The title of this post may seem contrarian. After all, the healthcare reform is dominating the agenda of the US Congress and is saturating media coverage, both online and offline. You might think this is #1 issue of interest to Americans.

No doubt, the level interest is remarkable. Every political group is mobilizing for a fight. Health reform hashtag (#hc09) briefly hit the list of trending topics on Twitter. But the real question is whether the engagement is limited to the most passionate activists or the entire American public is truly tuned in.

Recent piece on POLITICO highlights that it might be the former

What indicator should we look at? The TV ratings of President Obama's recent healthcare address and the subsequent discussion. The numbers hit all time-low for Obama's TV appearances, the speech lost out to an entertainment program and the most lively conversation had nothing to do with healthcare and centered on Obama's off-the-cuff remark that the police "acted stupidly" to arrest Professor Henry Louis Gates Jr. Politico summarizes the problem nicely:

Discussing the previous night’s low-key news conference, Ratigan said that “cable networks’ ratings go off a cliff” during the health care debate, which eventually “forces the conversation out of the TV.”

It’s not as if the public ignored Obama entirely as he took questions in the East Room on Wednesday night. Indeed, 24.5 million viewers tuned in across the broadcast and cable networks. Still, that tally was the smallest prime-time audience of Obama’s presidency, dropping 50 percent from five months ago. And Fox’s decision not to air the presser paid off: The network won the 8 p.m. time slot with an episode of “So You Think You Can Dance.”

“It’s bad for ratings,” The Washington Post’s Jonathan Capehart told Ratigan, “but not talking about it is bad for the American people.”

So Americans care about dancing and race more than health? 

This is not something we should be surprised about. Healthcare policy is anything but straightforward for John Q. Public. Most people do not understand the nuts-and-bolts of healthcare delivery and financing. Few use health services on a regular enough basis. Whenever they do, they are usually happy to leave the details of payment between providers, insurers and employers. Complex questions of health system redesign boil down to slogans, emotions and gut feelings. This puts most proposals for a "comprehensive" reform at risk.

Why the risk? The mistrust in our government runs high

Think about it. Most of the components in Obama/Pelosi plan are going to affect tens of millions of people, often in unobvious, unintended and unpredictable ways. In how doctor practice, insurers insure and employers pay for healthcare. There is a trillion-dollar price tag that someone will have to pay through higher taxes. Myriads of rules and regulations will have to be enacted - a recipe for disaster if adopted with too much hurry and not enough deliberation. Most of the immediate changes will be negative. These negatives will be all to easy to describe in emotional terms the general public will understand and reject. That's why the reform is stalling.

In my view, any reforms along partisan lines are doomed. Unless politicians build a broad consensus a "Yes" vote will cost them dearly.