Guest blogger James A. Morone is author with David Blumenthal of "The Heart of Power: Health and Politics in the Oval Office," which was published by University of California Press in June. Morone, professor and chair of political science at Brown University, peers into the history of health care reform to offer some forward-looking advice.

When Harry Truman first proposed national health insurance, Senate minority leader Robert Taft (R-Ohio) promptly tagged it "the most socialistic measure that this Congress has ever had before it." Shouting socialism in the middle of the red scare detonated a serious charge. Democratic James Murray responded by screaming back at his colleague: "You have so much gall and so much nerve... If you don't shut up I'll have...you thrown out."

Every time the issue comes up (and it has come up often - 1946, 1949, 1962, 1964-5, 1974, 1979, 1991-4 and 2009), the rhetoric runs long, loud, and hysterical. Why so hot? Because big health reforms always plays out on three different levels - every one one of them a killer.

First, the debates rest on honest philosophical differences: Basic rights versus market competition, communal good versus private responsibility, government provision versus private insurance. Here is a rare policy area where one side flatly excoriates markets and proscribes government while the other blasts government and touts markets. Health care has become a badge of shame for liberals ("we're the only nation without national health insurance") and a point of pride for conservatives ("we're the only nation without national health insurance!").

Second, national health insurance debates provoke intense symbols about the state of the nation - barely tethered to the specific proposals at hand: The triumph of socialism, the death of free enterprise, the iron rule of the bureaucrats or the cool murder of innocents. "If this program passes," warned Ronald Reagan about Medicare in 1963, "one of these days we will tell our children and our children's children what it was like in America when men were free."

The death panels are just the latest in a long line of monsters that seems to speak to a generation's anxieties - not just for health care but for the nation itself. Democrats always - always, every single time - get taken by surprise. Their full page newspaper ads during the Truman years were, to say the least, defensive: "The President's Plan is NOT socialized medicine." But the fears are real and can be answered - not by dismissal or denials or disdain - but by hopes and dreams that go as deep as people's anxieties.

Finally, as if all that were not enough, the battle for health reform invariably becomes a battle for political control. Harry Truman's famous come-from-behind 1948 election victory prominently featured national health insurance. The first square-off during the 1960 election campaign saw the candidates, Vice President Richard Nixon and Sen. John F. Kennedy, furiously working the Senate for their competing health plans.

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