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Controlling the Narrative: Industry-Led Misinformation in the Great Health Care Debate

Over the summer, former Cigna executive Wendell Potter made headlines for exposing the misinformation campaigns that corporate health insurance providers have long initiated against universal health care systems. During Potter’s tenure at Cigna, the health care giant regularly used misleading anecdotal evidence and methodologically questionable data to attack Canadian-style health care reforms in the United States – such as the Affordable Care Act and, more recently, proposals espousing Medicare-for-All – and thereby preserve the profitability of private insurers. Potter’s bombshell admissions are symptomatic of the larger, dangerous mythology that health care industry advocates have perpetuated amidst increasing calls for universal coverage in the US. By spreading falsehoods regarding wait times and government control, the medical lobby has deceived millions of Americans in its efforts to stymie health care expansion.

Among the most common criticisms of universal health care is the notion that such systems, especially the one up north, create unbridled demand among patients and, in turn, excessive wait times for routine procedures. In truth, the idea that Canadians wait unremittingly for essential medical care is an extreme exaggeration. Admittedly, Canada does have room for improvement when it comes to expediency of care in various areas. Certain elective, non-emergency surgeries, including cataract and hip surgeries, often must be scheduled months in advance, and it is these kinds of procedures that the American medical lobby generally points to in its broad repudiation of the Canadian system. However, in general, the more urgent procedures are conducted in a timely manner, refuting the characterization of Canadian health care as wholly inefficient. Last year, 97 percent of radiation therapy treatments in the country were carried out within recommended time frames.

In fact, whether or not wait times are an issue for a nation’s health care system is entirely independent of its single-payer status. As University of Ottawa professor Colleen Flood explains, Canada’s wait times are more a product of its own administrative and managerial shortcomings than its single-payer system as a whole. Flood adds that many single-payer countries (such as France, Switzerland, and Germany) encounter minimal issues with wait times relative to the United States, rendering this argument against universal health care fallacious. Dr. Marcia Angell, faculty member at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, likewise argues that wait times in the United Kingdom and Canada owe to the fact that each government spends considerably less on health care per capita than the US. According to Angell, these countries could streamline access to care and eliminate waits altogether if they devoted the same level of monetary resources toward their health care systems that the US already devotes to Medicare.

While the wait times critique is perhaps the most common myth peddled by the medical lobby as part of its anti-Medicare-for-All agenda, it is certainly not the only one. Indiana University medical professor Aaron Carroll pinpoints several other myths surrounding Canada’s system that, despite ample empirical evidence to the contrary, continue to circulate among a large and susceptible American audience. In particular, the health insurance industry has falsely suggested that Canadians flock to the United States to receive treatment (a proposition that research has long discredited) and that Canadian doctors similarly flock to the US to practice. As for the latter, studies have actually indicated that the reverse may be true, as US-based physicians, pediatricians, and psychiatrists have increasingly migrated to Canada. Because of fewer bureaucratic expenses and insurance-company hassles, these doctors can purportedly enjoy six-figure salary boosts in Canada.

Why, then, have these types of factual distortions persisted? As Potter puts it, the US health care industry has propagated an illusory vision of Canadian-style systems “by very carefully cherry-picking the data and telling anecdotes that cannot be verified.” By conveniently neglecting information that at all challenges the status quo, private providers and their benefactors have manufactured a narrative that has misled millions and stifled progress in the American health care sector.

A recent report highlights how the medical lobby employs discursive framing techniques to undermine universal health care proposals by characterizing them as “government-run.” Since the 1990s, industry leaders have implied that Americans can either support the existing private insurance system or they can support a system defined by complete government control. As the industry spins it, there is no in-between. Because this depiction of “government-run” health care has been so widely disseminated by industry PR groups, it has been embraced by the media, pollsters, think tanks, and the public at large.

In reality, under universal health care, the majority of the country’s medical infrastructure would not be nationalized; Medicare-for-All and other health care proposals are “publicly financed insurance programs that leave most of the health care system – including hospitals, physician practices, and drug and medical device manufacturers – in private hands.” Even private insurance companies would not be outright eradicated under universal health care, as individuals would still be allowed to have supplemental private plans to cover any medical treatments not already covered under the public plan. In New Zealand, for instance, about a third of the population has private coverage in addition to government health insurance. Thus, publicly financed health care still enables personal choice and keeps much of the medical sector privatized, which the insurance industry has cleverly concealed through its framing of universal health care as “government-run.”

The far-reaching effect that this industry spin has had on public perception and domestic health policy is illustrated by the right-wing Citizens for a Sound Economy, an organization led by the Koch brothers that spent millions to fight health care expansion initiatives during President Bill Clinton’s administration. In 1994, the group proclaimed that it was “the first to label the Clinton approach ‘government-run health care’ – a term that ultimately would help kill the myriad plans that subsequently were offered.” Evidently, the medical lobby has succeeded in making centralized, single-payer systems out to be authoritarian in nature, which is simply not the case.

The coordinated lobbying campaigns against universal health care are equal parts impressive and alarming. Documents uncovered in 2018 shed light on some of the medical lobby’s ongoing messaging strategies, including the explicit goal of the Partnership for America’s Health Care Future (PAHCF) to “change the national conversation” around Medicare-for-All proposals, just as these proposals were gaining significant traction in the lead-up to the 2020 election cycle. To execute this objective, the PAHCF launched daily online advertisements and social media postings, capitalizing on the often misinformed stigmas attached to Medicare-for-All – like the aforementioned portrayal of such systems as wholly “government-run” – to sway the narrative in their favor.

Unsurprisingly, the American health care lobby is incredibly well-funded and well-connected. America’s Health Insurance Plans (AHIP), which Potter worked with to spread misinformation while at Cigna and which helped create the broader PAHCF coalition in 2018, raised almost $62 million that year. The collective wealth of PAHCF members allowed the organization to, in August of 2019 alone, spend over $200,000 on regionally targeted television ads to counter growing calls for health care expansion ahead of the Democratic presidential primaries. In the political sphere, a staggering 270 federal lobbyists had been hired to focus on single-payer health care and Medicare-for-All by early 2019, and nine of the 10 groups that hired the most lobbyists in this area opposed said reforms. It is no wonder that the general public and politicians alike have been heavily influenced by the one-sided messaging and lobbying agendas of industry backers.

The media has a responsibility to correct the current, skewed perception of universal health care by refusing to allow private insurers to continue steering the debate. Through seemingly minor actions, like calling out misleading assertions about single-payer systems and using more nuanced language when describing these systems, the media can actively combat the misconceptions that the health insurance industry promulgates to improve its bottom line. It is time to level the playing field and have a more productive, balanced, and informed national dialogue about the promises and drawbacks of a single-payer system.

Photo: Image via Unsplash (Ibrahim Boran)