In her 1998 book The Argument Culture, linguist Deborah Tannen analyzes the ways incivility affects America's ability to pass effective laws and help the less well-off. In these passages, she points out how health care has deteriorated as a result of the tendency to polarize.

The rise of malpractice litigation, while prodding doctors to be more careful and providing deserved recompense to victims, has also made the doctor-patient relationship potentially more adversarial. At the same time, physicians are finding themselves in increasingly adversarial relationships with HMOs and insurance companies—as are the patients themselves, who now need the kind of advice that was offered under the headline "When Your HMO Says No: How to Fight for the Treatment You Need—and Win."

[To the list of problems caused by incivility] we could add the demise of the family doctor who came to your home, replaced by an overworked internist or family practitioner— if not an anonymous emergency room—and, if you're unlucky enough to need them but lucky enough to get to see them, a cadre of specialists who may not talk to each other or even much to you, or surgeons who may spend hours saving your life or limb but hardly ever see or speak to you afterward. . . . In all these domains, wonderful progress has been accompanied by more and more anonymity and disconnection, which are damaging to the human spirit and fertile ground for animosity.

The defeat of the Clinton administration's attempt to provide universal health care coverage is a dramatic example of the politics of obstruction (as well as the failure to seek compromise). . . . In analyzing why efforts toward health care reform failed utterly in [President Clinton's] first term—a failure they call "one of the greatest lost opportunities of our time"—journalists Haynes Johnson and David Broder dissect a large number of interacting forces, one of which was that "The journalistic culture—both its professional mind-set and its commercial, competitive pressures—nudges the coverage strongly to emphasize conflict and dissent rather than clarification of alternatives and the search for consensus."

From The Argument Culture, by Deborah Tannen. Copyright ©1998 by Deborah Tannen. Reprinted by permission of Random House, Inc.