It begins with a single step

In Massachusetts:

BOSTON (AP) -- Lawmakers have approved a sweeping health care reform package that dramatically expands coverage for the state's uninsured, a bill that backers hope will become a model for the rest of the nation.
The plan would use a combination of financial incentives and penalties to expand access to health care over the next three years and extend coverage to the state's estimated 500,000 uninsured.

If the GOP (and many Democrats) wasn't in the bag for PhRMA and the managed-care industry we could have universal health care.