All signs point to a crushing surge in health care costs for patients and employers next year — and that means health care industry groups are about to brawl over who pays the price.

Why it matters: The surge could build pressure on Congress to stop ignoring the underlying costs that make care increasingly unaffordable for everyday Americans — and make billions for health care companies.

[This special report kicks off a series to introduce our new, Congress-focused Axios Pro: Health Care, coming Nov. 14.]

• This year's Democratic legislation allowing Medicare to negotiate drug prices was a rare case of addressing costs amid intense drug industry lobbying against it. Even so, it was a watered down version of the original proposal.
• But the drug industry isn't alone in its willingness to fight to maintain the status quo, and that fight frequently pits one industry group against another.

Where it stands: Even insured Americans are struggling to afford their care, the inevitable result of years of cost-shifting by employers and insurers onto patients through higher premiums, deductibles and other out-of-pocket costs.

• But employers are now struggling to attract and retain workers, and forcing their employees to shoulder even more costs seems like a less viable option.
• Tougher economic times make patients more cost-sensitive, putting families in a bind if they get sick.
• Rising medical debt, increased price transparency and questionable debt collection practices have rubbed some of the good-guy sheen off of hospitals and providers.
• All of this is coming to a boiling point. The question isn't whether, but when.

Yes, but: Don't underestimate Washington's ability to have a completely underwhelming response to the problem, or one that just kicks the can down the road — or to just not respond at all.

Between the lines: If you look closely, the usual partisan battle lines are changing.

• The GOP's criticism of Democrats' drug pricing law is nothing like the party's outcry over the Affordable Care Act, and no one seriously thinks the party will make a real attempt to repeal it.
• One of the most meaningful health reforms passed in recent years was a bipartisan ban on surprise billing, which may provide a more modern template for health care policy fights.
• Surprise medical bills divided lawmakers into two teams, but it wasn't Democrats vs. Republicans; it was those who supported the insurer-backed reform plan vs. the hospital and provider-backed one. This fight continues today — in court.

The bottom line: Someone is going to have to pay for the coming cost surge, whether that's patients, taxpayers, employers or the health care companies profiting off of the system. Each industry group is fighting like hell to make sure it isn't them.

• Sign up for Axios Pro Health Care Policy for a special pre-launch edition about which cost battles to watch.