With the push for health care reform in a critical stretch, some bizarre coalitions are stepping up the fight to see the legislation through to the finish line.
One of the most peculiar, Healthy Economy Now, is spending millions to pressure members of Congress to get on board with health care reform.
The organization has brought together stakeholders from across the spectrum -- the pharmaceutical industry, doctors, union interests, business interests and advocacy groups among them.
The common thread for these strange bedfellows? Self-interest, observers say.
"Either you're sitting down at the table or you're on the menu," said Ernest Istook, a fellow at the conservative Heritage Foundation.
With the option of a national coverage mandate on the table, industry groups stand to win tens of millions of new customers regardless of the concessions the federal government extracts from them. Advocacy groups get the reform they wanted and union groups can win added benefits for their members.
"This whole thing has a lot of fascinating coalitions," Istook said, calling them a "convergence of individual self-interests rather than a shared vision of what is going to be best for the country as a whole."
In a statement, the senior vice president for Pharmaceutical Research and Manufacturers of America -- one of the coalition members -- said the groups came together because they share the goal of improving the economy through health care reform.
"We believe that without health care reform, America will continue to get sicker and poorer," Ken Johnson said, adding that a "healthier economy can happen if we have a healthier workforce."
Regardless of motive, such coalitions could prove vital to President Obama and his allies in Congress as opponents of health care reform flood town hall meetings to meet with their representatives during August recess.
According to a recent report, drug makers stand ready to spend $150 million to help Obama get the legislation passed.
The Healthy Economy Now ad buys have so far cost $12 million, according to another account. The group so far has run three ads in states targeting key lawmakers in the health care policy process.
The most recent ad warns that medical costs will skyrocket "if we don't act," and Americans will continue to lose coverage and benefits.
"But we can act," the narrator says. "The president and Congress have a plan to lower your costs and stop denials for pre-existing conditions. It's time to act."
The ads reportedly were made by companies with close ties to Democrats and the White House.
Healthy Economy Now includes Pharmaceutical Research and Manufacturers of America, the AARP, the American Medical Association, the Business Roundtable, Families USA and the Service Employees International Union, among others.
But at this murky stage in the debate, it's becoming less and less clear what is in the best interest of these organizations.
Several of them got on the bandwagon out of sheer survival instinct. They came to the table when public opinion was more favorable toward comprehensive legislation and Obama-led reform seemed inevitable. It was seen as better for industry organizations to get on board and shape legislation to their advantage than to actively oppose it while a bill that meets few of their needs tracked toward the president's desk.
"I think the groups just naturally want to be at the table thinking they're going to come out of it better," said Rick Scott, who heads Conservatives for Patients' Rights, one of the leading groups campaigning against the legislation in Washington.
But with public opinion starting to turn and town hall meetings getting raucous, it's unclear whether these groups backed the winning horse.
"We'll wait to see what September brings and if there's cracks in some of these coalitions," Istook said.
A crack started to show this week, after Obama claimed the AARP was "on board" with his health care plan. The line apparently hit a soft spot for the seniors group, which, though claiming to be nonpartisan and not behind any specific legislation, has appeared to side with Obama on health care reform -- even hosting a town hall-style event with him last month -- to the dismay of some of its members. The group drew the line after Obama claimed he had their endorsement, with Chief Operating Officer Tom Nelson calling the claim "inaccurate."
Istook said the industry groups also are "playing with fire," since they're dealing with other organizations and officials that ultimately want them "out of business."
The tension between the traditional forces for health care reform and the traditional forces against it flared most recently between Democrats and the insurance industry.
After coming to the table on health care talks earlier in the year, the insurance industry has been vilified by congressional Democrats and the administration in recent weeks. The Department of Health and Human Services just issued a report titled: "Coverage Denied: How the Current Health Insurance System Leaves Millions Behind."
Obama, though, insists he's not trying to pave the way toward a single-payer system -- one in which the insurance companies are mostly taken out of the picture -- despite past statements in favor of such a setup.
America's Health Insurance Plans is now conducting its own ad campaign advocating health care reform, but it is strongly opposed to the kind of public option that Democrats are calling for. A public option could significantly cut into insurance company revenue even if an individual mandate is part of the legislation.
Meanwhile, the groups in Healthy Economy Now have used some questionable tactics in pushing their agenda.
The New York Times reported last week that PhRMA struck a behind-the-scenes deal with the White House in which the administration would ensure nobody squeezes extra money out of the drugmakers in exchange for $80 billion in cost savings over the next decade. A PhRMA executive later walked that back in an interview with the Huffington Post.
Another unlikely alliance came with PhRMA and Families USA banding together to launch the sequel last month to the "Harry and Louise" ads that helped derail health care reform under the Clinton administration.
This time, though, the Harry and Louise actors, whose full names are Louise Caire Clark and Harry Johnson, are appearing in a multimillion-dollar ad campaign in support of health care reform.
AHIP spokesman Robert Zirkelbach said the scattered alliances stem from a desire to reach a mutually beneficial package and an acknowledgment that the status quo is not sustainable.
"You didn't see this type of collaboration 15 years ago. Never before have we had hospitals and doctors and employers and labor unions and health plans all coming together in support of health care reform," he said.
Despite the climate of advocacy for health care reform, several groups have lined up against the plans, including the U.S. Chamber of Commerce, the Association of American Physicians and Surgeons and the Blue Cross Blue Shield Association.