A carefully calculated and well-financed campaign against Medicare-for-All is now taking place just beneath the surface of America’s political debate on health care.

Consider, for example, why you keep hearing Medicare-for-All described as “government-run” and as a “publicly financed and administered” system. And why are we seeing all the hand-wringing about “losing” private insurance when so many people’s experiences with it are so negative?

The debate on health care has been consciously shaped by the health-care industry. The use of such terms as “government-run” and “government-controlled” are part of a deliberate strategy to milk deeply instilled fears of government bureaucracy while fostering the illusion that individuals have unlimited choice within their “own” insurance plans.

Less loaded and more accurate descriptions of government’s role in reform options—such as “administered,” “financed,” “managed,” “offered,” “provided,” or “sponsored”—are almost routinely bypassed in mainstream media coverage. And that’s no accident.

The systematic campaign to associate all meaningful health care reform with cumbersome and ineffective government bureaucracy has been carried out for decades by an intricate coalition involving the insurers themselves, Koch brothers’ front groups, Republican and Libertarian strategists like Bill Kristol, William McInturff, and Karl Frank Luntz, and championed by legislators including Newt Gingrich. The history is painstakingly detailed in an important new report from the National Economic and Social Rights Initiative, a New York-based advocacy organization.

“By drawing a contrast between ‘government’ and ‘private’ insurance, the media and polling organizations explicitly invoke government control of public insurance while rendering private insurance companies invisible,” states the institute’s report. It lays out the long-term propaganda campaign to insert “government-run” as the dominant frame for health-care reform.

A revealing series of leaked strategy memos show detailed testing of messages conducted by Republican pollsters including McInturff and Luntz, and paid for by the insurance industry. The Koch brothers’ organization Citizen for a Sound Economy spent millions working to label Hillary Clinton’s efforts at reform “government-run health care.” The report quotes Luntz on Fox News in 2009 saying, “If you call it a ‘public option,’ the American people are split. If you call it the ‘government option,’ the public is overwhelmingly against it.”

Given that the largest health insurer profits hit $7 billion and Big Pharma hauled in $30 billion in 2018’s third quarter, these industries have an enormous stake in blocking Medicare-for-All and maintaining the status quo.

These same massive profits also provide health-care industries with almost limitless resources to create and project messages condemning any reforms that might displace them from their commanding perch in the health-care system.

The characterization of reform as “government-run” has been widely adopted by pollsters, journalists, and “moderate” Democratic presidential primary candidates like John Hickenlooper.

“Many of the Democratic candidates might as well be speaking out of an insurer playbook,” says Robert McChesney, endowed chair and professor of communications at the University of Illinois Urbana-Champaign. “The major media and these candidates are doing everything they can to shift the debate from focusing on insurers and their investors.”

The systematic campaign to associate all meaningful health care reform with cumbersome and ineffective government bureaucracy has been carried out for decades by an intricate coalition involving the insurers themselves.

The “government-run” frame deeply influences even self-proclaimed advocates like Neera Tanden, president of the liberal Center for American Progress, a high-profile think tank and advocacy group (which receives some of its funding from health insurers). Tanden directly invoked the specter of “big government,” declaring to The New York Times, “If you’re worried about a Trump Administration now, just imagine if the government has control of everyone’s health care. And I say that as a big-government liberal.”

Nexis Uni searches of the phrase “government run health” reveal that the media almost never used this phrase before the insurance industry coined and pushed it, according to the National Economic and Social Rights Institute report.

“Politicized ‘government’ framing is now so firmly mainstreamed in journalists’ lexicon that virtually every major news organization covering health care policy routinely uses this insurance industry framing to define Medicare for All, public-option proposals, and the existing Medicare and Medicaid programs too,” the report states. “Google returns 13,300 news results with the phrase ‘government-run health care’ but just three with the phrase ‘corporate-run health care,’ a ratio of 4,433 to 1.”

To cite just one example, a relatively even-handed article in The New York Times from August on the Medicare-for-All proposal utilized the term “government-run” six times.

But far from the version described by Tanden and others, Medicare-for-All is not “government-run.” It combines public administration of funding with privately delivered care. The core mechanism of Medicare-for-All substitutes a single payer system—administered through the government—for a multiplicity of greedy, for-profit insurers.

Those corporate insurers now play a commanding role in health-care decisions—dictating which treatments are covered, which doctors may be chosen, et cetera., adding a layer of bureaucratic fat amounting to a stunning 31 percent of every health-care dollar. Canada spends between $15 and $32 billion less on “billing and insurer-related” activities, compared to the United States, because of greater administrative standardization.

Under Medicare-for-All, in contrast, government entities would replace the corporate insurers while doctors and hospitals would continue to be in private hands. Rather than restricting choice, as private insurers currently do in the United States, consumers would have full free choice of doctors and hospitals, as they do in Canada and Taiwan.

Currently, almost two-thirds of national health-care expenditures are publicly financed. Further, two-thirds of “private” insurance companies’ business is actually subsidized by the government. Yet while the public finances a huge share of health care, it has almost no voice in decisions, whether it is large-scale allocation of funds by insurers and hospitals, or the personal choice of doctors.

Instead of insurance corporations seeking to maximize profits by minimizing costs, the government would administer—not control—the provision of health care. The outcome would be universal coverage, in which consumers can choose their doctors and hospitals. Publicly channeled funding would be coupled with privately delivered care, as with the existing Medicare program for senior citizens.

But the basic character of Medicare-for-All has been twisted into a vision of distant, top-down government bureaucracy, impervious to individual needs. This version of “reform” draws on four decades of intense anti-government rhetoric enthroning private for-profit power at the expense of public programs that a democracy is intended to enhance.

As the public debate over fundamental health-care reform grows more intense, the exposure of the insidious campaign to disqualify Medicare-for-All and other publicly centered reforms only gains in urgency. America’s ability to conduct a thoughtful, fair debate on major public policy is being endangered once again by the corporate propaganda machine.

“The mainstream focus is almost entirely on the upfront costs and losing private-insurance—a useless middleman anyway—instead of pointing out that the current system means X number of people dying without insurance and more being unable to afford insurance,” McChesney says. “The insurers’ talking points are followed so closely that we never hear about the overall net effect of savings from real reform like Medicare-for-All.”