If you are looking to buy an ACA-compliant health insurance plan, there is a good chance the first thing you might do is google “Obamacare” or “ACA plans.” And if you do, you will be given a page of results that looks something like this:

If you click one of these links, you may be taken to a site like Obamacareplans.com that contains the logos of many legitimate insurance companies. It will promise to set you up with an insurance plan, if you give it your information. But if you look closely, you will find a small disclaimer indicating that the company is not affiliated with the government or these insurance companies. You will also find the even more worrying disclaimer that just by entering your phone number and email address you “authorize Quotelab, LLC, and one or more of Kaiser Permanente, and/or these marketing partners to contact you for marketing/telemarketing purposes at the number, email address and address provided above, including your wireless number if provided, using live operators, automated telephone dialing systems, pre-recorded messages, artificial voice, text messages and/or emails, even if the number you provide is on a state or Federal Do Not Call registry.”

This is not an idle threat. Better Business Bureau reviews for the company (also known as MediaAlpha) reveal that not only may you be called, but you may be called all the time. Some sample testimonials: 

• I inadvertently went to Obamacareplans.com thinking it was the government site to get a quote for healthcare. They apparently gave my information to advertisers and since May 7, I have received 77 calls from various numbers asking about buying healthcare. When I told them I was getting too many calls, they hung up on me. I called one back and asked to put me on the do-not-call list and they hung up on me. I’m tired of being HARASSED and it needs to stop. Once I block a number, I get calls from new numbers. When I try to call some of them back, it says it’s not a working number. It’s a horrible cycle that can’t be broken! I don’t recall agreeing to sell my personal information! This is a horrible, scam company….
• I accidentally submitted information to MediaAlpha’s Obama-careplans.com site in hopes of finding a new healthcare plan following the fallout of COVID-19. Now, I am receiving call after call all day long. It is constant harassment. I want my information to be deleted and I have submitted several requests for doing so, but I am not a California or Nevada resident. This company preys on people who need health insurance in a time of need by creating a website that appears credible, collecting data, and selling it to hundreds of third-party companies that will call you hundreds of times each day.
• Within seconds of entering my phone number, I became inundated with ceaseless phone calls. I’ve begun answering some and asking them not to contact me anymore. I also left feedback on obamacareplans.com, first under the category “Do Not Contact Me” and again left General Feedback explaining that I find what they do disgusting, and that if contact didn’t cease I would be contacting the BBB. Contact slowed but has not ceased. I’ve blocked over 20 callers in the last 3 hours.
• Their company name Obamacare-plans is obviously intended to fool people into believing they are part of a government program. Although they have fine print pointing out that they’re actually a private company, I did not initially realize that and foolishly filled out an online questionnaire on their website to see if I would be eligible for Medicaid. I IMMEDIATELY started receiving phone calls from them that originated from various states — all of the callers saying they were calling in response to my request for a quote. (I had NOT requested a quote, I had simply filled out their online form which they purported would simply tell me if I was eligible for Medicaid.) In the past hour, I have received more than 15 telephone calls from them. My phone is now ringing again! MAKE THIS MADNESS STOP! 

I hope I don’t need to point out to you that someone searching for Medicaid is likely poor and may well have health issues, meaning that not only are these companies tormenting and scamming poor sick people, but Google is profiting off their activity. (It’s not surprising the company abandoned its motto “Don’t Be Evil.”) According to ACASignups.net—which does appear to be a legitimate healthcare data analysis website—Google had indicated in April of this year that it was going to introduce a new certification process to get the scams out of its search listings, but here we are in October and people looking for insurance are still being tricked into handing their phone numbers over to marketers selling god-knows-what. So those searching for insurance “may be taken to a legitimate health insurance broker authorized to sell on-exchange ACA policies…or you may be taken to a fly-by-night quasi-legal outfit which either pushes junk plans or simply resells your contact info to fourth-party scammers.” 

There are two big underlying problems here, both of which relate to the way the profit motive is in conflict with the public interest. First, having health insurance sold in a “free market” was a ludicrous idea to begin with, and the Affordable Care Act’s emphasis on comparison-shopping opened the door to these kinds of scammers. You have a population of people who know they need to spend money, and who may be sick and stressed, and who are trying to negotiate an extremely confusing system. Americans often know almost nothing about their own country’s health insurance system, which makes them ripe targets for those who can trick them into thinking they are getting a bargain. 

The system established by the ACA is a bureaucratic hell that only a policy wonk could love. Here’s a genuine health insurance consumer support website explaining just some of the many distinctions that prospective buyers must keep in mind: 

In addition to outright scams like identity theft, consumers need to be aware of the possibility that some agents might try to portray their agency as “the exchange” and attract customers who think they’re purchasing coverage through the official exchange. This is further complicated by the fact that licensed agents and brokers who are certified by their state’s exchange can help consumers enroll in exchange plans. Individual policies can still be purchased outside of the exchanges. Like exchange plans, they are ACA-qualified which means they are guaranteed issue, cover the essential health benefits, and have the ACA’s limits on out-of-pocket maximums. Some are sold by carriers who also sell policies in the exchange, but some carriers only offer plans outside the exchange. From a consumer perspective, the primary difference between exchange and non-exchange plans is the availability of subsidies. Premium subsidies and cost-sharing subsidies are only available on plans that are purchased through the exchange. Each state has just one official exchange where subsidies are available and in 36 states as of 2021, it’s Healthcare.gov.

I have a law degree and I am pretty sure after reading that a couple of times that I can remember the differences between exchange and non-exchange plans.

Barack Obama’s former deputy chief of staff wrote a memoir about her White House Years called Who Thought This Was A Good Idea? I have often wondered the same about Obama’s signature piece of legislation, the Affordable Care Act. I have no idea how ordinary Americans—over half of whom read below a sixth grade level, are even supposed to begin to navigate this system. (Often they just don’t. Millions of uninsured people are eligible for free health insurance but don’t take it because nobody knows about it or has any idea how to get it. NPR reports that “puzzlingly few have enrolled.” Really, it’s puzzling?) American health insurance seems like a cruel joke, the kind of public policy dreamed up by Satan to amuse himself.  

We are still just talking about the agonizing process of getting health insurance. Once you have it, then you get to the fun part: realizing that the thing you need isn’t covered, or spending the period of your life when you or your loved ones are at your sickest trying to negotiate with an insurance bureaucrat. 

All of this is completely avoidable, of course. Need I remind you that in the U.K., when you need to go to the doctor you just go to the doctor. If you just have public hospitals, nobody needs to waste time doing comparison-shopping for insurance plans. Even a just public insurance plan like Medicare For All can eliminate enormous bureaucratic hassle. Far from being “efficient,” our market-based system requires a staggering amount of wasted human time and energy. The government has to spend years investigating and rooting out phony insurance scams that would not even exist if the government just insured everybody. There’d be no need to wonder why the uninsured aren’t taking up their free insurance if you just insured them by default. This entire system is fixable, and the sole problem is that we need to overcome the political influence of the private insurance industry. That’s difficult, but it shouldn’t be impossible. 

The Other Problem: Google 

Google effectively has a monopoly over web searches, holding a staggering 92% of the online search engine market share. “Googling” and “searching” are synonymous of course, and while the company has insisted that it operates in a competitive environment (You could use Bing!) a Congressional antitrust report from last year concluded this assertion was laughable, since “no alternate search engine even remotely approaches serving as a substitute.” 

Alphabet, Google’s parent company, makes more than 80% of its revenue from Google advertising, and has become one of the world’s most valuable corporations. It should not be difficult to see why there is the potential for a very serious problem here. If all of the world gets its queries answered through a single channel, and if the institution that operates that channel ranks information according to the amount of money it has been paid, rather than any sense of the public interest, and if people tend to read the first results that come up, then people’s entire picture of the world’s information will be economically determined; that is, your very sense of the truth will be warped by the interests of private corporations willing to pay for the privilege of answering your queries in the way that serves them. A search engine used by everyone has an awesome public responsibility, because it is treated like the voice of God, offering the answers to any question they could come up with. A universal search engine should absolutely not be governed by private interests, but should be like a public library or a university, its institutional mandate to keep people informed rather than to keep them buying products. And yet: we have blundered into a situation where what should obviously be a public service is instead a way of manipulating people into spending more money.

Over time, as we might expect with a profit-maximizing company that operates without  competition, Google has gotten lazier and lazier about giving people quality search results, and more and more corrupted by advertising dollars. Sometimes “you might have to scroll three screens down before you find actual search results rather than paid promotions.” While “in 2013, the average real search result link began at 375 pixels down the page…in 2020, it had dropped down to 616 pixels because of ads and all the other info Google puts on top of its ‘organic’ links to other sites.”  As the Washington Post’s Geoffrey Fowler writes, “on some searches, it’s like Where’s Waldo but for information,” the company being “more interested in making search lucrative than a better product for us.” 

One of the findings of the House report on tech monopolies is that Google works hard not to show you any of the internet, if it can help it. Instead, it tries to direct users to Google’s own products and sites. Google has turned from a “turnstile” to a “walled garden,” and research found that it “allocated 41% of the first search results page on mobile devices to Google’s own content.” The company has been “blurring the distinction between how ads and organic listings are presented on Google’s search results page” and has undermined competition, misled consumers, and degraded the overall quality of Google’s search results—all while enabling Google to further exploit its monopoly over general online search.”

It did not need to be like this. We have a reliable public encyclopedia, Wikipedia, because in the early days of the internet, those committed to the public interest ensured that Wikipedia would be insulated from the corruptions of the profit motive. If search engines had been developed and maintained by a consortium of universities, rather than a profit-seeking corporation, it would be very different today. The operators of a public interest search engine would take great care to make sure that people looking for health insurance were given the most informative possible sources that would help them make decisions. Interestingly, the founders of Google, Sergey Brin and Larry Page, actually knew this. In an early paper, they wrote that advertising was “particularly insidious” for a search engine, and that “we believe the issue of advertising causes enough mixed incentives that it is crucial to have a competitive search engine that is transparent and in the academic realm.” But even though they knew a public interest search engine was “crucial,” they decided not to build one, and produced Google instead.

Part of the problem, too, is that Google is somewhat brainless, and thus not just corrupted by advertising dollars but by those who are the savviest at “Search Engine Optimization (SEO)” aka tricking your way to the top of the page, which companies spend fortunes figuring out how to do. When it searches, it often gives you millions upon millions of results, almost none of which you will look at. There is no editorial judgment in the selection of what to show you; any halfway decent information guide would be put together by discerning humans trying to curate a quality list of informative links. Once again, we may note the contrast with Wikipedia, where what people see is the product of intensive debates among thousands of people about what the information presented to the public ought to be. 

Interestingly, the Australian Green Party suggested that their country’s government should fund the development of a public search engine. There are, of course, huge logistical challenges involved, and it might be easier to nationalize Google than to try to launch a public alternative that is also capable of indexing and searching the entire internet. But as Ethan Zuckerman writes in an excellent Columbia Journalism Review article, “The question isn’t whether a public social media is viable. It is if we want it to be.” Still, we do not necessarily need something that searches the entire internet and can spit out millions of results. What we need is something that produces the 20 or so results that are actually worth looking at, and makes sure these will be relevant and informative. You might make a better search engine just by having something that Googled your question and then tossed out all the crap. 

People need information all the time. Billions of Google searches are done every day. But it’s clear that the profit motive corrupts searches. It may be hard to imagine what Google would look like if run on the Wikipedia model, but we can quite easily imagine what Wikipedia would look like if run on the Google model. It would be hideous, with reliable information seamlessly mixed with paid corporate propaganda. Every company’s article would be an advertisement, articles on every subject under the sun loaded with deceptive sponsored content. (Kind of like the way the New York Times lets Shell buy space to run articles.) The world’s universities and governments, who have a responsibility to keep the public well-informed, need to devise a way to make sure that such a core piece of infrastructure as knowledge dissemination is done in a way that serves the general interest rather than that of the particular corporations who can afford advertising and optimization.

Perhaps Google will finally purge the Obamacare scams from its search listings. But they are just a symptom. On every subject people might search for information on, Google is willing to take money to distort people’s perception of what is useful and important. Ultimately, what we see here shows us exactly why we need strong public institutions. Public healthcare. Public search. These should be available to all of us. 

I am grateful to Lauren Lueder for drawing my attention to the Obamacare scams, and to Rob Larson and Jeremiah Miller for useful information on Google and the prospects for public search engines. Rob’s book “Bit Tyrants: The Political Economy of Silicon Valley” is an excellent summary of why the tech monopolies are harmful and Jeremiah’s paper “A Search Engine for Everyone: An Exploration of the Contemporary Search, Its Limitations, and a Path Forward” showed me that the idea is worth pursuing.