Customer Reviews

Medicare Meets Mephistopheles

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Professor David Hyman has used the seven deadly sins to serve up an easy to read description of the Medicare mess. His satirical approach is both amusing and on target. I think this small volume is required reading for both the layman and the expert. The book supplies a historical perspective, and provides a useful focus on the Medicare problem areas. I think this focus and fact driven perspective is essential, if the nation is to make any progress confounding Mephistopheles.

No ordinary survey, MEDICARE MEETS MEPHISTOPHELES takes the form of allegory, and is written as a memorandum from an underling demon to the devil himself. Devilish details demonstrate Medicare's pitfalls and the foundations that only undermine honesty and encourage greed and profiteering. In using satire as a vehicle for analysis, Hyman provides a biting analysis easy to digest.

Diane C. Donovan
California Bookwatch

I see the Cato true believers think this is a wonderful book. And it is well-written, so long as one is prepared to ignore the elephant in the room: How much would it cost to provide healthcare to this, or any, population under a Cato-endorsed program?

Until the day when I see the Cato institute suggest that corporations should not have individual rights as do people under the Constitution, and in particular that their accounting should be open to public scrutiny by anyone for any reason rather than shielded by the fourth and fifth amendments, I will know that Cato is still uninterested in free markets. Free markets cannot exist without transparent access to information.

In the specific case, we could compare the cost of providing care to those 65 and over via Medicare, a single-payer program with good enough reimbursement rates that health plans actively recruit new Medicare enrollees, with the costs of providing health care to the 55-65 year old population who are working within the marketplace for insurance. In order to make the comparison, we would need to have accurate information from three large groups of players whose real accounts are currently invisible to us: the insurers, the hospitals and the pharmaceutical industry.

To the extent that aggregate date exist, they indicate that 55-65 year olds pay far more per capita for healthcare than Medicare will pay per capita on their behalf once they are eligible; that even with that disproportionate cost, a large fraction have no access to insurance and another large fraction have very high co-payment rates for physician visits, inpatient care and medicines.

There are two large economic reasons for this; one, the private insurers are not in a position to negotiate rates as effectively as Medicare is due to simple economies of scale and two, the private insurers have no real incentive to negotiate rates. No one sees their true costs and in the current system everyone is rewarded for padding the costs - hospitals, drug companies and insurers.

What Cato is not answering in its book is the obvious question: How much will health care cost in the absence of Medicare? If the invisible hand of the free market would truly drive costs down, why are the insurance and pharms industries squealing so loudly about letting a government-backed plan compete against them?

20 years ago, Harry and Louise told us the market was a better solution to the problem of healthcare. In that 20 years, neither industry nor the Republican-dominated Congress have changed or innovated anything substantial in the way of improving access to care.

Guys, you've had two decades to do something believable here. Step aside, give a different approach a chance.

This book is really a satire against Medicare. It is written from the perspective of one of the Devil's executives. This executive writes a memo (essentially the whole book) to his boss (The Devil) about how well Medicare is working out in their malevolent plan. I considered it very entertaining reading.