Published: Sunday, 16 Aug 2009 | 8:47 AM ET

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By the time President Obama left Montana on Saturday, the Bozeman media market had been saturated with an advertisement opposing his health care plan — hard for anyone to miss since it ran 115 times in 36 hours on network and cable television channels.

“Say no to government-run health care,” a narrator says in the advertisement by a conservative group that particularly went after the idea of a government insurance option.

Photo by: Chuck Kennedy President Barack Obama

The spot, timed in advance of Mr. Obama’s visit, is part of a cascade of advertising swamping the airwaves across the country as the health care fight has become a full-blown national political campaign, replete with battleground states, polling, leafleting, fractious town-hall-style meetings, op-ed articles, talking points and videos. He held one of those public meetings in Colorado on Saturday .

This comes as President Obama said Sunday he's confident his drive to overhaul health care will succeed. The president writes in Sunday's New York Times about "health insurance reform" and says his attempt to overhaul the system is closer to reality "than we have ever been."

Obama cites support from the American Nurses Association, the powerful American Medical Association and the AARP for big changes. He also says there's "about 80 percent" agreement in Congress on shaping the overhaul.

Interest groups on all sides of the debate have spent more than $57 million on television advertisements in six months, most of it in the last 45 days, said Evan Tracey, chief operating officer of the Campaign Media Analysis Group, which tracks television advertisements.

“It’s the most we’ve seen this quick,” Mr. Tracey said. “If it goes on all year, we’re looking at one of the biggest public policy ad wars ever.”

Supporters of Mr. Obama’s plan to overhaul the system have outspent opponents, with $24 million worth of advertising, compared with $9 million from opponents. An additional $24 million has been broadly spent in support of overhauling the system without backing a specific plan.

Geoff Garin, a Democratic pollster who is advising several Democrats on Capitol Hill, said whoever defined the debate would win it. “Opponents are trying to cement the notion that this is all about government-run health care,” Mr. Garin said, “while supporters want to cement the notion that this is about fixing a badly broken system.”

Advertisements in favor of Mr. Obama’s effort mostly seek to reassure those who already have insurance that they will benefit because insurance companies will not be able to drop them if they are sick or deny them coverage for pre-existing conditions.

But at times, Democrats in favor of remaking the health system have been attacking fellow Democrats who are undecided or oppose an overhaul, which may partly explain why support for Mr. Obama’s effort has been eroding, even though his side has spent more money.

Opponents’ advertisements are sharper in tone. They are intended to fire up the conservative base and appeal to independents who may share conservatives’ concerns about a government takeover of the health system or excessive spending.

One commercial shows a red balloon that expands as the narrator warns that an overhaul would increase deficits, taxes and government control. Eventually, the balloon pops.

Other advertisements from opponents make more emotional but unsubstantiated assertions that an overhaul would ration care and deny treatment to older people.

Mr. Tracey said that, generally, the advertisements in favor of an overhaul had been “cheerleading” up to this point, while those against it had successfully raised doubts about it. “People may favor health care reform,” he said, “but if you can pull out end-of-life issues or taxpayer-funded abortions or rationing care and dictating lifestyle, those fit really well into 30-second spots.”

White House aides concede that Mr. Obama, who is stumping the country for his health care plan, has lost some ground; they chalk it up partly to misleading advertisements suggesting that the government will ration health care or that senior citizens will be denied end-of-life care.

Both sides are broadcasting their message in many of the same battleground states — including Arkansas, Colorado, Louisiana, Maine, Nebraska and North Carolina — to reach conservative Democrats and moderate Republicans who may determine the fate of the bill.

In a $12 million advertising buy that began last week in 12 states, a coalition of drug companies, doctors, for-profit hospitals and union members defended overhauling the system. With piano music playing over pictures of patients with health care workers, the commercial portrays the overhaul as providing “quality, affordable care you can count on.” The coalition calls itself Americans for Stable Quality Care.

“It’s very carefully drafted,” Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, one of the biggest players in the debate in support of an overhaul, said of the commercial. “We don’t want to fan the flames; we want to calm people down.”

The pharmaceutical industry has also resurrected “Harry and Louise” from 1993-94, when the fictional couple, like the drug industry, was against President Bill Clinton’s health reform proposal. But now, both the drug industry and the couple, still at their kitchen table 16 years later, have had a change of heart and are promoting an overhaul.

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