By most measures, our nation's health care system is in shambles.  We spend nearly twice more per capita than almost any other western country yet have mediocre (at best) health outcomes. There are nearly 50 million uninsured and tens of millions more with inadequate insurance. The cost of health care is rising at four times the rate of inflation, driving down wages, and economists predict that without reform, health care could bankrupt many of our businesses and institutions, undermining our nation's economic competitiveness.   

Yet health care reform is no inevitability. And the one measure that would bring down costs-the public option-is on the rocks. In the face of clear evidence and overwhelming public support, how could this be happening?

A report released last week by the Public Campaign Action Fund, elucidates part of the reason. Examining data from the Center for Responsive Politics, the watchdog group found that insurance companies and HMOs have been spending nearly $700,000 a day since the beginning of 2009 to stop meaningful reform. That's $700,000 per day, every day for the last 180 days, with no apparent end in sight.

This money has bought the industry nearly 1,800 registered lobbyists, or three lobbyists for every member of Congress. And it has meant millions of campaign contributions to members' re-election campaigns to help lubricate their arguments. All together, insurance companies and HMOs have spent well-over half a billion dollars on lobbying and campaign donations since 2007 to influence this debate, and they'll likely spend hundreds of millions more before the year is out. And by the way, that doesn't even include the expenditures of doctors, pharmaceutical companies, and hospitals, who are spending nearly as much promoting their own interests.

So what does all of this money mean for health care reform?

It means the health insurance industry is getting disproportionate access to our members of Congress, with more chances to make their case at cocktail parties, fundraisers, and dinners. It means industry phone calls are returned more promptly, and their concerns are given more attention. It means they get more face time with powerful senators and President Obama. And all together it means a palpable shift in the priorities of our representative government-in some ways subtle, some ways not-away from the public interest and toward moneyed interests. And this shift can mean the difference between health care reform that reduces your premiums and health care reform that does not, between reform that gives individuals real choice over their insurance and reform that does not.

Some sort of health care reform will pass this year.  The need for it is too overwhelming, and there has been too much good organizing by millions of people for nothing to happen. But we will likely not get reform that fundamentally reforms our broken system or reduces costs. And we may not get a public option-the one part of the plan that could actually take profit share away from the insurance industry. Until we can reduce our elected officials' dependency on special interest cash and provide a viable public financing option that would allow them to deny all corporate money, we will not get the health care reform that we desperately need. Until we can put a wrench in the corporate lobbying machine, we'll be stuck with broken systems, from health care to finance to the environment. 

Thankfully, there is momentum in Washington to establish a publicly financed Voter-Owned Elections system for all Congressional elections. The Fair Elections Now Act has been introduced by Sen. Dick Durbin and Arlen Specter in the Senate and Rep. John Larson and North Carolina's Walter Jones in the House. The bill now has 87 co-sponsors in the House, including Rep. David Price, and is gaining momentum. But it has a long slog ahead. It can still happen, but only if the intensity for reform heats up and key Congressional leaders realize how much the campaign money chase is hurting their own ability to govern.

Perhaps the best thing that might come out of the current health care debate is a new realization among members of Congress that fundamental campaign and election reforms are needed. Perhaps they'll finally realize they're a pre-requisite for pretty much every other kind of meaningful reform.

Chase Foster is the Coordinator of North Carolina Voters for Clean Elections