WASHINGTON — Top lobbyists for every major sector of the health care industry publicly insist they are squarely behind the health care reform effort of President Barack Obama's administration. But as the debate gets down to the details, the lines dividing friend from foe are getting blurry.

Each industry group is also working quietly to scuttle or reshape some element of the administration's proposals that might hurt profits — usually some measure aimed at cost control.

The drug industry struck a deal with Obama's administration and is now waging a major advertising campaign to help push the health care overhaul. But the drugmakers also abhor one of its cost-cutting components: a government initiative to study the effectiveness of treatments that the companies fear could mean lower payments for certain drugs.

So lobbyists have enlisted the help of Tony Coelho, a former Democratic congressman with epilepsy who cites his battle with the disease to argue against that idea.

"I don't want some government folks making a decision because of a cookie-cutter approach to health care, saying, 'We will only approve the three most common drugs,' so then my drugs are not approved, and I am going to have seizures," said Coelho, the chairman of an industry-backed group called the Partnership to Improve Patient Care.

The American Medical Association has made the most sweeping endorsements of the administration's efforts. But AMA lobbyists are also working to extinguish the idea of a government-run insurance program, which doctors fear could reduce their fees. The lobbyists are also using the AMA's support as leverage to persuade Democrats to roll back steep cuts in future Medicare payments to doctors.

Hospital lobbyists have a deal with the White House to limit their costs and are pushing to pass a bill. But the hospitals are haggling with the Senate Finance Committee over another proposal: a new Medicare oversight board that could impose payment reductions.

Lobbyists for the insurers say they support reform, including new restrictions on their own underwriting. But that does not mean they have laid down their arms.

Many in the health care business were pleased that Obama sounded open to a compromise substituting weaker not-for-profit cooperatives. Karen Ignagni, president of the insurers' trade group, said her industry was still lobbying hard against it. In the Senate draft of the compromise, the government would still support and oversee the nonprofits, thus threatening to take them over, she argued.