Google steers Americans looking for health care into “junk insurance”
I'm on a tour with my new book, the international bestseller Enshittification: catch me next in Toronto (THURSDAY!), San Diego and Seattle! Full schedule here.
Being "the enshittification guy" means that people expect you to weigh in on every service or platform that has been deliberately worsened to turn a buck. It's an impossible task (and a boring one besides). There's too much of this shit, and it's all so mid – a real "banality of enshittification" situation.
So these days, I really only take note of fractally enshittified things, exponentially enshittified things, omnienshittified things. Things like the fact that Google is sending people searching for health care plans to "junk insurance" that take your money and then pretty much just let you die:
https://pluralistic.net/junk-insurance
"Junk insurance" is a health insurance plan that is designed as a short-term plan that you might use for a couple of days or a week or two, say, if you experience a gap in coverage as you move between two jobs. These plans can exclude coverage for pre-existing conditions and typically exclude niceties like emergency room visits and hospitalization:
Crucially, these plans to not comply with the Affordable Care Act, which requires comprehensive coverage, and bans exclusions for pre-existing conditions. These plans only exist because of loopholes in the ACA, designed for very small-scale employers or temporary coverage.
The one thing junk insurance does not skimp on is sales and marketing. These plans outbid the rest of the market when it comes to buying Google search ads, meaning that anyone who uses Google to research health insurance will be inundated with ads for these shitty plans. The plans also spend a fortune on "search engine optimization" – basically, gaming the Google algorithm – so that the non-ad Google results for health insurance are also saturated with these garbage plans.
The plans also staff up boiler-rooms full of silver-tongued high-pressure sales staff who pick up on the first ring and hard-sell you on their plans, deliberately misleading you into locking into their garbage plans.
That's right, locking in. While Obamacare is nominally a "market based" healthcare system (because Medicare For All would be communism), you are only allowed to change vendors twice per year, during "open enrollment," these narrow biannual windows in which you get to "vote with your wallet" against a plan that has screwed you over and/or endangered your life.
Which means that if a fast-talking salesdroid from a junk insurance company can trick you into signing up for a garbage plan that will leave you bankrupt and/or dead if you have a major health crisis, you are stuck for at least six months in that trap, and won't escape without first handing over thousands of dollars to that scumbag's boss.
Amazingly enough, these aren't even the worst kinds of garbage health plans that you can buy in America: those would be the religious "health share" programs that sleazy evangelical "entrepreneurs" suck their co-religionists into, which cost the world and leave you high and dry when you or your kids get hurt or sick:
The fact that there are multiple kinds of scam health insurance in America, in which companies are legally permitted to take your money and then deny you care (even more than the "non-scam" insurance plans do) shows you the problem with turning health into a market. "Caveat emptor" may make sense when you're buying a used blender at a yard-sale. Apply it to the system that's supposed to take care of you if you're diagnosed with cancer, hit by a bus, or develop eclampsia, and it's a literally fatal system.
This is just one of the ways in which the uniparty is so terrible for Americans. The Republicans want to swap out shitty regulated for-profit health insurance with disastrous unregulated for-profit health insurance, and then give you a couple thousand bucks to yolo on a plan that seems OK to you:
This is like letting Fanduel run your country's health system: everyday people are expected to place fifty-way parlay bets on their health, juggling exclusions, co-pays, deductibles, and network coverage in their head. Bet wrong, and you go bankrupt (if you're lucky), or just die (if you're not).
Democrats, meanwhile, want to maintain the (garbage) status quo (because Medicare for All is communism), and they'll shut down the government to make it clear that they want this. But then they'll capitulate, because they want it, but not that badly.
But like I say, America is an Enshittification Nation, and I don't have time or interest for cataloging mere unienshittificatory aspects of life here. To preserve my sanity and discretionary time, I must limit myself to documenting the omnienshittificatory scams that threaten us for every angle at once.
Which brings me back to Google. Without Google, these junk insurance scams would be confined to the margins. They'd have to resort to pyramid selling, or hand-lettered roadside signs, or undisclosed paid plugs in religious/far-right newsletters.
But because Google has utterly succumbed to enshittification, and because Google has an illegal monopoly – a 90% market share – that it maintains by bribing competitors like Apple to stay out of the search market, junk insurance scams can make bank – and ruin Americans' lives wholesale – by either tricking or paying Google to push junk insurance on unsuspecting searchers.
This isn't merely a case of Google losing the SEO and spam wars to shady operators. As we learned in last year's antitrust case (where Google was convicted of operating an illegal search monopoly), Google deliberately worsened its search results, in order to force you search multiple times (and see multiple screens full of ads) as a way to goose search revenue:
Google didn't just lose that one antitrust case, either. It lost three cases, as three federal judges determined that Google secured and maintains an illegal monopoly that allows it to control the single most important funnel for knowledge and truth for the majority of people on Earth. The company whose mission is to "organize the world's information and make it universally accessible and useful," now serves slop, ads, spam and scams because its customers have nowhere to go, so why bother spending money making search good (especially when there's money to be made from bad search results)?
Google isn't just too big to fail, it's also too big to jail. One of the judges who found Google guilty of maintaining an illegal monopoly decided not to punish them for it, and to allow them to continue bribing Apple to stay out of the search market, because (I'm not making this up), without that $20b+ annual bribe, Apple might not be able to afford to make cool new iPhone features:
Once a company is too big to fail and too big to jail, it becomes too big to care. Google could prevent slop, spam and scams from overrunning its results (and putting its users lives and fortunes at risk), it just *chooses not to:
Google is the internet's absentee landlord. Anyone who can make a buck by scamming you can either pay Google to help, or trick Google into helping, or – as is the case with junk insurance – both:
America has the world's stupidest health care system, an industry that has grown wildly profitable by charging Americans the highest rates in the rich world, while delivering the worst health outcomes in the rich world, while slashing health workers' pay and eroding their working conditions.
It's omnienshittified, a partnership between the enshittified search giant and the shittiest parts of the totally enshittified health industry.
It's also a reminder of what we stand to gain when we finally smash Google and break it up: disciplining our search industry will make it competitive, regulatable, and force it to side with the public against all kinds of scammers. Junk insurance should be banned, but even if we just end the junk insurance industry's ability to pay the world's only major search engine to help it kill us, that would be a huge step forward.
If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
PSA for fellow USAmericans who might be considering their health insurance options (since it’s the time of year for it at time of writing):
If you have ANY other option, I recommend staying as far as possible from any private (non-government administered) plan talking about “reference-based pricing” or “disrupting the health insurance establishment to save you money”.
I hadn’t heard of this type of plan until a couple of months ago, and neither had my colleagues who’ve worked in my field (billing for a private healthcare specialist’s office) much longer than I have, when we all of a sudden had several clients switch to similar plans within a few weeks of each other, so I suspect it’s likely that they’ve been making a push to get a foot in the door this year. I’m sure it’s legally inadvisable to outright call them “scams”, but IMO they are at the VERY least operating on a business model that’s extraordinarily ill-thought out, and at worst (likeliest) it seems to me that they’re misleading and predatory in a way that’s somehow still shocking and infuriating to me after years of working in healthcare billing in the US.
More detailed explanation / further Advice from your Friendly Neighborhood Angry Socialist Healthcare Billing Administrator below the cut, for those who want more information.
So the issue here essentially is that these companies are trying to sell clients (looks like particularly small business owners and HR people looking for plans to offer their employees) on the idea that they’re ~shaking up the corrupt industry~ to improve transparency and costs, and like, if that’s what they were actually doing? I’d be so incredibly for it, you don’t even know. Fuck everything about the established health insurance industry, I want to see them burn as much as the next person.
But what they’re actually doing is deciding it would save THEM a lot of money to just pay doctors / other healthcare providers as little as they want to, and that the problem getting in the way of that is that there are usually contracts establishing how much they’re supposed to pay, and it would be cool to just… not have those! From there, the plan is:
1) telling bosses “hey, we’ll cut your costs by offering you a plan that’s cheaper than conventional ones!”
2) telling workers / clients “hey, you know how your health insurance plan determines what doctors you can see and have insurance pay for it? Fuck that, see whoever you want!”
3) conveniently neglecting to mention that if your brilliant plan to lower costs is “just don’t have contracts with providers, so there’s no agreed-on cost and we can pay them whatever we unilaterally decide is fair!”, that also means there’s no contract obligating the healthcare providers to accept your insurance at all (which is extra bullshit when you consider that they can’t tell you which providers have agreed to take their insurance, on account of how they don’t actually have a list of providers who have agreed to take their insurance, since they decided agreements were unnecessary)
Basically, it ends up saving the bosses and the insurance company a shitload of yachts-and-blackjack money, but then puts You The Patient in a situation where you’ve been told “yeah, see whoever you want, we don’t give a fuck”
So you go to the local clinic or your usual therapist or whatever and say “oh, here’s my new health insurance card, they said I could be seen here,” and hand them a card for a company that
A) they’ve never heard of
B) they have NO contractual obligation to work with, and
C) a brief google search can easily tell them openly intends to pay them significantly less than any of the insurance plans they do work with (besides the few that are allowed to get away with setting their own prices because they’re literally run by federal government-affiliated agencies and using that considerable leverage for the benefit of senior citizens, people on disability benefits, veterans, etc — they essentially plan to use the base pricing THOSE plans use, except… as a private, for-profit company, and without discussing it with the other parties involved.)
All of which is likely to just put the staff at your local clinic or whatever in the awkward position of having to tell you “I’m so sorry, it doesn’t look like that’s actually a plan we work with, we’re going to have to do self-pay for the recent visits / if you’d like to continue,” and put YOU in the awkward situation of having to pay for that shit out of your own pocket.
What do I do if my employer is offering a reference-based pricing plan?
So glad you asked, me.
My recommendation would be to look at what other options they have available if you work for a company that offers multiple options, or to opt out of their plan and look into the options available to you via your state’s health insurance marketplace — open enrollment for most states is November 1 - January 15th, so at the time of this post (November 23rd) it’s ongoing and now’s the time to do something about it!
But that means my work won’t help with payment of my insurance premiums?
Yeah, but in the context of this discussion, we’re weighing the cost of paying your own premium in full against the potential cost of being told you can see whatever providers you want, doing so, and then ending up having to pay them out of pocket at the uninsured rate because your insurance actually does jack shit and fuckall, which can EASILY get a lot worse.
Also, some employers will reimburse a portion of the premium cost if you have outside health insurance, so check with your HR department or your boss (and maybe let them know why you decided not to go with the insurance they’re offering).
Also-also, if you’re in a lower income bracket, the ACA / healthcare marketplace options on your state’s healthcare marketplace website will include Medicaid plans, which are subsidized by the government to help low-income folks afford them.
Ok, I’m looking, but how do I pick the plan that’s right for me?
Oh god I have a whole other post about this but it’s from ages ago and I don’t have the spoons to look for it right now, but the basics boil down to:
A) Look if possible for plans where, if there is a deductible, either it’s as low as possible or it doesn’t apply to services you anticipate needing at least semi-regularly
B) If the difference in monthly premiums for two plans is MORE than the difference in what you can reasonably expect to pay out of pocket in copays during a month, the “cheaper” plan isn’t saving you money.
So like for example, if I’m choosing between two plans and the up-front cost between them is like, $250 / month or $400 / month, and the $250 plan has specialist services I need 4 times a month covered under a deductible while the $400 plan has a flat copay of $20 for those same services, then my numbers will end up looking like “$250 + (4 x $125) = $750, vs “$400 + (4 x $20) = $480), which would make the $400 plan cheaper for me overall, even though the premium is more expensive.
You want the plan where the monthly costs for your premium PLUS expected average monthly out of pocket costs for services you’re likely to need routinely is as low as possible, is what I’m getting at here. No real way around doing the math, unfortunately, though if you DM me during open enrollment I’ll probably be willing to do the math for you out of sheer spite toward our country’s bullshit insurance “system”.
C) If you can’t afford a plan with a higher premium, it’s still worth getting something, but be aware that low-premium plans are typically going to be “catastrophic” health insurance plans, designed primarily to put a (high) cap on how much medical cost you can incur at once if you like, survive a freak accident or something — as a rule, they’re not going to do much to help you with much besides either the super basic preventive care they’re required by law to cover or keeping your total annual costs from an accident or major illness from getting too wildly astronomical. If you need non-emergency specialist care even semi-routinely, I’d encourage trying to avoid this type of plan if possible, and ALWAYS checking in with your plan and your providers’ billing department to figure out how much you need to budget for out of pocket costs when you do need to see a specialist or something, because you do NOT want to be caught off guard by that shit.
What else can I do?
Uhhhhh, advocate for socialized healthcare like every other fucking rich country in the world has had for decades, I guess? We’re not some special case where it would never work, we’ve just got a bunch of craven politicians invested in telling us that because of that sweet sweet insurance company lobbyist money they get in exchange for keeping things the way they are. Fuck ‘em, if that wasn’t clear.
Also, be gay / do crimes / look out for each other on this bitch of an earth / seriously DM me if you want me to help you figure out your options, ok I love you bye ✌️
@extremelysillyguy you dare get up in this bitch without a certificate… without a doctorate.without a degree. Without a permit…Without a license… not even a learners silly license…
you will pay for your sins
….
MR ELECTRIC SEND THEM TO THE SILLY MASTER AND HAVE THEM KILLLLLEDDD!!!!!
A quick reminder for folks in the US: if you haven't seen anything about ACA open enrollment this year, that is by design. Secretary Azar wants to lower enrollment numbers to justify pulling funds from medicare/medicaid. Here are your dates:
"Long haulers” — patients with lingering effects of COVID-19 — have joined the ranks of Americans with preexisting conditions.
What type of plan is best for someone with an unpredictable, ongoing medical concern? That question is popping up on online chat sites dedicated to long haulers and among people reaching out for assistance in selecting insurance coverage.
“We are hearing from a lot of people who have had COVID and want to be able to deal with the long-term effects they are still suffering,” said Mark Van Arnam, director of the North Carolina Navigator Consortium, a group of organizations that offer free help to state residents enrolling in insurance.
The good news for those shopping for their own coverage is that the Affordable Care Act bars insurers from discriminating against people with medical conditions or charging them more than healthier policyholders. Former COVID patients could face a range of physical or mental effects, including lung damage, heart or neurological concerns, anxiety and depression. Although some of these issues will dissipate with time, others may turn out to be long-standing problems.
