LEBANON, Pa. — When Sen. Arlen Specter (D-Pa.) held a town hall meeting here during the August recess, hundreds of his constituents packed into a community college auditorium to fire off questions and complaints about health care reform bills.

Perhaps the only scene more crowded and boisterous in this otherwise tranquil town was just outside the meeting, where hundreds more had gathered hoping to get inside the Harrisburg Area Community College building.

That was where 29-year-old Chris Archibald waited — unsuccessfully.

The health insurance industry’s grass-roots operation had reached out to Archibald, who owns a landscaping business in nearby Hershey, to help get its message out during the recess.

But in a month where angry crowds were stealing the show, insurers and other medical industry and health care groups from hospital associations to pharmaceutical companies had their work cut out for them to make their voices heard and to shape the debate in the way they would like. The groups not only worked to get their people inside town halls, but they also spent millions of dollars on paid advertising and held their own public rallies and private meetings with Members.

“Our people want to have a discussion and ask questions,— said David Barnhart of the Locust Street Group, a grass-roots organizing firm retained by America’s Health Insurance Plans. “They’ve found it slightly frustrating, but there’s a lot of real passion out there.—

AHIP, the lead lobbying group for the health insurers, armed its people with written “Town Hall Tips— and other talking points. The advice included, “people often use very pointed, divisive language. … It is important not to take the bait.—

Health insurers also participated in small, private meetings with lawmakers back home in the districts.

Those smaller meetings were also helpful to members of the American Hospital Association, said Mark Moore, president and CEO of Bloomington Hospital in Indiana. Moore has been in frequent contact with the local Congressman, Rep. Baron Hill, a moderate Democrat who is part of the Blue Dog Coalition.

Hill held a small meeting at Bloomington Hospital on Aug. 6 with local doctors and hospital representatives, including Moore.

“He led off by saying, Here’s where things are, here are some of the issues that we’re debating and discussing,’— Moore said of Hill. “That’s the good part of a small setting like that, you can really have some positive dialogue and direct give-and-take.—

The American Medical Association, which represents the nation’s doctors, also worked to get its message out in an otherwise noisy August environment.

Dr. Nancy Nielsen, an internist in Buffalo, N.Y., and the immediate past president of the AMA, said her group for the first time launched a blog during the recess in addition to relying on more traditional forms of messaging like running paid advertising in print and online. The AMA also held virtual town-hall-style meetings and conference calls.

Nielsen hit three Michigan cities during an AMA “house call— visit where she met with local editorial boards and appeared on live radio programs in Detroit, Lansing and Grand Rapids.

Some of the effort has been to get skeptical doctors on board.

“The idea is to really talk about why it is we need reform, what is really in the bills before Congress, why the AMA has stayed constructively engaged,— Nielsen said. “The passion from [the] doctors’ standpoint is clear because it’s pretty well agreed that reform is needed. It’s when you get down to the details where you get disagreement.—

One of the main questions she hears from fellow doctors, Nielsen said, is why tort reform isn’t a key part of health care reform.

“There is now an amendment that deals as a start with tort reform,— she said referring to a provision originally offered by Rep. Bart Gordon (D-Tenn.). “It’s really time somebody listens.—

The pharmaceutical industry’s lobby was active in 25 states and had a dozen separate advertising and advocacy campaigns running during the recess, said Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America.

Several organizations including PhRMA, the Service Employees International Union, the AMA, the Federation of American Hospitals and the health care advocacy group Families USA ran ads as part of the Americans for Stable Quality Care.

Additionally, PhRMA and Families USA ran a separate advertising campaign in about a dozen states to promote bipartisan reform.

“It has been anything but a quiet August for us,— Johnson said.

The employees of PhRMA member companies have taken part in town hall meetings and local Chamber of Commerce events.

“We’ve been very active in getting our base, if you will, engaged in this debate,— Johnson said. “Clearly, this is a very emotional issue, and it’s one of the most important public policy debates of our time.—

Kathleen Stoll, deputy director of Families USA, said that PhRMA and her organization were “trying to support and encourage those who are trying to do it in a bipartisan way.— Stoll added that the paid advertising Families USA did was actually a small portion of the group’s recess activities. Families USA worked with state groups to distribute talking points and helped identify and mobilize people with compelling health stories to participate in district events.

AARP launched a multimillion-dollar national TV advertising campaign on Aug. 9 that will continue through Monday. The group also participated in 60 community events and 30 town halls and readied 8 million pieces of direct mail to go out after Labor Day. And the American Cancer Society held 50 public events promoting health care reform, including a 600-person rally Aug. 25 at the Capitol in Lincoln, Neb.

Archibald, the Pennsylvania landscaper, said he was disappointed not to get into the Aug. 11 Specter event. “I have no problems with my insurance, other than I’d like costs to go down,— said Archibald, whose coverage is offered by Highmark.