#open enrollment

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:

https://www.cnbc.com/2025/11/24/republicans-push-obamacare-tax-credit-alternatives-as-deadline-looms.html

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:

https://pluralistic.net/2024/04/24/naming-names/#prabhakar-raghavan

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:

https://pluralistic.net/2025/09/03/unpunishing-process/#fucking-shit-goddammit-fuck

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:

https://pluralistic.net/2024/04/04/teach-me-how-to-shruggie/#kagi

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:

https://pluralistic.net/2025/07/15/inhuman-gigapede/#coprophagic-ai

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:

https://pluralistic.net/2025/11/25/open-season/#open-enrollment

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.