As the US continues to debate whether all citizens are entitled to free health care, here's two words of inspiration from north of the border - Tommy Douglas - http://en.wikipedia.org/wiki/Tommy_Douglas
The final version of the Senate bill, with all its concessions and deals, came together the way it did because of strategy from a few key states -- key states only because their Senators levied the power of their must-have votes to tweak the legislation to their own specifications. There is no reason to believe that the same won't hold true as the House and Senate bills are merged.
Individual states are already sending signals to Congress about their opposition to the Senate bill.
New York Governor David Paterson (D) and California Governor Arnold Schwarzenegger (R) have voiced concerns that the health care reform bill passed by the Senate threatens to overload their states with added costs of Medicaid.
According to Politico.com, Gov. Paterson said "I am deeply troubled that the Senate version of the bill worsens what was already an inequitable situation for New York and I will continue to be an advocate on behalf of New Yorkers to ensure we are treated fairly by this critical federal legislation," and Gov. Schwarzenneger wrote in a letter to House Speaker Nancy Pelosi, "When asked for my support, I was assured that federal legislation would not increase costs to California or include new unfunded mandates. Unfortunately, under nearly every scenario we can predict, the federal health care reform legislation being debated would cost California’s General Fund an additional $3 billion to $4 billion annually."
The New York Times reports that Florida, along with about a dozen other states, is debating a proposed amendment to its state constitution that would attempt to block much of the federal government’s health care bill on the grounds that it tramples individual liberty. It should be noted that a study by the National Institute on Money in State Politics, a nonpartisan group based in Helena, Montana, shows that almost all of the 42 co-sponsors of the bill received large campaign contributions from health care interests, most heavily in the states with the proposed amendments.
Lobbyists for health care interests have taken it to the states. Last year pharmaceutical companies spent more than $20 million in political contributions in the states. $85 million more was spent on advertising to defeat a California ballot measure to lower drug prices.
As Congress works to merge the House and Senate bills, various opt-in and opt-out provisions for the regional health insurance exchanges will undoubtedly be a factor in negotiations.
In Nebraska, Senator Ben Nelson (D) was bombarded by pleas from Democrats and groups like the AFL-CIO to support health care reform and from opponents like the U.S. Chamber of Commerce and American's Health Insurance Plans, who used webcasts and petitions to sway him to vote against reform. Television in Nebraska has been filled with arguments pro and con and hundreds of millions of dollars are being spent.
Even if a bill passes, many of the changes will not take place for several years, leaving a wide berth for state battleground strategy before the legislation can be implemented. 50 states, 50 battlegrounds. Brace yourselves. 2010 is going to be bumpy.