Nothing dramatic is the answer. Part of the problem is that they don’t understand a lot of the issues. See, for example, this sharp Media Blog account of last night’s Polis Seminar on Digital Britain.

Speakers at the event included Culture Secretary-in-waiting Jeremy Hunt. And what did we learn from the man who will surely assume control of the UK media following the next general election?

Well, we learned Hunt appears not to fully understand the controversial implications of "net neutrality", though he gamely attempted to answer a question from the floor which he thought was about illegal file sharing, defending in the process the rights of content owners who may ultimately feel the pinch of a tiered internet themselves (check out the BBC iPlayer effect to understand what first brought the net neutrality debate to the UK – clue: it’s nothing to do with file-sharing.)

What’s going on in the US now is really scary. The attacks on Obama make the ‘Revd’ Ian Paisley — even in his bigoted heyday — look like a bleeding-heart liberal. At the root of it is a sense of frustrated entitlement: it’s as if the Right in America simply cannot believe that its God-given right to run the country has been denied as a result of a liberal swindle. We saw some of this in the Clinton era (witness the continuous campaigns to harass and even impeach him), but what we’re seeing now is something else. It’s psychotic.

In that context, Andrew Sullivan has an interesting blog post this morning. Sample:

The pattern is now clear: the imperative to play the political game has won on the right. The longer-term pattern is just as clear: a faction of congressional Democrats sometimes backed Bush on his initiatives (such as his tax cuts). No one in the Congressional Limbaugh-run GOP will back anything this president does. Not only that; they will assault him, race-bait him and insult him in a continuous reel of populist bile.

It seems to me that the GOP was once recognizable as a human personality. It had an id; but it also had a series of responsible egos – Eisenhower, Reagan, Bush I and, to some extent, Bush II; and it had a super-ego – some kind of conscience that made it think of the broader society over partisan warfare. What we've seen in the last few years is the removal of both ego and super-ego.

What you have now is just the rage at the world and its confounding trade-offs and compromises. The knowledge of the Rove right’s total failure in the last eight years has only made the far right more fervent in its theo-ideology. Do they have a plan to balance the budget? To salvage or cut losses in Afghanistan? To integrate illegal immigrants rather than use their lives as political fodder? To get the working middle classes reliable healthcare insurance? Not that I can see beyond utopian platitudes.

But they do know that anything this president does is a threat to them. And the noise they can make and violence they can foment is out of all proportion to their numbers…

It reminds me of the old definition of ‘fanatic’ as someone who keeps bombing after he has forgotten the objectives that bombing was supposed to achieve.

I’m working on a theory of incompetent systems — i.e systems which are in danger of catastrophic failure but which, for various reasons (absence of effective feedback loops, undue power of vested interests, etc.) will not be able to fix themselves in time to avoid catastrophic failure. Climate change looks to me like an incompetent system problem. Intellectual property law is another. And the American healthcare system is yet another. Watching the way the public debate about health reform in the US has been maliciously hijacked by powerful vested interests was reminiscent of the way debates about IP are skewed. But healthcare is far more important, and yet it’s being allowed to happen. It’s unbelievable.

Not surprisingly, therefore, I was struck by this blast from Mark Anderson. Excerpt:

If it were not such a tragic struggle, watching the entrenched interests fighting any change in the U.S. healthcare system would be vaguely amusing, like watching elephant races.

Unfortunately, these aren’t cute elephants, but a cancer on our society: the growth in their wastefulness, and in the value they subtract from the healthcare process every year, is bankrupting good companies, destroying the business foundations of the country, and enriching a few at overwhelming cost to the many.

While the American healthcare system has many problems and parts, it does not defy analysis. And while it will take many different reforms to perfect it, just a single change would bring it back from the dead. The problem is simple: private insurance companies. These groups do not have patient care in mind; they are only focused on extracting money from the system. They do not even operate as part of a healthcare system: with the same basic structure, they could extract money from any supply chain.

The worst part of this scheme is that the real customer, the patient, is essentially prevented from being the customer. She does not know the cost of her care, she has little or no control over those costs, and the result is the vendor is free to drive them to the sky, with everyone getting a cut – except the patient. Why not charge $100 for aspirin? Who cares? Why not charge 2x for a broken leg? Why not run 4x too many MRIs? Who cares? The MRI vendor is happy, the hospital with the new machine needing to be paid off is happy, the doctor getting paid per use, and reviewed for quotas, is happy, and the patient – Who cares?

Most insurance companies learned long ago that their real business is in investment: life insurance companies are the obvious early case. Collecting and paying out premiums and claims is just a sideline, a way to get the cash needed for the investment business. You knew this, right?

So it is with American healthcare. These companies are not in the business of healthcare: they are in the business of extracting as much cash as possible from the system, on a compound annual growth basis which is 3-4x the cost of living. How much would they spend to keep this bloodletting from being interrupted? Well, the bank lobby spent $1B to remove the Glass Steagall protections, just before the banks helped blow up the US economy. I would guess that what we are seeing right now, in Washington, DC, is the largest amount of money ever spent on lobbying a single cause – all in the name of retaining a broken system, one which costs more than twice the next one down, one often classified as something like 37th in the world, just behind Slovenia…

When the US — after eight years of moronic, destructive, wasteful government — succeeded in electing Obama I remember being struck by the country’s extraordinary ability to reinvent itself. Now I’m not so sure. Maybe Obama was just a blip?

On the other hand, if he can succeed in getting meaningful healthcare refore passed, then he will go down as the greatest president since FDR.