Take, again, the town halls—in which so many angry audience members moved beyond the classic political accusation—you’re spinning—to a more pernicious one: you’re lying. While that isn’t, on its own, a novel accusation—citizens, of course, have accused politicians of untruth before, mostly because politicians have given them ample cause to do so—what is new is the blanket nature of the indictment. And the framing of the mistrust not in terms of bias, but in terms of truth itself. I don’t trust you. In other words: It’s not so much that I disagree with you, it’s that I will systematically refuse to believe anything you say. The declarations we’ve seen at the town halls haven’t been, generally, singular allegations; they’ve been broad. (“Everything the State says is a lie,” Nietzsche said, “and everything it has it has stolen.”) And, to a large extent, those allegations haven’t been specimens of reason so much as symptoms, apparently, of inarticulate outrage that has finally found an outlet for expression. “Now don’t you let the government get a hold of my Medicare,” and all that.

Taken together, these expressions of mistrust filter to something even deeper than cognitive dissonance. Call it cognitive dissociation.

“When we disagree,” President Obama said during his own town hall in New Hampshire yesterday afternoon, “let’s disagree over things that are real—not these wild misrepresentations that bear no resemblance to anything that’s actually been proposed.” But that simple suggestion—that basic call for, you know, reality—isn’t, in today’s world, as simple as it seems. On the contrary, it’s frustratingly, and in some senses tragically, difficult to realize. The rumors running rampant through the recent town halls—so often sprouted from seeds planted by talk radio and hyper-partisan Web sites and the like—ratify what we’ve known for some time: that the mainstream media are slowly losing the broad reach they used to enjoy. Even if they could overcome their baser instincts—he said/she said, love-of-conflict, spectacle-over-substance, etc.—to provide sober, informative, contextualized, and generally fair coverage…there’s still no guarantee that their voices would be loud enough to drown out the white noise of vitriol.

The challenge, then—if we accept the likelihood that the healthcare debate will continue to play out as a screaming match—is to ensure that the facts will simply make more noise than the fictions. If we fail in that, the future of much more than healthcare will be at stake. Democracy, George Bernard Shaw had it, “is a device that ensures we shall be governed no better than we deserve.” And if we abandon ourselves to a culture that treats “things that are real” as a choice to be made rather than a truth to be shared—then we can be fairly certain that, in the end, we’ll get exactly what we deserve.

Megan Garber is an assistant editor at the Nieman Journalism Lab at Harvard University. She was formerly a CJR staff writer.