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Millions of dollars are being spent on the home-stretch push to get healthcare reform enacted in Congress. It’s been a long, hard year for the proponents of President Barack Obama’s healthcare reform proposal. And there are signs that this could be the end, one way or another. The House is poised to take a vote that will essentially constitute the final word on the proposal, and the intensity of the issue is rivaling even the 2008 presidential race at this point. The Senate’s bill, long considered the inferior of the two chambers’ proposals, is up for a vote in the House. If passed, it would become the definitive healthcare overhaul that President Obama has sought since his election.

Hanging in the balance are the votes of about forty House Democrats who have to date remained wishy-washy on the topic of the bill and how they will vote. Advertising worth millions of dollars is being aimed directly at this group. Last year, twenty-seven of this group were in favor of the reform, and thirteen opposed it. All forty will have to be on board for the issue to pass. It is believed that the coalition of groups supporting the bill have already spent some eleven million dollars this month alone on swaying the opinions of the lawmakers in question, whose votes are so very important.

To an extent, these groups had very little choice but to spend lavishly. Pharmaceutical companies, the massively rich group that constitutes the largest opposition to the Obama healthcare plan, has laid out twelve million dollars in advertising as the final week of healthcare debate kicks off. It is believed that this sum could top thirty million dollars by the weekend, an amount that Democrats will probably match with their own campaign. But big-money advertisements are not the only tools in the arsenal. Both groups are using considerable get-out-the-vote techniques meant to get constituents to make persuasive phone calls to their lawmakers. The most influential phone calls might be those coming directly from President Obama himself. Today, he will travel to Ohio as part of a weeklong campaign binge meant to close the deal on the healthcare bill. Basically, the swing democrats can expect a full-on assault of influence by the end of the week.

Those representatives caught in the hailstorm of publicity admit that the conflicting whirlwinds of propaganda are making it hard for them to sort out their own opinions. Representative Jason Altmire, one of the thirty-nine Democrats who nixed the healthcare bill in its first incarnation last year, is called a “No to Yes” target. He stated, tongue firmly in cheek, that “there is definitely more passion” about the bill this time around, and that his office has been slammed with hundreds and hundreds of phone calls, e-mails, and protestors demonstrating outside. Altmire maintains that he is trying to do what is best for his district and the representation of his district. What exactly his district wants, however, is hard to say for certain.

According to Representative James E. Clyburn of South Carolina, the third most senior Democrat in the House, it still remains to be seen if enough Democrat votes will be obtained to lock down approval of the bill. He remained extremely optimistic that hard work would accomplish that goal, however, and that “we’ll get this done.” Republicans, meanwhile, are on high alert – the whole party gets blasted by e-mail and phone when it is announced that one of the Democrats has officially announced which way s/he will vote. Aligned with the Republicans against the healthcare bill is the Chamber of Commerce. The national group has kicked off an initiative called “Employers for a Healthy Economy.” This group alone is on target to spend ten million dollars in advertising by the weekend, with seven million already down the drain. Its brother in purpose, Americans for Prosperity, has an advertising campaign of almost a million dollars as well.

These groups have made healthy competition a very expensive prospect for Democrats. Luckily, prescription drug manufacturers’ trade union Pharma and labor unions have ponied up enough money to even up the fight a bit. Their battle cry is this: “When insurance companies win, you lose.” That statement will be the major theme in advertising this week. The party has realized that it is essential to take a creative approach to advertising and lobbying if there is to be any hope at all of conquering the tremendous opposition. In districts where enough money for cost-prohibitive TV ads couldn’t be raised, advocates took to the streets in a wave of grass-roots activism. Obama, for his part, is making daily phone calls to those Democratic party members who sit on the fence still.

One of those members is Representative Dennis J. Kucinich of Ohio, who opposes the current proposed healthcare reform due to his belief that the measure does not go far enough in scope. President Obama will make a trip to Kucinich’s district when he visits the state of Ohio, and invited the lawmaker to join him aboard Air Force One. But Kucinich stated that, despite the POTUS’s hospitality, he feels that he cannot in good conscience vote for a bill that isn’t “real.” He says that he wants to support his party, but that be believes strongly that this legislation is just not the way to do that.

There are definitely strong incentives for Democrats who vote the party line and agree to show favor for the bill. The Democratic Party has announced that priority assistance for those lawmakers facing midterm elections (presidential visits, fundraisers, etc.) will be allotted to those who support the healthcare bill. But not all lawmakers are being held to the same scrutiny. Some have been taken off the so-called “target list” due to other factors. Representative Arthur Davis, for example, is running for governor of Alabama, where healthcare reform is greatly unpopular. Making him cave to party demands might jeopardize his race. Those representatives who are most adamant against the bill have also been dropped from focus, to save money on persuading those who at this late point might still show some signs of potentially being convinced.

The health care debate is unfolding against the backdrop of an already difficult political year for Democrats. The White House has signaled to lawmakers that assistance for midterm elections — for example, presidential visits and fund-raisers — will be prioritized for those who support the bill. Some Dems who formerly were only tepid in their support of the bill have become a bit more energized, sensing that the end is in sight and that the measure needs their support at this crucial hour. For the most part, Democrats across the country (not just lawmakers) believe that the House should pass the Senate’s bill. Liberal think tank MoveOn.org conducted a poll, and eighty-three percent of its members stated their belief that the House should pass the bill. MoveOn was one of many liberal groups calling for a stronger piece of legislation, but it’s clear that inevitability is starting to set in amongst the ranks. Those party members, representatives, and advocates are feeling a sense of pragmatism, and realizing that perhaps a plan that isn’t necessarily the best might still be better than no plan at all at this point. After all, the vote on the Senate bill caps a full year of consideration into this matter.

Meanwhile, Obama supporters are already organizing corps of volunteers as part of an “extensive plan” to help voters understand the health care bill in the event that it passes. Brad Woodhouse, communications director for the national Democratic Party, was quoted as saying that he wants the House to know that “as they get ready to take this hard vote that they have troops underneath them to fight and scrap to get this passed and to help sell it.”