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.