Who will be the first American to lay down his life for (or against) healthcare reform? I'm serious. From a distance, the hysteria at politicians' town hall meetings these past two weeks across the US comes across as the theatre of the absurd. Except the show has featured a death threat to one congressman and a senator who asked for a special police guard when he took on his critics, as well as yelling crowds of supporters and opponents of reform accusing each other of being Nazis and communists. But are we not talking of comfort and healing? What on earth is going on?

Of course there is an element of showbiz in proceedings. These are the dog days, and news-starved cable TV channels are playing the rough and tumble for all its worth. For every unruly meeting, there may be half a dozen perfectly civilised ones you hear nothing about. The weather doesn't help either. The hot and humid fag-end of the American summer is more than conducive to short tempers. Come September, you would suppose, temperatures – both meteorological and emotional – should be cooler. As for the politicians who hold these meetings, they grin and bear it, insisting gamely that the ferocity of the debate proves the vibrancy of the US political process.

If only it were so simple. How the argument will end no one can say. For what it's worth, my guess is that Congress will pass something; for the Democrats who control Capitol Hill and who have been entrusted with the job of writing the health reform legislation to deliver nothing to a Democratic president would be collective political suicide. But what emerges will probably be much less than Obama would like.

In one respect, the hullabaloo is utterly normal. The way healthcare in America currently works may be morally wrong and financially unsustainable. But nothing is tougher than changing the familiar and the entrenched. Social Security, Medicare and Medicaid, the three pillars of America's state-run welfare and health structure, were all written on empty slates. Healthcare reform, as opposed to healthcare invention, has defeated every president since Harry Truman.

However much is wrong with the system, most of the population who are covered are happy with what they've got. And even if they weren't, the vast vested interests – insurance companies, drug companies, hospitals and the like – that have grown fat from the healthcare status quo would be obstacles to change.

Not surprisingly, these lobbies, as well as Republicans opposed to the Obama plan, have been accused of fomenting the town-hall uproar. If so, they are pushing on an open door. Deep down, America is a conservative country frightened by change, especially change that involves, as healthcare reform inevitably will, a greater role for government.

The Republican Party may be a dead man walking, but one baleful legacy of the Ronald Reagan era survived the party's rout in the 2006 and 2008 elections: an almost reflex distrust of government. And Americans have had to put up with a lot of government recently: the rescue of the financial system, the reordering of the car industry, and an $800 billion stimulus that will push the federal deficit to its highest level as a proportion of the economy since the First World War.

Even so, the nonsense spewed out by reform opponents can be breathtaking. "Keep the government out of Medicare," screamed one protester the other day, overlooking the minor fact that 40 years ago it was the government that set up the hugely popular healthcare plan for the elderly. And upon such ignorance, deceit and naked scaremongering prey.

Thus the talk of the "death panels" that would be run by federal bureaucrats, deciding whether ailing grandma would be treated or left to die. Thus the abuse that rains down upon healthcare systems such as those in Canada, Britain or Ireland, as examples of the "socialism", nay Stalinism, that awaits America should the public insurance option sought by reformers come into being. Yes, the "socialist" solution might be cheaper. But who could possibly wish to replace those tender and magnanimous for-profit insurance companies with heartless government?

In reality, the debate has moved beyond healthcare, a fiendishly complicated subject which taxes the skills of even Barack Obama, that most masterly of explainers, to convey in easily understandable terms. It now embraces the entire relationship between the state and the individual in a battle of slogans about freedom, democracy and the American way. As a woman told Arlen Specter (the Democratic senator who requested the protection of the Capitol police from Washington) at the meeting a few days ago in his home state of Pennsylvania, "This is about the systematic dismantling of this country."

And when a country faces systematic dismantlement, do not its citizens have the right to use any means to save it? "Extremism in the defence of liberty is no vice," was how Barry Goldwater once put it. That, though, was back in the 1960s. Things are more violent now. Gunmen shoot dead doctors who carry out abortions, and guards who get in their way at the Holocaust Museum.

For experts on the far right, these are worrying times. Hate groups are thriving, and far right 'Patriot' militias are multiplying, according to a new report from the Southern Poverty Law Centre in Alabama which monitors such organisations. The economy is in a mess; unemployment is rising and a "liberal" black man heads the government. Supposedly mainstream cable TV and talk radio hosts peddle the conspiracist fantasy that Obama is not American-born, and is little different in fact from those illegal immigrants who already haunt the nightmares of paleoconservatives. The National Rifle Association, spearhead of the gun lobby, is more formidable than ever.

I'm not saying the opposition at healthcare town halls comes from gun-toting survivalists who see black helicopters marked 'World Government' circling overhead. But the American right is a spectrum of overlapping segments, and when the twigs and grass are dry, a match in the forest can start a fire. That's why I worry that healthcare reform could unwittingly produce a martyr – and why things may not calm down so quickly, even in the cooler days of September.