After the tea-partying, town-meeting-disrupting, pistol-packing mensis horribilis of August, more than a few commentators complained, as one of them put it, that “Obama should have seen it coming.” No one doubted that the current attempt to overhaul America’s uniquely wasteful and unjust system of health insurance and non-insurance would touch off the kind of demagogic, misleading attacks that have greeted every past attempt at ambitious reform, successful (Medicare) and unsuccessful (all the rest) alike. The plan is socialism; government bureaucrats will choose your doctor and prescribe your treatments; the economy will be ruined; taxes will crush you—all that and more was to be expected. But the predominant tone of opposition to the emerging Democratic health-care proposals, and to the President personally, came as a surprise to the White House and a profound shock to many who voted for Barack Obama last November.

Illustration by Tom Bachtell

Perhaps it was naïve, and obviously it was optimistic, to hope that once Obama—having been elected by a large and undisputed majority, unlike his two predecessors—took office the nastiness of the assault against him would subside. And so it did, briefly. But as the reality sank in that this temperamentally conservative President intends to make good on his substantively progressive promises, the fury returned, uglier than before and no longer subject to the minimal restraints inherent in a national electoral campaign aimed at persuading a plurality of voters. Lies and fantasies about health-care reform swirled together with lies and fantasies about the chief executive himself. Obama is plotting to set up “death panels,” government tribunals authorized to euthanize the old and sick. Obama was born in Kenya and therefore his very Presidency is unconstitutional. Obama will cut Medicare benefits to provide coverage to illegal aliens. Obama seeks to indoctrinate children in Marxist ideology and put teenagers in “reëducation camps.” Obama is a Communist. Obama is a Fascist.

This sort of lunatic paranoia—touched with populism, nativism, racism, and anti-intellectualism—has long been a feature of the fringe, especially during times of economic bewilderment. What is different now is the evolution of a new political organism, with paranoia as its animating principle. The town-meeting shouters may be the organism’s hands and feet, but its heart—also, Heaven help us, its brain—is a “conservative” media alliance built around talk radio and cable television, especially Fox News. The protesters do not look to politicians for leadership. They look to niche media figures like Rush Limbaugh, Sean Hannity, Glenn Beck, Michael Savage, and their scores of clones behind local and national microphones. Because these figures have no responsibilities, they cannot disappoint. Their sneers may be false and hateful—they all routinely liken the President and the “Democrat Party” to murderous totalitarians—but they are employed by large, nominally respectable corporations and supported by national advertisers, lending them a considerable measure of institutional prestige. The dominant wing of the Republican Party is increasingly an appendage of the organism—the tail, you might say, though it seems to wag more often from fear than from happiness. Many Republican officeholders, even some reputed moderates like Senator Chuck Grassley, of Iowa, have obediently echoed the foul nonsense.

Over the summer, the organism probably succeeded, on balance, in accelerating the decline in Obama’s poll ratings, a decline that was inevitable once the inaugural glow faded, the economic crisis failed to vanish, and the messy, confusing legislative battles began. With the help of what appeared to be White House passivity, it certainly succeeded in demoralizing the center-left, stoking the fears of the ill-informed and persuading the press that health-care reform was in serious, maybe terminal, trouble.

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Part of Obama’s task last Wednesday evening, when he delivered an address to a joint session of Congress, was to dispel the talk radio–Fox News miasma—to give heart to his nervous supporters in the House chamber and beyond, reassure them that he knows what he’s doing, and bolster their confidence by showing them his. In that, he succeeded. The address was his best as President. Some centrist positioning early in the speech—especially an implication that “those on the left” who favor a single-payer system and “those on the right” who favor leaving everybody to buy health insurance individually are equally “radical”—gave some a sinking feeling. (Medicare is a single-payer system. It is not radical.) But the President’s bipartisan pleasantries only made his firmness more impressive. His civility was matched by fight and fire. He called the death-panels claim—“made not just by radio and cable talk-show hosts but by prominent politicians,” some of whom were sitting in front of him—exactly what it is: “a lie, plain and simple.” And this:

If you come to me with a serious set of proposals, I will be there to listen. My door is always open. But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than to improve it.

Obama is sometimes faulted for conducting government by speech. But this speech was part of a patient strategy that, despite August’s rough weather, is looking increasingly sound. In 1993, President Clinton delivered a similarly well-received health-care address on Capitol Hill. But he then dumped a detailed, already-worked-out bill in Congress’s lap. The implication: Take it or leave it. Obama has left the bill-writing to the legislators (with intense White House kibitzing, of course) and has waited until the stretch to take the reins. When Harry and Louise torpedoed the Clinton plan’s popularity, Democrats panicked and abandoned the foundering plan. Obama’s approach made it difficult for him to stump for “his” plan, because its shape was necessarily unknown; now his numbers are slipping, too. But slipping poll numbers are less apt to panic members of Congress who have invested themselves in the shaping of the legislation and have had time to reflect on what followed failure last time: the Democrats lost control of the House for the first time in forty years.

Obama’s treatment of the “public option”—a kind of mini-Medicare that would compete with private insurance in a limited way—encapsulated his strategy. He defended it passionately, convincing many liberal doubters that he truly believes in it and knows that it would yield better care at lower cost. He also made it clear that he prefers reform without the public option—but with near-universal coverage and an end to “preëxisting conditions,” arbitrary cancellation of insurance, and the fear that losing or changing your job will cost you your savings and perhaps your life—to no reform at all. If it were up to the House alone, of course, the public option would be a lock. But in the filibuster-hobbled Senate the fate of reform may come down to the whims of a tiny handful of preening moderates from states that are mostly empty of people, notably the Democratic chairman of the Finance Committee, Max Baucus, of Montana, and Olympia Snowe, Republican of Maine.

Bipartisanship is a fine sentiment and an appealing tactic, but where health care is concerned it was never a great idea. The boorish South Carolina Republican who shouted “You lie!” at the President after he said, truthfully, that reform “would not apply to those who are here illegally” did the public weal a favor by underlining bipartisanship’s futility. A bill that reflects a necessary compromise among Democrats is bound to be stronger than one that reflects an unnecessary compromise between Democrats and Republicans. And that’s no lie. ♦