Mephisto’s Medicare: A Parable

Canadian identity is founded on not much more than the national welfare programs. What is left but to laugh along with the architect of one such program?

While doing his rounds on earth, Mephistopheles, Mephisto for short, paused to take stock. He had been successful. His was a benevolent tyranny painlessly relieving people of their liberties. Mephisto liked to think of the pact with his flock, which he fondly called The Tribelings, as a voluntary exchange. As is always the case, what you give up you value less than what you get. And The Tribelings value the goods he provides more than their freedoms. The Agency over which Mephisto presides has an inexhaustible list of therapeutic wants, sardonically referred to in-house as human rights. The Agency’s charges, The Tribelings, expect no less from the Agency; this is a precondition for power.

Somewhat bored, Mephisto longs for the days when achieving compliance was a hands-on affair. But, and here he flashes a gleam of dentition, his facility with the art of propaganda is no less magnificent. The literature about a free society he has not banned—it has simply been reclassified. The men who once spoke of individual freedom in ideas, in trade, in the enjoyment of one’s property—of human agency, responsibility and self-government—were now The Rubes. The Agency’s agitprop, however, is cast as progressive.

The Firm is Mephisto’s crowning glory. Like all Agency Corporations, The Firm is not subject to the land’s bankruptcy laws. Mephisto busts a gut, because, while The Firm is insolvent, The Tribelings bankroll it indefinitely with their tax dollars. Compounding this, prices of services in The Firm are pegged at zero. This drives The Tribelings to use the service voraciously, with the result that endemic shortages ensue.

The Firm a.k.a. Mephisto’s Medicare has just received a large infusion of funds, and The Tribelings are scurrying about arbitrarily trying to figure out where it is needed most. Should it go to technology, staff, maybe towards new databases to keep tabs on The Tribelings, or how about equipment? Mephisto knows that under freedom, prices are like a compass: pegged to supply and demand, they ensure the correct allocation of resources. In The Firm no such knowledge is available. No one knows the prices of services The Firm provides. But for all Mephisto cares, let The Tribelings use derrière doctors (proctologists) if misallocation of capital causes shortages of surgeons.

By design, Mephisto’s Monopoly produces a different kind of worker. More mediocrity, less malcontents is Mephisto’s motto. To that end, his seminal paper entitled “Equilibrating Effects of Industrial Action” Among Doctors has helped stem privatization rumblings, and with them unease over the subversive power of freedom. In the paper, Mephisto elucidates how when wages are tied to a negotiated deal with labour rather than, in the case of a competitive market, to the individual physician’s performance, the position of the bad practitioner is reinforced. And all hail to that.

In Mephisto’s country, rated Number One according to the World Hegemonic Organization (WHO), the professionals can only but work for The Firm, that is if they want to use their skills. If their instinct for freedom is strong, they must flee Canada’s jurisdiction. While many of them have been expunged, Mephisto must labour to suppress the thinkers in The Firm. This he has done by entrenching a perverse incentive scheme. The hard rule in The Firm is that competency is rewarded with increased workload, but no extra pay, pervasive sluggishness guaranteed.

Mephisto’s Medicare in fact is a pit of perverse incentives. Can you get kinkier than to make failure tantamount to success? If a hospital consistently underperforms, the administration celebrates. Why? Because this means more Agency funds to ostensibly “fix the problem.” Absent competition, The Tribelings are trapped. As the Eagles song goes, “you can exit anytime you wish, but you can never leave.” The Underperformers, or The Winners, as they are known in Agency parlance, shoulder no responsibility. There is no out-of-pocket payment for the odd slip of the scalpel. The Tribelings pony up for such pooling of risks or insurance. A perfect system of unaccountability, Mephisto calls this.

A particularly enjoyable stint is pressing doctors into occasional slavery. Mephisto makes it an offense for them to refuse to treat defaulting Tribelings, thus ensuring that The Agency gets their free labour. No matter that some doctors are now suing one of The Agency’s front organizations for “not receiving payment for performing medical services.” Guess who pays? The Tribelings always do. Please excuse Mephisto as he heads for Pub Pelf to celebrate.

©2000 By Ilana Mercer

  Association of American Physicians and Surgeons

  October 13