MEDICARE MEETS MEPHISTOPHELES. I spent last night at D.C.'s best bookstore/coffee shop, Politics and Prose, reading through David Hyman's new book Medicare Meets Mephistopheles. Hyman is an adjunct scholar at the Cato Institute, and his book, as you may have guessed from the title, takes as its conceit that Medicare is a demonic program sent to encourage all manner of deadly sins and, eventually, bring down the American republic. Spending so much time in the blogosphere, where libertarians are over-represented, I occasionally forget that libertarianism is a distinctly fringe ideology. Seeing them (jokingly) suggest that the massively popular and successful (if deeply in need of reform) system of health insurance for the elderly has Satanic origins helpfully reminds me of that fact. That said, the book is actually quite good. I'd happily recommend it to anyone with a basic grasp on health care and a desire to learn a bit more about Medicare. Hyman is a felicitous and fun writer, and he conveys an impressive amount of history and data in as accessible and absorbable a manner as one could hope. I know how tricky it is to make health care a quick and gripping read, and I tip my hat to anyone who is capable of enriching the debate and educating readers by doing so. What always fascinates when I read right-wing critiques of American health care is how similar our diagnoses are, but how diametrically opposed our treatments would be. For the right, more consumer risk is required in order to encourage wise treatment decisions on behalf of patients. That means, of course, that those who make poor decisions, or simply get really ill, face financial ruin. That seems crazed and cruel to me. While I do think the left needs to take financial incentives more seriously than it does, I'd favor having many more carrots than sticks, and I'd want to separate out poor decisions and behaviors from simple bad luck. HSAs and all the rest punish the illogically stricken as surely -- or more surely -- than they do the stupid. And I'm not even ready to punish the stupid. So much as I think it inadvisable that half of those with HSAs haven't deposited a cent, I've no interest in abandoning them to the consequences of that oversight.
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Ezra Klein
