All the Democratic health-care proposals have one big problem

But looming in front of the discussion is an obstacle no amount of careful messaging will help them overcome: Even the most modest Democratic plan would face intense opposition from health-related industries, not to mention Republicans.

Already, powerful interest groups are mobilizing and pooling resources to undermine the Democrats’ plans. The Partnership for America’s Health Care Future—a lobbying group that represents insurance companies, drugmakers, hospitals, and other industry players—is running TV ads and commissioning polls designed to undercut support for any expansion of government-provided coverage.

The industry coalition despises Medicare for All, which would end private insurance, hammer pharmaceutical profits, and slash provider payments as much as 40% in the hope of making coverage universal and accessible. But the group’s also against letting Americans buy into a Medicare-like plan at lower cost. “We want to build upon what is currently working and fix what is not,” says Lauren Crawford Shaver, the Partnership’s executive director, who worked in the Obama administration and on Hillary Clinton’s 2016 presidential campaign. “Candidly, we do not see Medicare for All, Medicare buy-in, or public option helping to accomplish those goals. Our members are not really together on many things in this town, but they are united in this.”