Health Insurance Industry’s Attack on ‘Medicare for All’ Relies on Old Playbook

When corporations sense a threat, they often frame the free market as the optimal venue for Americans to enjoy individual autonomy, writes Burton St. John III.

If you’re strangled by health care costs, are you really ‘free’? (jwblinn/

By Burton St. John III
The Conversation 

As a debate continues to rage within the Democratic Party over “Medicare for All,” the health care industry has quietly girded itself to fight the elimination of for-profit health care.

In the summer of 2018, trade groups representing hospitals, insurance companies and pharmaceutical makers banded together to form the Partnership for America’s Health Care Future.

Determined to curtail support for universal health care, this group is disseminating messages that single-payer systems like Medicare for All would force individuals off their health care plans, thereby eliminating patient choice.

The trade group argues that the country should build on what’s working in health care and fix what’s broken – not start over.” That way, Americans can continue to have the “greater choice and control over their coverage and care” that comes from free-market health care.

In appealing to choice, the Partnership for America’s Health Care Future is evoking a value that’s important to many Americans. As a former public relations practitioner, I’ve seen corporations do this countless times in a range of contexts.

It’s often deceptive. But it works.

Freedom as a Frame

My research has found that when corporations sense that their viability is threatened, they often frame the free market as the optimal venue through which Americans can pursue and realize their dreams.

They do this by appealing to a core American belief: individual autonomy. This value is remarkably durable. A poll taken in 2015 – just six years after the end of the Great Recession – found that 65 percent of respondents believed they could attain the American dream through their own individual efforts.

In the late 1930s, the National Association of Manufacturers was the first organization to pursue this strategy in a mass public relations campaign. The industry trade group was concerned that the New Deal’s regulations – and its support for unions – would be bad for business. So over the next several years, the group’s American Way campaign used ads, speeches and op-eds to argue that values like freedom of religion would be threatened by more market regulation.

Such appeals can be compelling, but they’re deceptive. The marketplace cannot be compared with individual freedoms. You can’t simply decide to open a business on a whim or work for an employer of your choosing. There are barriers to entry: You need capital to start a business and you need to be hired for most jobs. But no one needs permission to follow a religion of their choosing.

Nonetheless, the National Association of Manufacturers’ internal polling found that these messages resonated. By the early 1940s, about 75 percent of Americans indicated that the free enterprise system was essential to their sense of personal freedom.

Candidates Adopt Industry Rhetoric

Now we’re seeing the same story play out in the health care debate.

The Partnership for America’s Health Care Future maintains that Medicare for All would be a one-size-fits-all approach that imposes a “government-controlled health insurance system” on Americans. This, it says, would thwart “patient choice” while handing over important health care decisions to government bureaucrats.

A Partnership for America’s Health Care Future television advertisement.

There are two prongs to this message. Each highlights threats to autonomy.

The first, patient choice, carries a halo. It would be difficult to imagine arguments against choice.

But a free market health care system already constrains choice. Most Americans under 65 get their health care coverage through work, meaning their employers actually choose what plans are available. Once employees have signed up for a plan, their ability to freely chose their care and providers is often dictated by the plan. Meanwhile, the looming threat of co-pays and deductibles – especially in households living paycheck-to-paycheck – actively discourages people from seeking care. And according to the consumer advocacy group Public Citizen, almost half of Americans with health insurance still had difficulty affording medical care in 2018.

The second part of the message, “government-run health care,” is actually an industry-tested phrase that dates back to the early 1990s, when industry groups fought President Bill Clinton’s proposed health care reforms. Before that period, the phrase was pretty much nonexistent.

In the early 1990s, an association of health care companies, hospitals and drug companies formed a group – much like today’s Partnership for America’s Health Care Future – called the Healthcare Leadership Council. This organization blanketed airwaves with ads that claimed that Clinton’s proposals would “force” people “to pick from a few plans.”

“Having choices we don’t like is no choice at all,” a woman grouses in one of the ads. “If we let the government choose,” a voice-over adds, “we lose.”

We’re starting to see industry-funded health care policy ads that echo those of the early 1990s.

Then, as now, health care companies asserted that their private plans were a bulwark against a government supposedly intent on restraining individual autonomy. Of course, as noted earlier, a profit-driven system doesn’t necessarily equate to more choice or better outcomes.

Nonetheless, during the 2020 Democratic primary, even health care reform-minded candidates such as Pete Buttigieg have already adopted the industry’s language of “choice” and “autonomy.”

“I will put Americans in charge of their own health care with affordable choices for all,” he wrote in a Washington Post op-ed explaining why he wasn’t backing Medicare for All.

Yet as the health care debate ensues, it’s important for Americans to understand what companies are doing to protect their profits – and how appealing to prevailing cultural values can actually undermine individual well-being.

Burton St. John III is professor of public relations at the University of Colorado Boulder.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The views expressed are solely those of the author and may or may not reflect those of Consortium News.

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15 comments for “Health Insurance Industry’s Attack on ‘Medicare for All’ Relies on Old Playbook

  1. Jeff Harrison
    December 16, 2019 at 21:48

    It’s funny. My representative sent out a survey and asked if I wanted the government to be in control of my health care. My response was that I wouldn’t be enthused about the government being in control of my health care but that would be a damned sight better than having the insurance industry in control of it which is the case today. My wife was having female plumbing problems. I say that with confidence because (a) the pain came roughly every 28 days and (b) the ultimate fix was a hysterectomy. But in this wonderland of medical care we have here, it took her 4 years to get things fixed because (a) she had to work her way through 4, count ’em 4, Ob/Gyns to find one what had two brains to rub together. The first one gave her Prozac. Apparently he thought that when a woman got a hysterectomy, her hysteria organ was removed. It takes time to go through 4 OBs. And (b) doctors don’t just make a diagnosis and then take steps to remedy the situation. The fourth OB then put her through close to a year’s worth of testing etc before she would eventually conclude that ” well the insurance company can’t say that I hadn’t tried everything”. Clearly, my wife was not in charge or control of her health care. You couldn’t see the problem on any of the X-ray/CAT scans she had but once the uterus was removed then suddenly everyone was soooo sympathetic. I learned several things
    1. As a general rule, Doctors only know some of what they are talking about.
    2. You are not in control of your health care. The insurance industry is.
    3. As incompetent as they are, I’d rather have the doctors making the decisions rather than insurance bureaucrats.

  2. dean 1000
    December 15, 2019 at 16:36

    A much needed piece on corporate propaganda.

    Thanks Burton St. John and CN. There is a distinction between advertising (buy our product) and corporate efforts to control the political agenda through deception – trying to con the public that what is good for the profits of healthcare corporations is good for the patient and the public.

    An honest government would require equal time for those who want to present a more efficient, affordable, and humane healthcare alternative. As the political campaigns approach November 2020 the corporate healthcare propagandists will begin to howl that Medicare for all, or any no cost to the patient plan is socialism. Of course programs like Social Security and Medicare for all are no more socialistic than government protection of property. If it is OK for government to protect property why is it Not OK for government to protect Life and health? It is OK in the democratic countries.

    The opponents of MFA wildly inflate its costs. The government need not pay cash for non-profit healthcare anymore than it pays cash for the multi-Trillion dollar wars congress funds. Over 60% of workers have employer provided healthcare. The federal government pays for it by giving employers tax breaks for the costs of the group healthcare insurance policy they buy. Whatever that cost currently is, it will provide healthcare for many more people if the insurance middlemen & employers are not involved.

    The insurance corps now run healthcare and impose burdensome regulations on doctors.
    Maybe that is why a majority of doctors now support Medicare for all or single payer. See Physicians for a National Health Program – The conservatives are wrong. The government will not run a national healthcare program. The doctors will run it.

    I would like to read more articles like this as the insurance companies, price gouging hospitals and drug companies crank up their propaganda campaigns. Also how about an occasional piece by doctors who are longtime advocates of Single Payer Healthcare.

  3. AnneR
    December 15, 2019 at 14:08

    Peter in Seattle – Thank you for the heads up re the bills HR 676 and 1384 and their differences.

    From my perspective (having been born in England a couple of months prior to the inception of the NHS, and living there till 1988 and thus fully able to access medical attention when and as needed I do know what a fully state funded medical-health care service is and offers, thus it is from that experience I look at what MFA in any/all guises offers), a major problem would continue to lie in private, profit-making *provision.*

    The government having to negotiate costs/prices/charges/payments – call them what you will – with clinics, doctors, hospitals, drug companies and so on does not prevent ever-skyrocketing “prices” (not costs, of course, because prices are determined with profits in mind). And the providers would have a fairly strong hand. The consequences could well be, likely would be, a faltering public medical care provision, if for no other reason than that the medical industry would have the government over a barrel: full medical care for all Americans free at point of service, low priced drugs, (and if like the UK and most of Europe, wage/salary deductions gradated according to the weekly/monthly/yearly income and deduction-free for the elderly, poor, unemployed) all while trying to prevent ever-rising taxation on the 80% of the population who actually pay taxes. (Unlike those bribers, corruptors and funders of political campaigns, writers of self-serving legislation, money-drenched plutocratic ruling elites who pay no or all but no taxes at all.)

    (An additional argument for ending all of our wars and warrings and scaling back significantly the MIC – it is the non-wealthy, non-bourgeois population of this country that should be first and foremost, not world domination via the colossally, unimaginably expensive, wasteful, polluting destructive military force. Minding our own business, tending to our own internal problems, income inequality, and therefore lack of access to medical care, decent housing, decent jobs, education primary among them.)

  4. December 15, 2019 at 09:34

    If people believe the hyperbole – they deserve what they get, or don’t

  5. Susan123
    December 14, 2019 at 18:50

    Doctors working for salaries only affects the outcome.

    In order to make the system reasonably-priced, the “pay-per-view” billing system must be eradicated (a friend of mine broke three ribs and went to the doctor in order to get medical proof for skipping work. He knew nothing could be done, yet he was billed $2,500 for the ER visit just for showing up and another $2,000 for “diagnostics,” which was a single x-ray. On the bill, there were three identical charges for $437. When his wife asked the doctor about these, the doctor smugly responded, “Why, he broke three ribs, didn’t he?).

    Moreover, pharmaceutical ads must be forbidden and any form of incentives to prescribe
    medications or administering vaccines must be considered bribes and prosecuted both at criminal and civil courts. Of course, that can come true only in an ideal world, because

    (1) the pharmaceutical mafia has politicians and courts in its pockets.

    (2) Some people working for the insurance racket might become homeless.

    (3) There would be a huuuge disruption in the money flow for hospitals and clinics (and providers are already overburdened by treating those without insurance, which is basically forcing them to overbill those with some assets).

    See, even with the best intentions, no single interest group has the power to unboggle so many powerful, convoluted, and overlapping interests.

    As far as I can see, the current system has to collapse before a new one can be built from the
    ground. However, if the ones in power remain in power, they will simply get bailed out and carry on until the vast majority is impoverished, dead, or both.

    December 14, 2019 at 14:44

    Members of congress who are against Medicare For All should be voted out of office. VOTE THEM OUT—-.

  7. Eddie S
    December 14, 2019 at 14:05

    When the corporations and/or the ‘elite’ among us start talking about ‘freedom’ and their concerns that we have a maximum amount, I go and change my online banking password, It brings to mind the old quote “The law, in its majestic equality, forbids rich and poor alike to sleep under bridges, to beg in the streets, and to steal their bread.” by Anatole France. As this article correctly points out, ‘freedom’ WITHOUT the necessary agency to exercise the options is nothing more than a scam.

  8. ML
    December 13, 2019 at 19:00

    Before I retired from medicine as an NP, I worked with a German born physician about 40 years of age. She’d take a month or two off every summer to vacation in her homeland and she and her American husband, also a highly paid physician, decided to allow her to “go bare” without insurance in Germany for her extended trip one summer. Well, she found a breast lump, ran to a doctor there, got an exam from a physician, got an ultrasound of the lump right then and there, (no waiting for yet another appointment) and when she left, she stopped at the front desk and asked how much she owed… low and behold, she owed the German equivalent of just $100 dollars! She was amazed. So I asked her, “Wouldn’t that be great if we had a nationalized healthcare system here, so that everyone could get the high-quality, low-cost, timely care you received?!” “Why, NO!”she replied in her thick Germanic tongue- “Then I wouldn’t make as much money here!!” So ya see, folks, the whole sociopathic system we have with all the greedy jerk doctors and insurance companies here, will “never, ever” let that come to pass. The longer I live, the more I despise my government and all the unelected plutocrats that make people’s lives a living hell. Cheers and good health to you all. And Happy Holidays.

    • Skip Scott
      December 15, 2019 at 08:02

      Good anecdote, ML. And it gets to the core of the problem that the health care industry is a very sizable chunk of our economy, and just like the “defense” industry, greed rules the day at the expense of what is in the best interest of the country as a whole. The health care industry is an entrenched power structure that is soaking the American public for billions of dollars. And since it is mostly poor people who suffer and die as a result, and they have no representation, the game goes on. It also robs middle class estates at the end of life, so there is no money left to be inherited. Only the looters are represented in the halls of Congress. Meanwhile medical mistakes are the third leading cause of death. So much for getting your money’s worth.

    • ML
      December 15, 2019 at 22:02

      Great points, Skip.

  9. rosemerry
    December 13, 2019 at 16:45

    Like the people who speak disparagingly of “government schools”, these are speaking of “elected” governments and public servants, ie NOT commercially-minded profiteers. Why should this be more constraining than corporations?I would not object to public services if the system is in a real democracy, so I understand why US citizens may worry- all their politicians are bought, so perhaps “public servants ” are not as they seem!!

  10. Peter in Seattle
    December 13, 2019 at 14:10

    Gold-standard “Medicare for All” bills (like HR 1384, the successor to HR 676) would cover virtually all healthcare services and products 100%, from any licensed provider in the country. There would be no premiums, no deductibles, no coinsurance, no copays, no arbitrary exclusions, and no out-of-network providers. The system would be funded by taxes — ideally, highly progressive taxes.

    According to a 2013 funding study or HR 676 by Gerald Friedman, Medicare for All would cost $600 billion less than the current system in the first year of operation, and around $1 trillion dollars a year in the medium term, once private investors had been bought out and redundant administrative workers had been retrained to do economically productive jobs. (Friedman’s trillion-dollar-a-year estimate jibes with “big picture view” comparisons to our peer countries. They spend under 12% of GDP to provide good-to-excellent coverage to virtually 100% of their populations, versus our nearly 18% of GDP to provide wildly variable coverage to around 90% of our population. Apply the 6% difference to our GDP, and you get over $1 trillion a year in potential savings.)

    If it doesn’t make intuitive sense that you can provide better coverage to more people for less money, consider that according to recent calculations by David Himmelstein and Steffie Woolhandler of the Harvard School of Public Health, the administrative waste inherent in our highly fragmented, highly redundant multi-payer system amounts to over $500 billion a year. When you consider that administrative overhead is 1% for Taiwan’s National Health Insurance system (which is the “purest” single-payer system in the world), 2%-3% for our own Medicare for Seniors (which has to operate in a multi-payer environment), around 12% for Canadian Medicare (which is provincially rather than nationally based, a terrible initial decision), and around 25% (at the low end of estimates) for our current system as a whole, Himmelstein and Woolhandler’s calculation seems conservative.

    And administrative waste is not the only source of potential savings. There is also the money lost to price-gouging, which in the US is often extreme. (We are the only developed country that doesn’t monopsonistically bargain or set medical prices, and our prices are by far the highest in the world — from ambulance rides to imaging to hospital stays to devices to the fees of licensed healthcare professionals.) If administrative skimming indeed accounts for only half a trillion a year, the missing half trillion in potential savings is likely almost entirely accounted for by price-gouging….

    So, under Medicare for All we’d end up with guaranteed lifetime coverage for practically everything, completely free choice of providers, and zero out-of-pockets, all for significantly less money. That’s a tough proposal to discredit, so it isn’t surprising that the administrative skimmers (private insurance companies) and price-gougers (providers) who are currently extorting over a trillion excess dollars a year out of our pockets are trying to con us into believing that free choice of administrative skimmer is more important than free choice of provider.

  11. December 13, 2019 at 10:03

    The “debate” over health Care is as flawed as the system it takes place in. What people are not talking about is the need for systemic change that requires present system to be a knowledged as being hopelessly bankrupt and in need of a real cleansing under Glass Steagall. In order to have a healthy population we need a healthy physical economy. No healthcare can be of any real good without a healthy economic system such as Lyndon LaRouches Four Laws Initiative.

  12. AnneR
    December 13, 2019 at 06:40

    Prof. St John – thanks for this heads up re the coming media blitz by the execrable medical industry (I refuse to call it health *care* given my and my late husband’s experiences with it: *care* – as in concern for and working with you for you to remain alive and healthy is the last thing they deliver).

    MFA would be an enormous improvement over the existing set up, but as it stands now, Medicare is far from perfect. It is *not* free – each elderly person in a household has a monthly deduction (at source) from their Social Security (the full rate, without extras, is to rise beginning in January). There are co-pays and for procedures they are not in the tens of dollars, which for the comfortably off would remain readily payable,and drug costs are not cheap, unless generic (which, e.g. insulin is *not* in any shape or form); but for those millions of poor, working families who can barely make their rent and put food on the table those co-pays, along with the deduction for using Medicare, could well be far more than they could afford.

    The only way that MFA would really fulfill the need for everyone to have good, truly affordable medical/health care is for it to fully and completely cease to be private owned, profit-making (and I include so-called non-profits). Yes, let those who are rolling in money and so on continue to purchase their private, profiteering medical care if that is viewed as a “good thing” – but for the rest of us, the removal of the profit motive, the ending of privately owned hospitals, surgeries, clinics (and thus doctors who seek ever bigger bank balances) *and* controls on the prices charged by both Big Pharma and pharmacies for all and any essential drugs (bringing the US into line with the rest of the world) is the best option.

    While private health insurance, hospitals, clinics, uncontrolled drug prices remain in place (i.e. in control of our “health”), the MFA will not necessarily improve, as much as is believed, hoped for, the medical needs of the poorer peoples of this country.

    • Peter in Seattle
      December 13, 2019 at 14:58

      @AnneR: It’s unfortunate that when HR 676 was reintroduced as HR 1384, its title was changed from “Expanded & Improved Medicare for All” to just “Medicare for All.” Be that as it may, HR 1384 still contemplates fair, negotiated prices, no premiums, and zero out-of-pockets. The big difference is that 1384 doesn’t include any funding (tax) provisions, leaving congressional leadership free to engineer the most regressive funding mechanism possible, on behalf of their corporate-billionaire sugar daddies.

      At any rate, the substance of HR 1384 responds to most of your objections. Our current Medicare for Seniors is grossly underprotective insurance; the Medicare for All contemplated by HR 1384 is not.

      But it’s not worth losing sleep over. The medical-industrial complex now dictates mainstream-media healthcare coverage, courtesy of the $14 billion a year it spends on direct-to-consumer advertising, and it owns Democratic Party leadership outright, through campaign support, insider stock tips, high-paid contemporaneous jobs for family members, and lucrative “golden parachute” opportunities for the leaders themselves, if and when they leave office. Absent a second American Revolution, a new democratic Constitution with enforceable anti-corruption provisions, and a diverse, deconflicted, deconcentrated, deconglomeratized press, I don’t see any possibility of Medicare for All in the foreseeable future. A majority of Democrats in the House may have co-sponsored HR 1384, but if you’ll recall, the entire Congressional Progressive Caucus voted for the ACA — the diametrical opposite of Medicare for All — back in 2010. I doubt there are more than five ostensibly pro-Medicare-for-All Democrats in Congress today who aren’t just running a cynical con on their electorates — like Lucy with the football. I’d like to be wrong, but I just don’t see any realistic prospect of ending a healthcare extortion racket that generates over a trillion dollars a year in “skim,” and that gives both Congress and the media a cut of the action, within the framework of our current political system.

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