Massachusetts State Senator Scott Brown, R-Wrentham, speaks at a rally in Worcester, Mass., Sunday, Jan. 17, 2010. Former Boston Red Sox pitcher Curt Schilling applauds at left. Brown is running against Democrat Martha Coakley and Joseph Kennedy, a Libertarian who is running as an independent, in a special election to fill the U.S. Senate seat left empty by the death of Sen. Edward M. Kennedy, D-Mass. (AP Photo/Robert F. Bukaty)

After all the speeches, politicking, and attack ads, there are just two issues that will determine the winner of the Massachusetts Senate seat in Tuesday's special election. The first is health care and the second is one-party government.  And in Massachusetts, neither issue works exactly as outsiders might think -- and right now both are working in favor of Republican Scott Brown.

On health care, Massachusetts is in a unique position.  It already has near-universal coverage, enacted in 2006 by Republican governor Mitt Romney and the Democratic legislature, so a national measure designed to extend coverage to millions of currently-uncovered Americans means little to Bay State residents.  But the Democrats' national health care plan would force Massachusetts residents to pay higher taxes to expand coverage elsewhere in the country -- with relatively few new benefits at home.

"In this state, we basically have universal health care," says Joey Buceta, a Boston independent who attended a Scott Brown rally in the North End Friday.  "Why should we pay more money for it?  We already have it."

It's an opinion heard often in this race, and it unites conservative voters who don't like the Democratic national health care plan because it is too intrusive, expensive and coercive with independent voters who don't like the plan because it seems redundant for Massachusetts.

Scott Brown, the surging Republican candidate, has been hitting the issue hard in his campaign appearances.  "We already have 98 percent of our people insured here in Massachusetts, so you have to be a little bit parochial here," Brown said last week during a visit to a medical devices company in Chelmsford.  "We're going to be basically paying for our plan, and then we're going to be subsidizing Nebraska and Louisiana…boy, that's a real bargain."

On the second issue, one-party government, Massachusetts is also in an unusual position.  Often called the bluest of blue states, it is certainly dominated by Democrats.  But over the years Massachusetts voters have shown an inclination to elect a Republican to the occasional state office.

That balance has usually meant a GOP governor; four of the last five Massachusetts governors have been Republicans.  At the same time, the rest of the state government, as well as the state's delegations in the House and Senate, have been dominated by Democrats.  But even with that lopsided situation, the presence of a GOP governor gave voters a certain sense of balance.

Now, even that is gone.  Not only are all other significant state offices occupied by Democrats, the governorship is in the hands of the very Democratic, very liberal, and very unpopular Deval Patrick.  There is not even a token of Republican leadership to be found.  And for the independent voters who will play a critical role in Tuesday's election, Massachusetts' one-party rule mirrors the one-party rule in today's Washington, where national Democrats are deciding important issues among themselves without even the pretense of including Republicans.