The health care debate brings up tough questions about the role of the state in a democracy.
On one hand I am tempted to embrace a strong state that will "slap some sense" into the many groups that are making it almost impossible to enact meaningful reform that will control costs and maintain quality. At times I even fantasize about a strong state that will eliminate all lobbyists and makes insurance companies, pharmaceuticals, hospitals, lawyers, doctors, patients and fast food manufacturers "rise above their narrow interests" and "do the right thing."
On the other hand, for good and for bad democracy involves allowing disparate parties and interests to offer their input into the development of laws and policies, which makes the pursuit of difficult solutions much, much more difficult.
On answer that is suggested is to separate "special interest lobbyists" from "public interest lobbyists." Unfortunately that is far more challenging than it sounds. A "special interest" may offer valuable input and advice that ultimately offers a net-benefit to the public even if they are only pursuing their own interests. And a "public interest" lobby may offer net-costs to the public, even while they are purportedly pursuing the public's interest. One example is the clash between "public interest" lobbyists and pharmaceutical lobbyists over the quest of the former to eliminate patents on medicines, as part of a drive to lower costs. This will certainly offer short to medium term benefits, but in the long term it will lower incentives of pharmaceutical companies to invest billions of dollars in the development of new drugs and cures, something that is certainly not in the public's interest. So, ultimately the ideal is to strike a balance and compromise between both positions, which hopefully can be accomplished by the democratic interplay of disparate interests.
In other words - I don't have the answer!