Generating Opposition to universal healthcare policies the United States: An analysis of private health industry advertising on Meta platforms, PLOS Global Public Health, July 16, 2025, by Kendra Chow, et al.

Abstract

In 2019, the Partnership for America’s Health Care Future (PAHCF), a private health industry lobby group, launched a campaign across Meta platforms (Facebook, Instagram) to generate opposition to universal health care policies in the United States. This study investigates the content and the themes prevalent in PAHCF’s campaign and how these might shape public discourse and perceptions around universal health care policies. Using qualitative content analysis, 1675 advertisements were examined on Meta platforms within PAGCF’s campaign. Inductive methodology was applied to develop a coding framework. Details of campaign spend and number of impressions advertisements received were also collected. The qualitative coding strategies identified three overarching foci: policy targets, claims and themes, and targeted appeal groups. These elements were found to strategically and mutually reinforce one another to generate the narrative that proposed universal health care policies will be detrimental to public health, the economy, and society. Analysis identified that PAHCF engages in strategies common among unhealthy commodity industries. Social media in this instance powerfully perpetuated PAHCF messages that undermined universal health care efforts and contributed to the commercial determinants of health impacts of this industry. These findings indicate that the private health care industry is participating in wider commercial determinants of health activities, acting to protect their profits to the detriment of public health. Like other campaigns by unhealthy commodity industries, PAHCF’s campaign is designed to increase doubt in the benefits of health policies, undermine public trust in government and evidence, and promote public alignment with their own messaging and preferred solutions. To counter such tactics, public health professionals need to gain a better understanding of the strategies unhealthy commodity industries utilize to deflect attention from their underlying health-harming intentions, especially through more novel platforms like social media.

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

This study shows that anti-insurance reform forces are aggressively exploiting the power of social media, our era’s central tool for disseminating ideas. The Partnership for America’s Health Care Future social media campaign cleverly crafts negative (and misleading) perceptions of a universal health care system.

Those of us advocating for universal, comprehensive, affordable health care have faced intense opposition, often from organizations like PAHCF. Such opposition has not relied solely on social media. Other avenues include political parties (both Republican and Democratic) and large media networks such as Fox News. These strategies have been all too successful at creating resistance and fear about an insurance approach that is functioning and appreciated around the world.

Support for universal health programs derives from a belief in social justice: everyone should have access to comprehensive health care that is kept affordable through progressive taxes. Opponents place a high value on each person being individually responsible for funding their own care, with a minimized role of government. The centrist consensus (GOP & Dem alike) is that free market dynamics and limited government programs like Medicaid will assure efficiency and (limited) generosity. However, anyone who has studied recent US health policy knows that the market model fails – neither efficient nor generous. The current system increases the wealth of investors by depriving lower-income individuals of needed care.

Could individuals across the political spectrum assemble to calmly devise a system that works of all of us? It appears not. Those supporting single payer, which requires funding based on the ability to pay, will never win the support of individuals who deem it unfair to require them to pay more, no matter how wealthy they are. In an age of billionaires, there seems to be rising inflexibility on this issue.

Ok, much education and persuasion is needed before we can gather to devise a functioning universal approach. Could we build this support through expanded social media? It certainly must be a central part of the strategy.

However, before we dive into persuasive techniques, let’s explore what substantive arguments might work. Both of us really like AI LLMs (large language models) for the ability to frame issues. Thus, to structure our thinking, we asked ChatGPT.

Let’s all ponder and critique this framework. In coming weeks we’ll refine these AI comments and build the persuasive arguments.

Prompt:

What factors make a person decide that society should support an equitable, universal financing system for health care that enables everyone to receive the health care that they should have, as opposed to the view that each person should be individually responsible for providing the funds that are needed to pay for their own health care, whether by direct payment or payment through insurance?

ChatGPT said:

The decision to support an equitable, universal financing system for health care versus an individual responsibility model is shaped by a mix of moral, cultural, economic, and practical considerations. Here are the major factors that influence which viewpoint a person adopts:

1. Moral and Ethical Values

Belief in health care as a human right: People who see health care as a fundamental human right often favor universal systems, believing that access should not depend on wealth or employment.

Empathy and social solidarity: Those who place a high value on community welfare, fairness, and compassion tend to support systems that ensure no one is left behind.

Views on individualism vs. collectivism: In cultures or families that emphasize individual responsibility, people may lean toward self-financed health care. Conversely, collectivist values emphasize shared responsibility.

2. Economic Perspectives

Risk pooling and efficiency: Some recognize that universal systems spread risk across society, lowering overall costs and avoiding the inefficiencies of fragmented, for-profit insurance systems.

Concerns about personal cost: People who believe they can afford their own care (or have good insurance) may resist universal systems because they fear higher taxes or subsidizing others.

Awareness of market failures: Those who understand that health care markets don’t function like regular markets (due to emergencies, unequal information, and lack of consumer choice) may see universal financing as more rational.

3. Personal Experiences

Encounters with medical bills or gaps in coverage: A personal or family experience with medical bankruptcy, denial of care, or lack of insurance often shifts people toward supporting universal care.

Positive or negative experiences abroad: Exposure to universal health care systems in other countries can strongly influence perceptions.

Trust in existing insurance or employer coverage: People satisfied with their private insurance may feel less incentive to support systemic change.

4. Knowledge and Awareness

Understanding of how health care is financed: People who learn that even private care is heavily subsidized (through tax breaks, public programs, etc.) may be more open to universal financing.

Evidence of better outcomes elsewhere: Awareness that countries with universal health care often achieve better health outcomes at lower costs can sway opinions.

Misinformation or myths: Some oppose universal systems due to beliefs that such systems mean “rationing,” poor quality, or lack of choice, even when evidence suggests otherwise.

5. Political and Ideological Beliefs

Role of government: People who trust government and view it as a vehicle for public good are more likely to support universal systems. Those who distrust government often favor private solutions.

Perception of fairness: Some believe it’s unfair to require healthy or wealthy individuals to pay for others’ care, while others see universal care as a fair use of shared resources.

Influence of political parties and media: Political messaging significantly shapes opinions, with universal care often framed differently depending on ideological leanings.

6. Social and Cultural Factors

Sense of social safety nets: In societies where public education, roads, and policing are accepted as communal goods, people are more likely to see health care in the same way.

Cultural attitudes toward poverty and illness: Societies that view illness as a personal failing may favor individual responsibility, while those that see it as largely random and unavoidable lean toward shared financing.

7. Fear of Economic Insecurity

Job-based insurance concerns: People who fear losing health coverage due to unemployment or changing jobs may prefer universal financing for stability.

Desire for protection against catastrophic costs: Recognition that anyone can face unexpected illness can lead to support for collective risk-sharing.

https://healthjusticemonitor.org…

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The Same Script: Value-Based Payment, Managed Care, and Neoliberalism, The Law and Political Economy Project, July 15, 2025, by Hayden Rooke-Ley

Ultimately, the private rationing of managed care and value-based payment is an abdication of governance – a failure of policymakers to wield the public authority required to equitably and efficiently administer a public health care program. A post-neoliberal health care agenda, by contrast, would contain costs through proper price administration and cutting private-sector administrative waste – the true drivers of overspending. It would directly reimburse physicians and other clinicians and nurture their professional autonomy, rather than empowering corporate executives and financiers to control them. It would use savings to make Medicare and other insurance programs more affordable for patients, and to properly pay overworked and underpaid caregivers. Now is the time to depart from the four-decade experiment with managed care and to structure financing policy to serve the interests of clinicians, patients, and their local communities.

Delays and Denials in Medicare Advantage, JAMA, June 25, 2025, by Hayden Rooke-Ley et al.

The growth of privatized Medicare is increasing the rates of prior authorizations and claim denials creating barriers to care, increasing administrative waste, and demoralizing clinicians. At the core of this problem lies a conflict of interest: the Medicare Advantage (MA) insurance companies that profit from denials are entrusted to make neutral determinations of medical necessity as they apply Medicare’s coverage rules. They do not. Unsurprisingly, MA plans serve their financial interests first.

Privatized Medicare was not supposed to work this way. MA plans are mandated by law to cover the same benefits as Traditional Medicare (TM) and follow Medicare coverage rules. However, MA insurers often refuse to follow them.

For decades, observers have raised concerns about denials in managed care, researchers proposed various solutions, and regulators have promulgated rules to clamp down on certain conduct. However, these solutions stop short of addressing the core conflict of interest. Fortunately, a solution lies in plain sight. TM uses third-party contractors, known as Medicare administrative Contractors (MACs), to implement coverage rules, engage in targeted prior authorization, and process and adjudicate claims. Although MACs are not perfect, they do have one major advantage over MA insurers: they are not biased toward denying care. MACs are paid a simple administrative fee. They are not at risk for medical costs and have no financial interest in denying services or payments. This process is efficient: CMS spends less than 2% on administrative costs, compared to 13% in MA.

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Health care in the United States is far costlier than in all other countries, and the performance of our system falls near the bottom of industrialized nations. As often discussed in HJM, we understand the functional reasons for this underperformance – grossly inefficient processes and massive financial access gaps.

In these two publications, Hayden Rooke-Ley digs deeper to explore underlying causes. He cogently critiques our neoliberal economic approach, which places blind faith in private sector mechanisms to optimize system performance. The fundamental problem is: optimize for whom? The private sector-dominated insurance system prioritizes creating wealth for investors at the cost of depriving consumers of the medical care they should have. He finds a defective nexus of managed care, value-based payments, prior authorizations, and denial of care and/or care payments.

These highly detrimental dynamics could be resolved by applying a sound policy principle: return control of decisions that affect patients to individuals who have no financial stake in the decisions. These are public guardians and their agents, interacting directly with medical providers. Remove the profit-seeking intermediaries. This would also help us end other faulty policies such as narrow provider networks and excessive patient cost-sharing should.

Hayden Rooke-Ley has also written about how to transform the provider side – i.e., how the harm from private equity could be mollified by the revitalization of public provisioning of medical resources.

Both of these papers are well worth downloading to be fully consumed. And to be used to explain to others why our system is functioning so poorly considering its high costs. They can serve as a springboard to a system that would be affordable and work well for all of us: a single payer national health program.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis, The New England Journal of Medicine, July 5, 2025, by Patricia Mae G. Santos, et al.

As the federal government seeks to curb immigration of all forms, immigrant health care workers and their patients will inevitably find themselves caught in the dragnet, which will have serious consequences for the system at large. The United States already has been grappling with severe health care worker shortages, which are projected to worsen over the next few years. For aging populations the forecast is especially dire.

The physically demanding nature of direct care work (home health aides, personal care aides, and certified nursing assistants), combined with low pay and high susceptibility to exploitation, makes these roles unattractive to U.S.-born and highly skilled foreign-born workers. Indiscriminate mass-deportation policies not only infringe on basic civil liberties but may also exacerbate existing worker shortages.

Immigration policy must therefore protect the dignity of people who dedicate their lives to caring for others, The recent deportation of immigrant health care workers is our canary in the coal mine: policymakers must act swiftly, or risk endangering the health of us all.

What a $178 billion gift means for the immigration police state, The Washington Post, July 8, 2025, by Catherine Rampell

Trump’s new mega-law invests $178 billion in additional immigration enforcement over the next decade. To be clear, this is not merely about “border security.” It’s largely for more detention centers and boots on the ground within the U.S. interior. This means spending more dollars to round up gardeners, home health aides, grad students, nannies, construction workers, etc.

In other words, the administration is going after your family, neighbors and friends, regardless of how long they’ve been here, whether they present any “safety” threat or how much they’ve contributed to their communities.

With daily arrest quotas to meet, agents are filling detention centers not with criminals and gangbangers, but people with no criminal history whatsoever.

Trump is not merely siccing immigration forces upon those who had been undocumented (with or without criminal records), under the stewardship of Deputy Chief of Staff Stephen Miller, this administration has also been working to “de-document” hundreds of thousands of immigrants who are here legally.

The Justice Department recently announced plans to prioritize revoking citizenship from naturalized U.S. citizens. The administration is also still trying to strip birthright citizenship from babies born in the United States, including those born to both undocumented and many authorized immigrant parents.

Comment:

By Don McCanne, M.D.

Stephen Miller has been working with President Trump to advance immigration policies that are opposed by most of the American public. Perhaps foremost amongst these is his effort to dramatically reduce legitimate immigration into the United States, much of which is beneficial because most of these individuals improve our national productivity, not only in menial occupations but often in professional roles as well. Yet Miller distorts his pronouncements to provide a rhetorical basis for obstructing US residence of these qualified individuals.

Listening to his framing induces a “thought experiment” that places him as the object of similarly distorted thought processes:

“To repair a problem you must first define it. Stephen Miller defines immigration as a broad negative. This implies the need to expel foreigners whom he considers to be undesirable, even if they are upstanding, contributing to our health and economy. A prominent medical journal offers a more positive and honest view of immigration as implied in the title, “Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis.”

“The growing dislike of Miller for his disruption of the valuable contributions made by immigrants to US prosperity creates a new proposition: How can we neutralize Miller’s harmful actions? Removing him from his current White House role seems the logical path. Some say his own immigrant origins should be investigated, to scrutinize the legitimacy of his claim to be in the US. That seems fair. However, we reject drastic measures, as suggested by some, because we value humanity, which we’re unsure Stephen Miller does.”

The ”oust Stephen Miller” path should have far greater appeal to the public than the despicable ideas and actions he is foisting off on us. In removing him, our society would achieve a trifecta: more humane, healthier, and wealthier.

https://healthjusticemonitor.org…

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Defining Health Care “Corporatization”, The New England Journal of Medicine, June 28, 2025, by Erin C. Fuse Brown

In Paul Starr’s seminal 1982 work, “The Social Transformation of American Medicine,” he observed the corporatization of health care proceeding along five dimensions: the shift from non-profit and government organization to for-profit companies; horizontal consolidation of locally controlled entities to nationally or regionally controlled corporations; the shift from state single-unit and single-market firms to conglomerate enterprises; vertical consolidation among levels of care delivery and payers; and increasing concentration, size, and scope of organizations. In the four decades since the publication of this work, the U.S. health care system has progressed further along every one of these dimensions toward greater corporatization.

Insurance conglomerates, such as UnitedHealthcare and CVS-Aetna, now control physicians, home care, pharmacies, and pharmacy benefit managers. Vertical consolidation was spurred by the rise of managed care and its value-based progeny, particularly as private insurance companies have assumed a growing role in publicly financed health programs. The term “corporatization” now refers to the general trend throughout the health care industry toward higher levels of integrated control by consolidated profit-seeking enterprises.

Two key elements of this definition are worth highlighting. First is the elevation of profit generation as the primary goal of health care enterprise. Embedded in the term “corporatization” is the concept of shareholder primacy, advanced by neoliberal economists, that the primary duty of the corporation is to maximize shareholder profits. Shareholder primacy subordinates the interests of other stakeholders, such as patients, the health care workforce, or the community.

The second key element of corporatization is consolidation. The sheer size of conglomerate health entities makes them systemically critical and “too big to fail.”

Recently, the term “financialization” has been used to describe the growing involvement of financial institutions, such as private equity firms, using financial tactics to extract wealth from health care companies for investors.

Although profit motive has always existed in medicine, the control that large profit-seeking conglomerates have over the people and entities engaged in health care delivery has intensified and spread to every corner of the health care system. Corporatization has produced a system that is incredibly profitable for investors but increasingly unaffordable, inaccessible, and uncaring for everyone else.

Public satisfaction with the health system is low. Future health policy efforts must confront the fundamental question of whom our health care system is meant to serve: corporate giants or the members of our society as a whole.

Comment:

By Don McCanne, M.D.

The New England Journal of Medicine just released the first article in its series on the corporatization of US health care. Excerpts appear above. Since you, as a reader of Health Justice Monitor, are well-informed on health policy, you likely are unsurprised for corporatization to be described as a scourge for health care.

In an accompanying editorial, Debra Malina et al state, “Despite the fact that the United States leads the world in health care expenditures, American life expectancy at birth is 4 years lower than the average life expectancy in peer countries.”

Tweaking the corporate model will not be adequate to fix this problem. We not only need to replace our private insurance model with a publicly financed and administered model (single payer), we also need to shift the expenditures for health care away from private investors and into financing the health care system itself. We can do this through mechanisms such as public provisioning of health care (i.e. public and truly non-profit ownership of the health care delivery system), and by adopting regulatory oversight that prevents diversion of our health care dollars through nefarious financial gimmickry such as private equity usurpation of the delivery system.

How are we doing? This week we witnessed the passage and signing of federal legislation that will immediately produce massive tax benefits for the most affluent members of our society while mandating reduction or elimination of medical care and other social programs desperately needed by low-income and indigent individuals. These measures will exacerbate the negative effects of corporatization on health care. The GOP knows the cuts are unpopular, and hopes to elude electoral repercussions by deferring implementation until after the 2026 mid-terms.

It is fine to follow the monthly NEJM series, but don’t wait until the end of the series to begin thinking about what we need to do. Begin immediately with the transformation of the insurance system from private to public, and start on the long and arduous path to shifting our health care dollars away from wealth creation for the intermediaries to paying for the legitimate costs of the services and resources that are needed to provide an optimal health care system for all of us.

Unfortunately, our political system has just demonstrated, once again, that we need to select our leadership based on beneficial public policies that we support rather than on whether or not you enjoy leadership led by arrogant, pompous, blowhard personalities who value their personal wealth far above the fate of the rest of us.

https://healthjusticemonitor.org…

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