A recent television ad against health care reform in the U.S. shows Canadian Shona Holmes staring straight into the camera and telling the audience a brain tumor would have killed her had she relied on her government-run health plan, which would have provided treatment far too late.

"Now, Washington wants to bring Canadian-style health care to the U.S.," a narrator says darkly.

The TV spot from a conservative group is dramatic but deceptive.

In fact, U.S. President Barack Obama and the Democrats pushing to overhaul health care want to create an optional, government-run plan to compete with private insurers, not replace them.

As Obama told a health forum last week, "We're not suddenly just going to completely upend the system. We want to build on what works about the system and fix what's broken about the system."

The ad with Holmes, who says she borrowed and saved money for a crucial operation in the United States, illustrates how groups are intent on bending the debate toward their agendas.

It is one of a handful of commercials that are expected to grow in number and criticism this summer as detailed health bills emerge from Congress and dozens of interest groups, companies and labour unions tussle to influence lawmakers.

The sponsor of the ad, Patients United Now, is an offshoot of the Americans for Prosperity Foundation, a privately funded, Washington-based conservative group that believes in limited government and cutting taxes. Among its directors are businessman and conservative activist Art Pope and James C. Miller, a top Reagan administration official.

The group says it has spent nearly $1.8 million US running the ad in Washington, D.C., and 11 states with senators on committees writing health care bills or ones seen as wavering on the issue.

Patients United spokeswoman Amy Menefee says the ad is fair because giving government more control over health care would be a slippery slope toward increasing the federal role and because some Democrats still favor government-only insurance.

Through June 27, $31 million has been spent for roughly 47,000 TV ads on health care this year, says Evan Tracey, president of the Campaign Media Analysis Group, a firm that tracks issue advertising. That's double the roughly $14 million the insurance industry spent in 1993 and 1994 for the famous "Harry and Louise" ads, credited with helping kill President Bill Clinton's attempt at health care reform.

Tracey estimated that $250 million will ultimately be spent on the campaign this year.

Hoping to shape the early debate, the initial ads are "really being aimed at some people in the administration, some people on Capitol Hill, a whole bunch of reporters, a few bloggers," Tracey said.

As Congress's direction becomes clearer and interest groups seek public support, "then I think you're going to see the spending go on a hockey stick curve straight up," he said.

Dueling commercials from left and right

So far, Tracey said about $15 million has been spent on ads favouring the Democrats' push to revamp the health care system and $4 million to oppose it. Another $12 million has gone to ads generally favouring better health care, nearly all of it from the Pharmaceutical Research and Manufacturers of America, representing drug makers, which hopes its market will expand if more people have insurance.

These figures might be too low, with several groups reporting higher figures reflecting costs Tracey doesn't track.

Ken Johnson, spokesman for the pharmaceutical group, says his association has spent tens of millions of dollars on television ads since late 2008, thanking lawmakers for supporting previous health initiatives or urging them to support a comprehensive effort this year.

"It's conditioning the environment, it's setting the table for the debate to come," he said.

Dominating the spending among opponents is Conservatives for Patients Rights, led and largely financed by Rick Scott, who was ousted as chief of the Columbia/HCA health care company during a fraud probe that ultimately saw the firm plead guilty to overbilling charges.

Spokesman Brian Burgess says the group has spent over $4.5 million on TV ads that have run hundreds of times this year, mostly criticizing public health coverage.

On the other side, progressive and labour groups have not been shy about using ads to assail Democrats viewed as insufficiently loyal in the health care struggle.

Health Care for America Now says it plans to spend $11 million on TV ads. The group is funded by labour, liberal groups and the progressive Atlantic Philanthropies, an international grant-making foundation whose president, Gara LaMarche, worked previously for billionaire Democratic donor George Soros.

Its latest ad: a $1.1 million campaign aimed at prodding senators of both parties from 10 states to support a public health insurance option. Targets include Senator Ron Wyden, a Democrat from Orgeon who HCAN says has not shown strong enough support for the government-run option.

"Tell Senator Wyden, it's your health; it should be your choice," the ad says.

MoveOn.org and other liberal groups began airing a 60-second ad on Friday in Louisiana criticizing Democratic Senator Mary Landrieu for not yet embracing a public insurance plan. They dropped plans to run ads challenging Kay Hagan, a Democratic senator from North Carolina, after she expressed support for a bill containing a government insurance option.

Last Tuesday, the Laborers International Union of North America began airing ads in the home states of two Democratic senators, Max Baucus of Montana and Kent Conrad of North Dakota, criticizing them for considering a tax on workers' employer-provided medical benefits to help finance the overhaul.

Union spokesman Jacob Hay says the ads, which had been scheduled to run through Friday, were pulled after a request from Baucus aides. Baucus has agreed to meet with the union's president, Terence O'Sullivan, to discuss the legislation.

"Ads really do get their attention quickly," Hay said.