington, to "His Most Exalted Satanic Majesty," Lucifer (a U.S. citizen), in the seventh ring of Hell.

The memo, titled "Market Share Report," details the progress of DISS's attempts to "corrupt the American Republic" through the age-old recipe we know as the Seven Deadly Sins.

According to the memo, Medicare was not designed to help the elderly, but instead to eat away at the nation's moral fabric. Its success (or failure) is based not on economic calculations but rather on the number of souls corrupted.



Diabolical Scheme

Hyman finds a way to demonstrate rather cleverly how Medicare serves each of the seven sins. For example:

  • Avarice. Medicare reimbursement is based on inputs, rather than outputs. How much a provider is paid depends on how much he or she spends. This creates enormous incentives for gaming the system--so much so the government has been forced to pass a series of Medicare-specific anti-fraud laws. Of course, Hyman points out, the devil double-dips because the anti-fraud laws have become so strict they snare honest practitioners along with the guilty.
  • Sloth. Medicare is a sacred cow in Washington. So many people benefit from it that no one wants to touch it. But its finances are a "ticking time bomb" that will prove a crisis in future generations. More inactivity breeds more inactivity, until complete paralysis sets in.
  • Lust. Politicians "lust to extend the 'security' of Medicare to the balance of the population," Hyman writes. He goes on to quote newly minted House Majority Leader Nancy Pelosi (D-CA) declaring the "highest purpose of government is to send people checks in the mail."
  • Vanity. Medicare tarnishes the policy analyst, who becomes consumed by vanity and rationalizes that any program, no matter how horrid, is better than no program at all. The analyst ignores the burdens Medicare puts on the private market, preferring instead contorted and "asymmetric" arguments for maintaining the status quo.



Weak Spots

The attack on American virtues is robust, enduring, and (the devil hopes) overwhelming, according to Hyman's book.

But Hyman reminds us Beelzebub's grand design has weaknesses. Means testing, health savings accounts, and defined-contribution plans pose significant defenses against the havoc Medicare can wreak on American society.

In addition, Hyman notes, the Medicare Modernization Act (MMA) of 2003 established the "45 percent trigger," which requires the president and Congress to act (though the law doesn't say how) once 45 percent of Medicare's funding comes from general revenue as opposed to dedicated revenue.

Despite these threats, Lucifer still feels relatively safe. His Medicare system "pits the young against the old" and "guarantees politicians will make promises they cannot keep," Hyman writes. Any attempt to fix the system breeds "dissension and class warfare."



Amusing Read

Hyman's book is probably the most entertaining critique of Medicare available. He's able to lay down the nuts and bolts of the system, from the original legislation in 1965 to the MMA of 2003, and yet avoid lulling the reader into a coma. He does this through revealing anecdotes, historical asides, and even a joke or two. (Yes, Medicare can be funny.)

Hyman tells us about Operation Coffee Cup, an American Medical Association campaign to defeat Medicare in 1961. Women were encouraged to invite their friends over for coffee and listen to a recording of Ronald Reagan speaking against socialized medicine.

He also relates the amusing spectacle of angry seniors ambushing Rep. Dan Rostenkowski (D-IL) to protest the Medicare Catastrophic Coverage Act of 1988--a federal law passed to protect seniors from being financially ruined in the event of catastrophic illness. Hyman even scatters historical editorial cartoons throughout the book, keeping the reader's spirits up along the way.

The creative way Hyman approaches policy is refreshing. Though there's plenty of policy in Medicare Meets Mephistopheles, you don't have to be a policy wonk to read and enjoy it. Amen for that.


Mike Van Winkle (vanwinkle@heartland.org) is The Heartland Institute's media relations manager.