THE BURNED OVER DISTRICT

The thought of not being able to profit from the misery of others has so frightened the healthcare and insurance industries to mobilize their forces before they have any clear picture of what manner of progress they are called upon to prevent. So far only the idea is out there, any plans are still being created but the hired guns are leaving no public benefit unmauled by their hired guns.

Even before Democrats finish drafting bills to create a single-payer health care system, the health care and insurance industries have assembled a small army of lobbyists to kill “Medicare for all,” an idea that is mocked publicly but is being greeted privately with increasing seriousness.

Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item. They have hired a top lieutenant in Hillary Clinton’s 2016 presidential campaign to spearhead the effort. And their tactics will show Democrats what they are up against as the party drifts to the left on health care.

They also demonstrate how entrenched the Democrats’ last big health care victory, the Affordable Care Act, has become in the nation’s health care system.

The lobbyists’ message is simple: The Affordable Care Act is working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a big new public program. More than 155 million Americans have employer-sponsored health coverage. They like it, by and large, and should be allowed to keep it.

“We have a structure that frankly works for most Americans,” said Charles N. Kahn III, the president of the Federation of American Hospitals, which represents investor-owned hospitals. “Let’s make it work for all Americans. We reject the notion that we need to turn the whole apple cart over and start all over again.”

The Democrats’ proposals could radically change the way health care providers do business and could drastically shrink the role and the revenues of insurers, depending on how a single-payer system is devised.

The hospital federation and two powerful lobbies, America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America, created a coalition last June to pre-empt what they saw as an alarming groundswell of interest in proposals to expand the federal role in health care.

In a daily fusillade of digital advertising, videos and Twitter posts, the coalition, the Partnership for America’s Health Care Future, says that Medicare for all will require tax increases and give politicians and bureaucrats control of medical decisions now made by doctors and patients — arguments that echo those made to stop Medicare in the 1960s, Mrs. Clinton’s health plan in 1993 and the Affordable Care Act a decade ago.

The coalition will step up the tempo in the coming week as Democrats in the House and the Senate plan to introduce bills to establish a single-payer system.

The name of the coalition is intentionally nondescript, and its executive director, Lauren Crawford Shaver, who led Mrs. Clinton’s efforts in 2016 to put marginal states into play, is cagey when asked for details. She says only that the group is planning “a big nationwide effort” with grass-roots allies.

But its reach is undeniable. The coalition has picked up more than 25 members, including the American Medical Association, the American Hospital Association and the nation’s Blue Cross and Blue Shield plans.

And it has already sprung into action.

They missed the boat with Medicare/Medicaid but their Republican minions have been gnawing away at it ever since. They weren't able to stop the ACA but they burdened it with junk and once more set their Republican minions to gnawing at it, always seeking to diminish it. Their very actions speak to the value of Medicare For All. And with their current private administrative costs running 5 times what medicare costs, maybe it is time to send them the way of the buggy whip.