President Barack Obama has boasted in recent days that agreement on health care reform is close, but there are new threats to reform from the health insurance industry, which doesn't like the latest changes to leading reform plans.

The health insurance industry is attacking reform efforts and warning that family premiums will cost $4,000 more by 2019 than government projections suggest. Other groups dispute that figure and see scare tactics.

An article in Sunday's New York Times describes how a variety of ideas for reducing health care spending have been attacked by special interests. In some cases, it was the health insurance industry and in other cases it was drug makers working to protect profits. Beyond those groups, lobbying by hospitals, doctors and other health care providers also have shaped legislation in Congress.

Obama's promise to rein in health care spending is taking a back seat to expanding coverage. The basic problem is that reducing health care costs generally means reducing profits of some special interest.

Health insurance companies would face stiff price competition from a "public option" insurance plan, so health insurance lobbying was employed to kill the idea.

Allowing the government to negotiate for lower drug prices, as is done in other advanced nations, would cut into pharmaceutical companies' profits, so lobbyists for the drug makers offered some limited cost savings in exchange for a deal that would prohibit the government from going after bigger savings.

The health care debate started with two main goals: reducing health care spending and providing universal coverage. But because cost reduction often means profit reduction for powerful special interests, cost reduction appears half-hearted and only advances with industry approval.

At just about every turn, reform ideas with the most potential to reduce health care costs have been "killed, bit by bit," according to the Times article.

In the same article, U.S. Rep. Jim Cooper, D-Tenn., simply said, "The lobbyists are winning."

That is not a surprising statement, but it should be an eye-opener for those who still believe that health care reform will expand coverage and reduce costs. It might, but only if those efforts don't threaten profits of health insurance companies, drug makers, hospitals or doctors.

The reason the health insurance industry is fighting the latest reform effort is that Congress has scaled back the number of people who will be forced to buy insurance. With fewer new customers, including many who are young and healthy, being forced to buy insurance, the health insurers will not see quite the level of higher profits that they had expected with universal coverage.

The health insurance companies and other health care interests have spent hundreds of millions of dollars on lobbying and campaign contributions to help ensure that any health reform emerging from Congress reflects the industry's interests. Beyond that, many health care lobbyists are former congressional staffers, or former White House advisers. So the heath care industry is well-positioned to influence, if not control, the work of Congress.

Lots of people pass through the revolving door between Washington and health care interests. One estimate, by the Public Accountability Initiative, says that 500 congressional aides have gone on to work as lobbyists in the health care industry.

The senior health care aide for Sen. Max Baucus, D-Mont., is a former employee and adviser for WellPoint Inc., the big health insurer. Another staffer working on the Baucus health care bill worked as a lobbyist for drug companies Amgen, Eli Lilly and Pfizer, as well as insurers Aetna and Blue Cross.

It can be argued that these lobbyists-turned-aides and aides-turned-lobbyists can provide expertise on many of the complex issues involved in health care reform. But there is growing evidence that the interests of the American public are heavily outgunned by special interests in health care, including insurance companies, drug makers, hospitals and doctors.

The interests of consumers, patients and taxpayers are secondary to the profits of the health care industry. And most of the reform proposals in Congress, including plans backed by Obama, reflect that fact.

Americans should question why the United States should continue to spend about 17 percent of gross domestic product on health care, while nearly all other advanced nations spend between 6 percent and 10 percent of GDP on health.

Health care reform in the U.S. should start with the objective of bringing our spending in line with other countries, then find ways to accomplish that goal. Unfortunately, today's efforts in Congress seem less concerned with bringing down costs than with keeping major players in the health care industry happy.