Android Auto is a proprietary standard that’s basically glorified spyware - if one thing isn’t being fed to it 24/7 exactly as Google wants it so they can sell it, it breaks. It’s basically just that there are a lot of dependencies that it would need that are fundamentally incompatible with privacy.
It’s the cost of federation with instances that try to be giant general-purpose instances (.world and .ee, mostly): just constant shitty takes that overwhelm participants in the conversation. Federation works far better with lots of small purpose-driven instances instead of gigantic ones; my small (<1000 users) specific community-focused Mastodon instance sees absolutely nothing like this and is full of people who intentionally engage in good-faith conversation with the rest of the community while every large instance I’ve seen has the same issues as centralized social media in that regard.
Is there another alternative? Bandcamp is the only similar website that a lot of artists I enjoy use.
If you’re watching movies with friends and want a FOSS alternative, Jellyfin is the way to go. It’s basically a way to host a media streaming center that others can connect to. It might be a bit overkill depending on your needs, but it’s great for that exact purpose. It doesn’t have chat or anything, though, so you’ll want to keep something else around for that.
The article explicitly talks about that multiple times, though. Were you reading one of the articles that this one references? It mentions repeatedly how inaccessible and unaffordable healthcare is, using both of those points, and then moves on to discuss the issue as part of a broader societal trend.