"The medical-industrial complex — consisting of the private health insurance, pharmaceutical, hospital, and other related corporations — viewed single-payer as a threat to the industry’s bottom line and worked overtime to stop it. Health industry corporations and trade groups donated heavily to campaigns for federal office in 2008 and invested billions in lobbyists to shape the ACA in their favor. The Center for Public Integrity reports that a total of $3.47 billion was spent to double the number of health care lobbyists in Washington, D.C., in 2009. There were eight lobbyists per member of Congress. Millions were also spent on public relations campaigns to portray Medicare for All negatively and to convince people that what they really wanted was a choice of health insurance.

Progressive organizations also played a role in preventing national Medicare for All. Tens of millions of dollars were donated to establish a front group called Healthcare for America Now (HCAN), which was intentionally given a name similar to the national grassroots Medicare for All group, Healthcare Now. HCAN convinced advocates for universal health care that a single-payer system was not achievable, and that a more practical demand would be a public health insurance plan called a “public option.” It worked, and progressives became the loudest defenders of a bill that former Cigna executive Wendell Potter renamed the “Private Insurance Profit Protection and Enhancement Act” — even though it didn’t include a public option."