Reuters PhotosCongressional Republicans listen during President Obama’s address about healthcare reform to a joint session of the US Congress

Spare a thought, and maybe even a dime, for Kenneth Gladney. In August he and other members of the right-wing St. Louis Tea Party arrived at a town-hall meeting organized by Missouri Democrat Russ Carnahan to lobby against universal healthcare. In the spirit of this fraught summer, a fight broke out, ending in six arrests.

Who threw the first punch depends on whom you ask. But who got the worst of it was fairly clear. Gladney was taken to the emergency room with injuries to his knee, back, elbow, shoulder and face and ended up in a wheelchair. His troubles were just beginning. Recently laid off, this particular anti-health reform protester, it turned out, had no health insurance. Last heard, he was still accepting donations for his medical expenses.

It’s not difficult to ridicule the American right. Its peculiar blend of paranoia, mania, fantasy and misanthropy has been given full rein these past few months. Those who demanded in July to see Obama’s birth certificate (which does exist) ended August invoking the British healthcare system’s “death panels” (which do not). That most of their claims were verifiably false was of little consequence–to them at least. At one point they insisted that if scientist Stephen Hawking were British and subject to the National Health Service, he would be dead, even though Hawking is British, alive and grateful to the NHS for his care.

So progressives could be forgiven for branding the right as stupid and crazy. But they would also be wrong. For if this is madness, there is great method in it. It is well organized and well funded. It has proven effective in mobilizing support, creating “controversy” where little exists and disrupting and disorienting whatever national conversation there is. If it is stupid, then what does it say about us, since time and again it manages to outmaneuver the left? Annoying, bizarre, incoherent, divisive, intolerant, small-minded, misinformed, ill informed and disinformed, certainly. But stupid and crazy–anything but. It takes considerable skill to convince people that something that is clearly good for them–like universal healthcare–is not. If the right is crazy, it is crazy like a Fox News presenter. Reducing a political strategy or belief to a psychological disorder to dismiss and ridicule its proponents may be comforting. But it also abandons any hope of defeating it or stymieing its influence beyond therapy.

There are three important points to acknowledge about people like Gladney. First, they are not new. The cold war in general and McCarthyism in particular was built on lies, misinformation, obsession and guilt by the most tenuous of associations. After Eisenhower defeated Taft at the 1952 GOP convention, a woman emerged insisting, “This means eight more years of socialism.” In the late 1940s, a chairman of a federal loyalty review board conceded, “Of course, the fact that a person believes in racial equality doesn’t prove that he’s a communist. But it certainly makes you look twice, doesn’t it? You can’t get away from the fact that racial equality is part of the communist line.” Today the Internet distributes these slurs faster, and cable TV gives them more outlets. But there has always been a sizable section of society that seeks to fashion a bespoke reality out of whole cloth. These are the people who believe that civil rights was really about miscegenation, abortion rights is about promiscuity and gay rights is about pedophilia. There are more of them than we’d like to think. And they are not going away.

Second, you can’t argue with them. A good two and a half weeks after failed rescue efforts during Hurricane Katrina left bodies floating in the streets and people abandoned on roofs, 35 percent of the country believed that George W. Bush had done a good or excellent job responding to the crisis. That is roughly the proportion of the country with whom there is no real means of engagement. These are the birthers, Swiftboaters, climate change skeptics, Obamaphobes and Palin-tologists–the base. They live in a politically parallel world where everyone they know believes the same as they do. They don’t like established facts, so they come armed with their own. The left has such people too, but they are marginal. With no news channels to promote them or Congressmen prepared to advocate for them, their views rarely reach the mainstream.

Third, we can beat them. These people gain the kind of purchase that shifts them from an irritant to an obstacle only when there is a vacuum of leadership and the absence of good alternatives. It is only under these conditions that they are able to cast unreasonable doubt in the reasonable minds of those who seek clarification, encouragement or a stake in any substantive change. This is precisely what has happened with the healthcare debate over the past few months.

Less than a third of the country believes Obama has clearly explained his plans for healthcare reform. Two-thirds of independents and more than a third of Democrats believe he hasn’t. According to a CNN poll, only one in five believes he or she will be better off after healthcare reform has passed, and 40 percent say they are confused by the proposals. Who can blame them?

A decisive portion of the country is desperate to be convinced. They know that what they have now is terrible but have yet to be convinced that what might come is better. How could it be otherwise when the very person who launched the reform process–the president–keeps hedging on its most essential element: the public option? The only thing that is controversial about universal healthcare is that America does not have it. The idea that a Democratic president with substantial Democratic majorities in both houses of Congress might fail to pass healthcare reform, well, that’s enough to make anyone crazy.