In Canada, it took the dogged determination of one province, Saskatchewan, and a visionary leader Tommy Douglas, to pave the path to a national health care system, which they call Medicare.

For all the detractors of the Canadian system in the studios of Fox News and the board rooms of rightwing think tanks, consider this one note: In 2004, the Canadian Broadcasting Corporation conducted a national poll to select the greatest Canadian of all time. The winner in a landslide -- Tommy Douglas.  

While the federal window remains open for reform, with two national single payer bills, John Conyers' HR 676 in the House and now Bernie Sanders'  S 703 in the Senate, many nurses, doctors, and health activists are turning to the states to lead as well.

It's worth recalling that Supreme Court Justice Louis Brandeis famously called states "the laboratories of democracy."As columnist Froma Harrop has suggested,"being closer to the people and more attuned to the local culture, states are better equipped than the federal government to introduce new social policies. Innovations are usually first tried in the places most receptive to them."

More than a half dozen U.S. states now are considering legislation to establish single payer systems, essentially an expanded and updated form of the U.S. Medicare system to cover everyone in their states.  Here's a roundup of some of the state bills:

California

The latest bill SB 810 passed its first legislative test Wednesday in the Senate Health Committee on a party line 7-4 vote before a room packed with nurses, doctors, medical students, California School Employees Association members, and healthcare activists.

In her lead testimony, Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses Organizing Committee noted that "nurses know insurance companies don't provide any value whatsoever in the delivery of medicine. Under SB 810, we would be free of their interference, their denial of care, their massive bureaucracy, and their waste of healthcare dollars."

UC Irvine medical student Parker Duncan said that he did not want to "be in a world not doing what I was trained to do," referring to the paperwork that is one of the expensive burdens that undermine the ability

Twice this decade California's legislature passed earlier versions of SB 810 (SB 840 carried by now retired Sen. Sheila Kuehl), but the bills were vetoed by Gov. Arnold Schwarzenegger. State activists say they will continue to push single payer in California, even if they need to wait until the next governor, who won't be Schwarzenegger, is elected in 2010.

Colorado

House Bill 1273 by Fort Collins Democrat John Kefalas, passed its first vote in the state House April 6. The bill sets up a 23-member commission to design a universal health-insurance system.

"Our current health-care system is not well," Kefalas said. "Our current health-care system is unsustainable, with the cost of health care and the numbers of the uninsured rising dramatically."

Press reports note a state Blue Ribbon Commission on Health Care Reform two years ago studied single payer and found it was the only approach that saved money compared to what Coloradans now spent on healthcare.

Illinois

HB 311, the Healthcare for All Illinois Act, sponsored by Rep. Mary Flowers, had its first hearing in March. Though no votes have been taken yet, the new Gov. Pat Quinn is a long time supporter of single payer reform.

At an introductory press conference, Brenda Langford, Cook County RN, said that "Illinois can once again be a symbol of hope and progress for our nation. Nurses are tired of watching our patients suffer from denial of care and lack of access to coverage.  We see far too much of this at Cook County hospitals--and that's why we support guaranteed healthcare through a single-payer system."

Maine

LD 1365, sponsored by Brunswick Rep. Charles Priest, and co-sponsored from legislators from all over the state, had its first hearing April 13.
The hearing came just days after both houses of the Maine legislature passed resolutions calling on President Obama and Congress to enact federal single payer legislation. A poll this winter showed 52 percent of Maine physicians also favor single payer.

As Cathy Herlihy of the Maine State Nurses Association/National Nurses Organizing Committee put it in a state forum featuring U.S. Senator Olympia Snowe, a single-payer system is the "the only solution," she said. "We do not have time to wait. Our health should not be sacrificed for limited reforms."

Pennsylvania

Two single payer bills are alive in the state, House Bill 1660, the "Family and Business Healthcare Security Act of 2009," and Senate Bill 300.

Gov. Ed Rendell has said that if a single payer bill were to make it to his desk, he will sign it, reports Chuck Pennachio of Health Care for All Pennsylvania.

The state Democratic House Caucus is holding a public forum on the bill Friday, April 17 at 10 a.m. at the University of Pennsylvania campus in Philadelphia, featuring speakers from Physicians for a National Health Program, the Pennsylvania Association of Staff Nurses and Allied Professionals, and other single payer supporters.

The hearing comes on the heels of a resolution passed by the Philadelphia City Council calling for both state and federal lawmakers to establish a single-payer health system.  

Other states

Single payer bills are also on the docket in Minnesota, Missouri, and Washington.