In this lively and creative debate, Professors David Hyman and Jill Horwitz argue about the virtues and vices of the federal Medicare program. As some predict a bleak future for the American’s government’s ability (or inability) to continue paying for Medicare as the population ages, this debate shows that there is genuine disagreement about the severity of the problem. In his Opening Statement, Professor Hyman offers a satirical letter to the Devil from one of his demonic servants, describes the Medicare program through the lens of the seven deadly sins. Arguing that Medicare’s faults are represented in each sin, the servant promises that Medicare is on track to “destabilize the virtue of the American republic.” Hyman’s fictional minion predicts that, unless the federal government enforces “fiscal discipline” on the program, the Medicare program will “implode within two generations.” Hyman advocates for a market-based solution, believing that “[i]f people spending their own money don’t want what the Medicare program is offering, we are by definition spending more on health care than we should, and, in doing so, we are undermining the fiscal integrity of the nation as a whole.” He writes, “[o]nly the Devil could come up with something that fiendishly clever.” Professor Horwitz responds by arguing that some of Medicare’s supposed vices to be not as sinful as Hyman presents them and that “there may be some virtue buried in that program design.” While she agrees that the Medicare system as it exists today is flawed, she counters that Hyman’s “preferred design, one more oriented to the market, would generate plenty of its own injustice.” Horwitz ultimately argues for a smarter, more effective Medicare program, one that applies “the many tools that we have in our toolbox” and would involve a “more comprehensive implementation than we’ve had before.” These changes and modifications should aim to towards “controlling spending and improving quality,” but Horwitz also urges caution in making those changes, as any step will have reverberations that will be felt everywhere.”
Horwitz, Jill R. "(Debate) Medicare: Did the Devil Make Us Do It?" D. A. Hyman, co-author. U. Pa. L. Rev. PENNumbra 156 (2008): 453-80.