Americans may be growing sick of the debate over health care reform.
Lobbyists, though, are getting well.
In the first six months of 2009, financial disclosures show, health care groups spent more than a quarter of a billion dollars - that's billion, with a "b" - to hire lobbyists who can influence Washington's deliberations on health care and insurance reform.
That total, which doesn't include lobbying by health insurance groups, is expected to grow by $125 million or so this week, when lobbyists submit disclosures for July, August and September - the months when work on health care reform got serious.
That's on top of the $485 million that health groups spent on lobbying last year.
"What many of these groups are trying to do is spend one dollar now to save 10 dollars later," said Dave Levinthal of the nonpartisan Center for Responsive Politics, which compiled the spending numbers. "If you're a drug company, for example, you want to make sure that you're at the table."
Health care groups aren't the only ones spending hundreds of millions of dollars on the health care reform campaign.
Political parties, industry and trade associations, labor unions, grassroots groups and others are paying for radio and TV commercials, news conferences, newspaper ads, rallies, billboards, e-mails and Web sites, all pushing various positions on the complicated legislation.
The spending is so widespread that figuring out the final total may never be possible, Levinthal said, but $1 billion isn't out of the question.
U.S. Rep. Emanuel Cleaver - watching the health care overhaul in Washington - said lobbyists were so thick it was hard to walk across the street from his office to the Capitol to cast a vote.
"I've never seen anything like this in 30 years in politics," the Missouri Democrat said.
Groups with a big stake in the health care reform debate argue they don't have any choice but to spend money to influence lawmakers.
"There are those who want to demonize the insurance industry," said Tom Bowser of Blue Cross and Blue Shield of Kansas City, which recently spent $20,000 to buy five full-page ads in The Kansas City Star outlining the company's views on reform. "We think it's (essential) to help people understand the issues and our position on the issues."
A Florida health care company recently agreed to pay former Kansas congressman Jim Slattery $20,000 to keep on eye on reform legislation. Slattery said the spending helped his clients and members of Congress.
"Health care is ... enormously complicated, and members of Congress and their staffs often do not know how various proposals affect businesses and people in the real world," Slattery said. "Some politicians would have the public believe that they are under the spell of lobbyists. These politicians should be fired at the next election. Members are paid to think for themselves."
The effort to help members of Congress "think for themselves" extends beyond the one-on-one persuasion that Slattery and more than 3,000 other registered health care lobbyists practice.
A broad-based insurance industry trade group called AHIP - America's Health Insurance Plans - will spend an estimated $1 million this month to air TV ads that suggest the federal Medicare Advantage program will be cut dramatically if current health reform plans become law.
"We want to begin to build an awareness of the potential implications to seniors," AHIP president Karen Ignagni told The Washington Post.
Democrats, labor unions and interest groups are responding with multimillion-dollar campaigns of their own. Organizing for America - an offshoot of the Democratic National Committee - is sponsoring rallies across the country Tuesday that will feature a live webcast from the president.
Last week, Missouri's Organizing for America chapter sponsored a news conference near the Country Club Plaza with area doctors who support a health care overhaul. "People need to have their voices heard," said director Dan Herman.
Opponents of health care reform also have spent millions organizing rallies and a media message, Levinthal noted.
"Is the grassroots stuff actually working? A lot of people would argue that the town hall meetings were proof positive that some of those efforts have been very successful," he said.
The ultimate grassroots reaction to health care reform will come next year at the ballot box, and here, too, health care groups have not been bashful.
Already, the Center for Responsive Politics said, health industry-related groups have given more than $35 million to congressional candidates.
Sen. Pat Roberts sits on the Finance and Health, Education, Labor and Pension committees, each with a key role in health care reform legislation. He has gotten more than $363,000 from health care groups since 2005 - the most among the area's four members of the Senate.
Roberts voted against the two reform bills now headed to the Senate floor.
"Sen. Roberts' actions on behalf of the people of Kansas have never and will never be influenced by his political contributions," said spokeswoman Sarah Little. "Sen. Roberts will continue to fight for health care reform that does not cut Medicare, raise taxes, raise premiums and still leave 25 million Americans uninsured."
With all the money - and noise - it's possible that members of Congress are getting so many different messages they may tune everything out and make up their own minds.
Cleaver said lobbyists were not bothering him much because his position (he supports a public option) is well known.
"I tell other members all the time, the way to get lobbyists to leave you alone is to make up your mind," he said.