Whether it's behind the scenes or in your face, North Carolina's medical industry is working to shape the health-care reform debate in Washington.

"The old saying is: All politics is local. And that is true," said Greg Griggs, executive vice president of the N.C. Academy of Family Physicians. The statewide group of 2,700 doctors is supplementing the lobbying efforts of its national organization because it has decided that the stakes in Washington are too high for the group to sit to the sidelines.

Some local groups are running ads or sponsoring Web sites to communicate directly with the public — a tried-and-true way to influence Congress. A commercial sponsored by a national insurance group featuring fictitious couple Harry and Louise is widely credited with helping to derail the Clinton administration's efforts to remake health care.

It's hard to find anyone opposed to health-care reform. But the industry has many players — physicians, hospitals, insurers, drug companies and more — and each is pushing a different vision of reform.

In addition to large sums traditionally spent on lobbying by some companies and organizations, here are other recent efforts to influence the debate:

• North Carolina's drug industry is running full-page newspaper ads that say it supports health-care reform but not "policies that harm biopharmaceutical research."

• Pharmaceutical maker GlaxoSmithKline and Blue Cross Blue Shield, the state's largest health insurer, have started Web sites that explain their stances on universal health coverage.

• The N.C. Medical Society has disseminated information, such as its "guiding principles" on reform, to its 12,000 physician members so they will be prepped to discuss the issue with patients. One of the many principles: "Reform the tort system to prevent non-meritorious lawsuits."

But the devil, as always, is in the details.

As Congress hashes out what reform will really mean, industry groups are pushing their own agendas.

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