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Health Care Reform: The Slugfest BeginsMeet the interest groups that will decide the fate of medical insurance.

By Timothy Noah
Posted Tuesday, July 22, 2008, at 5:24 PM ET

If you want to learn the current parameters of the political debate over health care reform, scrutinizing the plans proposed by presidential candidates Barack Obama and John McCain will get you only so far. A sharper picture of where the battle lines are drawn is starting to emerge from two new lobby campaigns recently created by two key opposing groups.

In this corner … the insurance industry, which today launches its Campaign for an American Solution with a "listening tour" that starts in Columbus, Ohio. The insurers must be fast listeners, because, according to Politico's Chris Frates, they plan to start placing print ads in newspapers next week. One thing the insurers won't want to hear is that the only practical solution to the unholy mess that is American health care is either to extend Medicare coverage to everybody (which, if successful, might wipe out private health insurance altogether) or to regulate health insurers so closely that health insurance would become a government program in everything but name. These two solutions have been adopted in nearly every advanced industrial democracy except our own, and by and large they do seem to work. But the very name of the Campaign for an American Solution suggests that part of the insurers' strategy will be to suggest that consideration of any health care system existing outside the United States is inherently unpatriotic.

In that corner … the labor unions and various liberal nonprofits, which this month launched Health Care for America NOW! with a $25 million advertising campaign that demonizes private health insurers with ingenuity and wit. This coalition helped craft the bake-off proposal adopted first by John Edwards and subsequently by Obama and Hillary Clinton. Under the plan, everybody would get to choose either private or public health insurance. Let the market decide which is better! Conservatives who are usually enamored of free choice hate this idea because they know it's a foregone conclusion that the public plan would be more generous—and more efficient, too. Unlike Federal Express, which found a niche by beating the quasi-governmental U.S. Postal Service at its own game, private insurance has consistently been found less cost-effective than big-government health insurance provided through programs like Medicare and the State Children's Health Insurance Program. Like Michael Moore's Sicko, Health Care for America NOW! has figured out that the health care crisis has grown well beyond the problem of the uninsured; today even the insured are constantly discovering that their insurance companies won't necessarily cover expensive and necessary procedures. This is the constituency most likely to put health care reform over the top.

Let the wild rumpus start!

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Timothy Noah is a senior writer at Slate.
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