In one of the most aggressive efforts in the nation to curb soaring healthcare spending, a new California measure would put the state in charge of setting prices for hospital stays, doctor’s visits and most other medical services covered by commercial insurers. But opponents counter that capping prices could reduce patients’ ability to get care by driving doctors out of state and hospitals to scale back their services.

The bill, backed by labor unions and consumer groups, is certain to face fierce opposition from physicians and hospitals, setting the stage for a brawl between some of the Capitol’s top lobbying heavyweights. Proponents also face friction on the left from advocates of single-payer healthcare, who see an alternate vision of how to overhaul the state’s healthcare.

This creates an interesting battle between conflicted players: Hospitals and healthcare providers are also business owners who deliver and provide healthcare to their own employees. Unions and employer groups who are struggling to contain the costs of healthcare as a means to maintain profitability and retain employees.

Driving the measure is the country’s escalating healthcare spending, which is by far the highest in the world. The United States spends about 18% of its gross domestic product on healthcare, nearly doubling the average of other advanced industrialized nations, according to the Organization for Economic Cooperation and Development.

How will it play out? Unlikely the state can be successful in regulating an entire industry. But much like the debate over single-payer and the individual mandate, this argument won’t end any time soon.