The prognosis for universal health care in California is grim this year, and experts say a failure could set back similar efforts nationwide for years to come.
Unions, doctors and other powerful interests are arrayed against Gov. Arnold Schwarzenegger's $12 billion-a-year plan to make medical insurance mandatory.
He has threatened to veto the Democrats' less ambitious alternative and take his plan to the ballot instead.
A showdown could come as early as Thursday, when the Democrats
plan to put Schwarzenegger's proposal to a vote in the state assembly.
The aim is to show how little support it has.
With the campaign for the White House under way, what happens in the nation's most populous state could have especially wide repercussions.
"If we fail, it will have the effect of a wet blanket on health reform nationally," said Robert Ross, president of the California Endowment, a foundation devoted to health care.
"I think the presidential candidates will all look with a very watchful eye at what happens in California."
Following the lead of Massachusetts, which passed universal health care last year, Schwarzenegger announced his own plan in January to provide everyone in California with insurance.
As many as 6.7 million people in California, or 18.5 percent of the population, are uninsured.
The Republican governor's plan would impose new fees on doctors, hospitals and employers. The uninsured would be required to buy coverage, though the poorest would be subsidized.
The governor says his plan is fair because it would spread the burden.
But doctors are fighting it, as are unions, because they say it asks too much of the working poor. Hospitals, most of which would get more funding, have stayed on the sidelines.
The governor's own party has offered him no help.
GOP leaders skewered the tax increases, making it highly unlikely the plan will receive the bipartisan support it needs to pass.
A two-thirds vote is required.
The Democrats, who control both houses of the Legislature, crafted an alternative written in such a way that it needs only a simple majority.
It would require employers to spend at least 7.5 percent of payroll on health care or pay that amount into a state-run pool.
That is almost double what Schwarzenegger has proposed, and he has warned he will veto it.
"The governor and the Legislature are inches apart, but neither side wants to give that final inch," said Larry Levitt, a vice president with the Kaiser Family Foundation.
Success in California could be crucial to Democrat John Edwards' presidential hopes.
The former North Carolina senator's plan for nationwide health care is a compromise between Schwarzenegger's and the Democrats'.
"What the experience in California shows is it's very hard to do," Levitt said.
The governor never found a legislative sponsor for his plan until Assembly Speaker Fabian Nunez, D-Los Angeles, decided to introduce it this week to show it will not pass.
Instead, the governor held public forums to exhort people to take responsibility for their health and make sure they have insurance.
But support for his ideas has slipped as the debate has bogged down.
In December, the nonpartisan Field Poll found it was favored by 52 percent of voters. By August, that had fallen to 33 percent; that is about equal to the number who said they supported a single-payer system run by the government.
The governor's salesmanship has paid off in some quarters.
Small businesses and restaurants - who said this week they would support a sales tax increase to fund health care - have moved closer to his side.
But that may be because they fear the Democratic alternative would be far worse for them.
Democrats also have moved away from the plan they passed four years ago, which placed a far greater burden on employers.
Voters repealed it the next year, with help from the newly elected Schwarzenegger.
Labor unions say they are behind the Democrats' new plan.
But they worry the working poor will be asked to pay too much and that
employers will dump their workers into a state-run insurance pool.
Depending on when lawmakers decide to adjourn, there may be as little as two weeks before the legislative session ends.
A prolonged budget stalemate drained time and energy, and created
much bitterness in the Capitol.
While the governor and Democratic leaders insist they want a deal on health care, one lawmaker has concluded that failure might be the best option.
"I hope that none of these ill-conceived, quickly thrown together plans will pass this year," said state Sen. Sheila Kuehl, the Santa Monica Democrat who chairs the Senate Health Committee and advocates a single-payer system.
"Because really, that is not good for California."