Officially at least, the Democratic Party is currently engaged in a spirited debate about the future of health care policy in America. While the plans being proposed by the presidential hopefuls come in endless shades and variations, the basic division is formally about how best to provide and improve coverage: through reform of the current system or comprehensive replacement with a single-payer model. Though the former camp acknowledges the shortcomings of the status quo, it continues to express skepticism about a “one-size fits all” solution that reduces the “freedom” and “choice” afforded via privately provided insurance.

Seen in these terms, Democratic politicians are helping lead a constructive public debate about how to improve health care and having a good faith disagreement about the best way forward — with most, having weighed the alternatives, coming down on the side of some model that includes a continued role for private insurance companies.

Anyone with even a perfunctory knowledge of how Washington, DC functions in practice will, of course, instantly recognize something amiss in this portrait. Health care is a multitrillion-dollar industry and private insurance is a hugely lucrative business. Given the Wild West that is America’s political financing regime, it would be unthinkable for corporate actors to sit on the sidelines when so many billions in current and prospective future profits are potentially at stake. Construed a bit more accurately then, the current Democratic dispute over health care policy is merely the most publicly visible portion of a debate that industry actors are seeking to shape and circumscribe behind the scenes for purely self-interested reasons.

They can’t officially say this of course, because no self-respecting member of the public who doesn’t work at a think tank or billionaire-owned media venture would give it the time of day. The business of protecting private profits at the expense of public goods — particularly when it comes to something as urgently needed as the universal provision of health care — is an impossible sell on its own terms, which is why so many Beltway apparatchiks are employed to garnish it with a patina of social concern. From lobbyists and dark money groups to corporate-funded think tanks and advertising efforts, the enterprise of giving the most nakedly evil schemes a human face is a lucrative business in and of itself.

In this respect, the campaign to undermine Medicare For All has been a veritable full employment program for people who make a living at the noxious intersection of government and private industry. Every time a Democratic politician or network talking head suggests Medicare For All would undermine freedom of choice or rob average Americans of their oh-so-beloved private health insurance plans, it’s the more or less direct outgrowth of a concerted effort by special interests spending unfathomable sums of money to protect their profits.

This may sound like hyperbole, but as Jeff Stein of the Washington Post reported earlier this week a lobbyist connected to the Astroturf group Partnership for America’s Health Care Future (PAHCF) quite literally helped draft recent op-eds published by two Democratic lawmakers in Montana. Emails obtained by the Washington Post show extensive revisions including the removal of language acknowledging that the United States “clearly spends significantly more on health care per capita than other developed nations” and the insertion of a passage denouncing the solutions proposed by “extreme ends of the political spectrum” while claiming “what most Montanans and Americans would prefer lies somewhere in the middle.”

Joe Biden or Pete Buttigieg could hardly have said it better.

In a properly functioning democracy, a lobbyist using elected lawmakers like marionettes on behalf of corporations would be considered a national scandal. Not so in twenty-first-century America where money is speech, war is peace, and freedom is the right to die of a preventable illness thanks to stratospheric deductibles that prevent you from seeing a doctor.

Without a doubt, the Astroturf effort revealed by the Washington Post is just a tiny (and probably unexceptional) snapshot of the industry’s insidious work to insert its talking points into the public domain and undermine Medicare For All. Here’s how a 2018 report published by the Intercept described PAHCF’s thinking and strategy according to its own internal documents:

The campaign has worked with advertising agencies to draw up a series of messages to convince select audiences. Several of the messages, categorized as “positive,” are dedicated to educating the public on more minimal reforms that do not include expanding Medicare. Other messages, categorized as “persuasion” and “aggressive,” are designed to instill fear about what could happen if “Medicare for All” passes. In the coming weeks, the Partnership plans to ramp up a campaign designed to derail support for “Medicare for All.” The group, working with leading Democratic political consultants, will place issue advertisements to target audiences, partner with Beltway think tanks to release studies to raise concerns with the plan, and work to shape the public discourse through targeted advocacy in key congressional districts. The Partnership has tapped consulting firms with deep ties to Democratic officials. Forbes-Tate, a lobbying firm founded by former officials in President Bill Clinton’s administration and conservative Democrats in Congress, is managing part of the Partnership coalition. Blue Engine Message & Media, a firm founded by former campaign aides to President Barack Obama, has handled the Partnership’s interactions with the media.

As Lee Fang and Nick Surgey point out, the campaign is almost a mirror image of the one deployed by industry groups during the presidential primaries of 2008: an effort which culminated in the Obama administration’s passage of a much-defanged bill that included major concessions to special interests in the form of the ACA.

Given the ongoing industry push to undermine Medicare For All during the Democratic presidential primaries, it’s deeply revealing how many nomination hopefuls seem willing to regurgitate talking points quite literally engineered by soulless lobbyists in proverbial smoke-filled back rooms. More striking in some ways, however, is the sheer number of influential Democratic insiders personally connected to the campaign of corporate agitprop directed at Medicare For All and anyone who champions it.

Far from being a disinterested or good-faith conversation featuring divergent views over public policy, the Democrats’ internal debate over the future of health care is a clash between private interests and the public good in the starkest and most literal sense. Don’t let a PR flunky, lobbyist, or politician qua corporate sock-puppet tell you otherwise.