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“Medicare Meets Mephistopheles,” So True

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By Leslee Kulba-The moral of the story, Medicare Meets Mephistopheles, by David A. Hyman, is that it’s all been done before. This silly little book takes the perspective of laughing rather than crying over problems with Medicaid. The book was published in 2006, long before the arguments were recycled with such precision one could learn a lot about Obamacare by merely replacing “Medicare” with the latest iteration of the diabolical doings.

Though factual, the story is written from the perspective of what was going through the mind of Underling Demon 666, Deputy Assistant Special Coordinator for Accelerating Recruitment in the Department of Illness and Satanic Services. Hyman claims he is only reprinting a memo the minion sent to Satan boasting Medicare’s successes. Hyman, presumably, intercepted it.

Chapters are organized around the seven deadly sins and the two American virtues, which the author says are thrift and truth. Had Hyman really wanted to be demonic, he would have written in a far more insidious tone. Instead, he merely lays out the problem, presenting facts, and then interjecting little kiss-ups for the DASCAR’s master. The main point would be that anything designed to please the animal brain with instant gratification also tends to enslave the poor sucker to the hand that feeds it. At one point, the demon lauds the program for allowing his comrades to “further our mission on a wholesale basis, instead of continuing to buy souls at retail.”

Demon 666 starts with an overview of the history of Medicare, noting it was “dysfunctional from the get-go.” President Lyndon B. Johnson sold it to the American public as a miracle, noting only the demand side and what people would get, paying no attention to the fact that the recipients were also the ones footing the bill – with overhead. The trick was to get enough humans suckered into the pyramid scheme before anybody realized it was a sinking ship of fools. Notes the demon, “The sinking of the Titanic closed relatively few of our open accounts. The temptations of Medicare, its impending implosion, and the resulting demoralization will add tens of millions to our ranks.”

Medicare is a bloated bureaucracy. Its administrators were initially transferred from the Department of Social Security. Its focus is on processing paper and has nothing to do with ensuring or encouraging quality of care with efficient delivery. The demon gloats the program, which focuses on inputs not outputs, is discharging patients “quicker and sicker.” Because utilization is more important than healing, do-gooders have developed a mantra against anecdotal “waste, fraud, and abuse;” which the little devil celebrates for pitting suspicious patients against healthcare providers. It also creates demand for regulation that “has doctors, lawyers, and administrators at one another’s throats.”

The underling quotes a former insider who said, “There are plenty of $400 toilet seats in the Medicare program because Medicare cannot deliver services to its beneficiaries without a provider and because providers are major sources of campaign contributions in every Congressional district in the nation.” Since the healthcare lobby is the largest in the country, a number of laws have been enacted to cater to special interests. The result is conscientious physicians sometimes have to choose between helping people and obeying the law.

The vanity of politicians and their lust for re-election serves the demons well. Indeed, the demon notes, half the politicians have been deluded into believing “’the highest purpose of government is to send people checks in the mail.’” Medicare is the achievement of bipartisan cooperation. It is hailed by the “groups purporting to support the elderly.” Medicare was described as the third rail of politics: touch it and you die. Putting it all together, “any harebrained idea that occurs to some junior staffer in Congress or midlevel bureaucrat in HHS can be packaged and deployed as an explicit exercise of the spending power.”

The demon boasts success in the failure of potential human recruits to see who is really behind the diabolical scheme. The demons get a particular thrill when advocates for their program think they are working for the other side, and opponents, who would “exorcise” the diabolical nonsense are branded as working for Mephistopheles. Then, when the righteous get fed up, they get angry and say things that don’t make sense, making the demons roll on the floor with delight. The demon quotes Saul Bellow to try to explain the humans: A great deal of intelligence can be invested in ignorance when the need for illusion is deep.

Threats of exorcism the demon lists are efforts to liberate humans to stand tall and use their own brains, and perhaps even hang out with the demons’ angelic enemies, to improve their own conditions. Angelic proposals the little devils will continue to demonize include “prudent purchasing.” The demon notes seven strategies Al Dunlap, former president of Scott Paper and Sunbeam, says are essential “for any company buying anything.” Demon 666 then exults, “The striking thing is that Medicare has historically done none of these things!”

Another threat is demand for means testing. Healthcare plans that offer defined contributions instead of defined benefits will provide some predictability for the books of insurers. More importantly, plans that give the insured a lump of money and tell him he can use it on healthcare or whatever else he wants should put a clamp on overutilization of healthcare services. Allowing persons to contract with private providers or to own their own HSA’s are two other rumblings keeping the minion ever vigilant. Highest on the demon’s list, though, are attempts to stop Medicare drug funding.

In conclusion, the demon tells his master, “Your design of this program guarantees that politicians will make promises they cannot keep and delays the day of reckoning so that the citizenry will order their entire lives around the unreasonable expectations the politicians create. You have guaranteed that when the day of reckoning finally arrives, all you-know-what will break loose.”

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