Health insurers are using every tool at their disposal to pressure senators into opposing a public option.

The latest example: Blue Cross Blue Shield of North Carolina has sent a mailer -- obtained by TPMmuckraker -- to voters in the state, warning that a public option will lead to "a single payer system," and urging recipients to send a postcard to Sen. Kay Hagan that asks her to "oppose government-run health insurance."

You can see the mailer here. It reads:

Public option?
Government Cooperatives?
Community plan?
Single payer?

No matter what you call it, if the federal government intervenes in the private health insurance market, it's a slippery slope to a single payer system.

Who wants that?

The enclosed postcard to Hagan reads:

Senator Hagan,

Please oppose government-run health insurance. We can meet our health care challenges without the government unfairly competing with the private sector. Tell Senate leaders that North Carolina doesn't need government-run insurance.

Lew Borman, a spokesman for Blue Cross Blue Shield of North Carolina, told TPMmuckraker: "It was important for us that North Carolinians understand the impact of what's being proposed: government-run health care." Borman declined to say how many people had received the mailer, and how much the company is spending on the campaign.

Borman added that the mailer was "targeted to a particular cut of the population that would be impacted" by reform, but declined to elaborate further. He said the company made a decision to target ordinary voters, rather than using its customer lists. Humana Inc. was investigated by the government last month for enlisting its beneficiaries to lobby against reform.

Borman said the campaign is targeting Hagan, a Democrat, alone, because she hasn't yet said definitively whether she'll support a public option. North Carolina's other senator, Republican Richard Burr, has long been clear in his opposition to the idea.

Hagan's office did not immediately respond to a request for comment about the impact of the campaign on her position.

Late Update: It's worth noting that Hagan worked to craft, and voted for, the Senate Health, Labor, and Education committee's version of the public option -- which is stronger than what will be in the Senate bill. So it's far from clear whether BCBS's effort has a chance of succeeding.