Wendell Potter, the former health insurance industry executive turned single-payer advocate, came clean in a Twitter thread last week about how the big lie in every healthcare debate in the last decade—choice in private insurance—came to be. He says that when he was in the industry, "we were instructed to talk about 'choice,' based on focus groups and people like Frank Luntz (who wrote the book on how the GOP should communicate with Americans)." Because what would motivate people the most against a change that threatens the profits of the entire industry—the threat that something was being taken from them. Even though almost no one actually does have free will when it comes to their private insurance or their health care.
If you have employer-based coverage, your company chose a handful of plans for you to pick from and it only had a handful of possible offerings. Within those plans, you are limited as to which doctors, or specialists or hospitals you can choose, those who are "in network" and have negotiated rates with insurers. What's more, you employer can change offerings every year and your "choice" will have to change with it. Or you might get a new job, and have to change insurance, and doctors. Or you turn 27 and aren't on your parent's plan, and you have to change again. Or your doctor moves or retires and you have to find a new one. So-called "churn" in health insurance and in the system as a whole is just a given. Everything changes all the time and that makes the individual's choices in the system limited at best.
That's the reality that Potter said they set out to "muddy." He says they "spent millions on lobbying, ads and spin doctors—all designed to gaslight Americans into thinking that reforming the status quo would somehow give them 'less choice.'" They created an industry front group that launched a campaigned called "My Care, My Choice" to push the myth to Americans that they have a choice and that reform of the system was going to take that away. After the Affordable Care Act passed, they morphed that front group to the "Choice and Competition Coalition," to lobby states against creating their own insurance exchanges with multitudes of plans.
Here's what's particularly galling in all of this—under Medicare for All, you actually would have more choice. Every doctor and every hospital would be on your plan because there would be one, all-encompassing and generous plan. If doctors want to keep working and getting paid, they have to take patients. That some Democrats are actually using this argument is the other part that's discouraging, because they should most definitely know better. Using the same arguments that have been used by Republicans for the past decade against any change in the system is fundamentally dishonest.
This argument is as ridiculous as the one that says people love their health insurance, which we all know is bullshit. There's not a person in this country who looks forward to open enrollment season and their chance to pour through page after page of incomprehensible industry-speak and fine print. And when a candidate—Democrat or Republican—tries to tell you the status quo is better because you'll have "choice," you'll know you're being conned.