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There have been a series of great lobbying battles in the first decade of the 21st century, but surely one of the greatest was over the Obama administration's efforts to create a more substantial role for the federal government in managing the nation's huge health care insurance program--a sector that accounts for one-sixth of the nation's gross domestic product each year and continues to grow. While the nation's financial system struggled to recover from its near collapse in late 2008 and early 2009, health insurance companies, hospitals, doctors, pharmaceutical manufacturers, corporations, labor unions, consumer associations, and lawmakers organized for a fight over health care. The administration's success or failure in passing a reform bill was regarded as a defining moment for the Obama presidency, just as it had been in 1993-1994 for the Clinton administration. After months of confusion involving the Democratic-controlled Congress putting forth a variety of different proposals, the Obama administration stepped in with a compromise that managed to get just enough votes in the House and Senate to pass. The measure was signed into law by the president in March 2010.

Opponents such as the American Medical Association, the lead association of the nation's medical doctors, continued to oppose medical insurance reforms--as it had since the 1930s, when President Franklin Roosevelt proposed a national health insurance program to be added to his social security initiative, and then again in the 1940s, when President Harry Truman proposed a similar idea. The health insurance companies, too, in this latest round of debate, hired hundreds of lobbyists to descend upon Congress and advocate against the "socialization of American medical care." On the opposite side, a national health care insurance program, including a "single payer" provision that would have bypassed the private insurance companies that lie at the heart of the U.S. system, had long been on organized labor's political agenda. And, in a major switch from the time of the Clinton debacle of the 1990s, the pharmaceutical manufacturers this time were on the side of reform, because the Obama administration had promised them protections once they agreed to reduce the prices on some drugs covered in the new proposals. Big Pharma (i.e., the pharmaceuticals industry) ran some $100-million worth of TV ads in support of the administration's efforts.

When all of the issue advertising and spending on lobbying was over, a new law on health insurance in the United States was passed--and yet no one was completely happy. Tens of millions of Americans gained better access to health care, but the system of for-profit, private health insurance that makes U.S. health care different from care in every other developed nation, was still intact. Insurance companies, however, were now unable to deny people coverage for preexisting health problems, and they could not so easily terminate coverage for people who developed costly diseases or health conditions. Like many interest group battles before it, in this case, too many compromises on both sides produced a mixed outcome for all.

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