With the first installment of Maryland's $4.4 billion settlement with the big tobacco companies due to arrive next week, all manner of charitable groups, health advocates and hospitals are trying to make the scramble for cash look dignified.
The $55 million won't be doled out until after the General Assembly passes a budget next year, but there is feverish interest in portions not earmarked for a cause or recipient.
That interest has brought a strange dynamic into Annapolis, where such health groups as the American Cancer Society and American Lung Association, traditionally strong allies, find themselves at odds.
"It's brother against brother and sister against sister. It's going to be a real battle," said Sen. Leo E. Green (D-Prince George's).
Health advocates predict that battle will be centered on the $500 million that Gov. Parris N. Glendening (D) has pledged to conquer cancer. Of that money, he has promised that Johns Hopkins and the University of Maryland each would get roughly $15 million a year for the next 10 years.
The remaining $200 million is essentially up for grabs. And while Glendening has spent considerable effort in recent months fine-tuning his proposal for spending it, lobbyists will pursue it until it is cemented into the budget.
The governor and lawmakers, who will give their input on the budget during the legislative session, expect to hear from a cavalcade of interest groups. Many have already starting jockeying.
"The advocates are very aggressive," said House Speaker Casper R. Taylor Jr. (D-Allegany), who has proposed that some of the money be used to hire more school nurses.
The rumbling began in earnest in June, when Glendening announced his plan to spend $1 billion over the next 10 years dealing directly with the health effects of smoking.
The decision was widely praised as a departure from the pattern in other states, where the settlement has been accepted as found money and used to cut taxes or pave roads.
But deciding to spend the money on health issues has meant choosing among dozens of worthy causes.
In an effort to breathe some civility into the process, the governor set up three task forces to study how to best divvy up the windfall. One group is reviewing how to use $30 million set aside to campaign against smoking. A second is looking at the $83 million slated to help tobacco farmers convert their farms to other crops.
The third group, dealing with the largest chunk of the settlement money, focused its deliberations and public hearings on the battle against cancer. They are scheduled to finalize a proposal with Glendening within two weeks.
The attention to cancer made sense, the governor argued, not only because of its link to smoking but also because Maryland has for years had some of the highest cancer rates in the nation.
Del. Dan K. Morhaim (D-Baltimore County), an emergency room doctor who sits on the 21-member task force examining cancer programs, said members have decided to recommend that most of the spending be concentrated on the most common cancers--lung, breast and colon. They plan to target the diseases with spending on research, education and campaigns for early detection.
Money also would target issues of special interest in Maryland, Morhaim said. The plan would help fund research to explain the prevalence of prostate cancer in African American men. And it would include money to fight throat cancer, a form of the disease that occurs in high rates in Maryland.
Even with those priorities set, Morhaim said, plenty of interest groups will try to present themselves as best suited for the job.
"There are public health groups, groups that transport patients, patient advocates, medical groups, everybody will be trying to get in on this, and I'm sure there will be pressure," Morhaim said.
Lobbyist Eric Gally, who represents the American Cancer Society and American Heart Association, said his clients have made it clear that they don't want to appear crass, even if the amount at stake is 10 times what the cancer society raised through private donations in the mid-Atlantic region last year.
"They have told me their only interest is to see the money spent on things that are scientifically best for saving lives," Gally said.
Of course, there is one other issue that must be resolved before any of the first installment is spent. The state still must decide how much it owes Baltimore Orioles owner Peter G. Angelos in legal fees for handling the tobacco lawsuit for Maryland. Settlement proceeds will be held in an escrow account until the state and Angelos reach agreement.