By Jonathan Beale
BBC News, Hagerstown, Maryland
Opponents of health reform feel their arguments have been dismissed
Opinions seem to be as important as facts in America's healthcare debate.
Go to any of the scores of "town hall" meetings taking place up and down the country and you will find plenty of opinions, but relatively few facts.
Hundreds turned out for such a meeting at Hagerstown, Maryland - about an hour's drive from Washington DC.
In theory, they had come to hear from the state's junior senator, Democrat Ben Cardin.
But it seemed that most had already made up their mind.
Angry and vocal
At one extreme there were the protesters carrying posters of Barack Obama with a Hitler moustache.
These are the fringe - often followers of Lyndon LaRouche, an extremist whom many regard as a conspiracy theorist.
His supporters claim that the president is a Nazi who wants to take away healthcare from the elderly and that he is somehow advocating euthanasia.
They are armed with pamphlets that contain dubious quotes.
Not everyone present agrees that access to healthcare is a "right". This is the biggest difference between Europe and America
More common are the homemade banners warning of "socialised healthcare".
These are the opponents who say that America is about to adopt a European-style health service.
And there is one particular example they have in mind, one health system they want to avoid mimicking more than any other: Britain's National Health Service.
One man asks me why the British have such awful teeth.
He says he has heard it is because Britons have to wait six months to see a dentist. (He kindly tells me that mine are not that bad, but that I clearly never had braces as a child.)
Another man tells me that the UK has the highest mortality and the worst recovery rates in Europe. When I ask whether he has experienced this at first hand, he replies: "Why would I? I'd be dead."
And then there is the young woman who likens Britain and Canada to third world countries because of their health systems.
She is wearing a T-shirt that reads: "Proud To Be A Member Of The Angry Mob". It is a defiant demonstration of how those opposed to healthcare reform feel their arguments have been dismissed by the left.
These are the vocal - the most prominent opponents of the president's plans to bring about healthcare reform.
But there are others who keep a lower profile and feel uneasy.
Louise, for example, is a senior citizen who seems genuinely worried that expanding health coverage to 47 million uninsured Americans will leave her and her husband worse off.
Standing in the long queue to enter the auditorium I also speak to Eric Linn, a man who helps to run a private rural radiology unit. He fears that reform will cause healthcare to be rationed.
You cannot dismiss every opponent as just a sore loser.
As for proponents of healthcare reform, they seem to be fewer in number.
Supporters of healthcare reform were less numerous at the meeting
There is a mix of die-hard Democrats and those who believe the system is broken.
Charles Stewart - a small-business owner in a suit and tie - tells me that the tone of the debate has turned "ugly".
He says he cannot afford health insurance and wants a more affordable system.
I ask him about the dangers of expanding health coverage and adding to the national debt. He replies that it will be more expensive to do nothing.
Mr Stewart is one of hundreds who are turned away at the door. In the auditorium every seat is taken.
At the start of the meeting, the organisers make a vain appeal for the attendees to respect one another's opinions.
Senator Cardin arrives to polite applause. It is pretty much the only applause he gets all afternoon.
After a few opening remarks about the importance of hearing views and holding this debate, he faces the - mostly hostile - questioners. Instead of questions, they have come armed with well-rehearsed statements.
Most have a familiar theme: the government wants to take over healthcare and in the process will bankrupt the nation.
One brave soul tries to ask about the dangers of leaving 47 million people in America uninsured. But to this audience the question sounds suspiciously like a "plant".
Senator Cardin's biggest problem is that he is short on detail. He keeps on having to remind the audience, above the shouting, that neither the senate nor the president has finalised the details on healthcare reform.
Passions at the Maryland town hall meeting ran high
He repeats a few broad principles designed to reassure the critics: that there will always be private medicine and choice; and that America is not going to adopt another country's system.
He bravely suggests that all Americans should have access to healthcare.
Not everyone present agrees that it is a "right". This is the biggest difference between Europe and America.
But Mr Cardin's arguments all sound rather vague.
The biggest problem with America's healthcare debate is that no-one has really explained how it will work. Barack Obama has yet to spell it out.
These town hall meetings certainly show that democracy in America is alive and kicking. But that is about all.
There has been more heat than light.