With the passions rising in the health care debate, there’s a bit of a tendency to get crusty and brittle in our ability to compromise, and to keep the “all or nothing” psychological trump cards at bay. The wrangling on SCHIP is already giving everyone a run for his (or her) money in the ‘divided we fall’ camp.

Yet being in the middle is exactly where we need to be if positive incremental change — the kind that does justice to the every day lives of ordinary people — is going to happen. I was reminded of this in reading Christine Harold’s new book, Our Space, where she tries to dissect the countercultural response to the “proliferation of commercialization in civic life” or better known as “cultural jamming.”

As you would imagine, Harold has to take notice of a number of political and rhetorical strategies that pit the rebellious “outside hero” who sees through the false consciousness of branding, consumerism and the commercialization of public space (and freedom) against global capital and an increasing and highly effective corporate control of civic discourse and everyday life.

This kind of rhetorical construction of the political landscape (or media-scape as Harold describes it) has led to an unleashing of widespread counterculture tactics — pranks, hoaxes, parodies, anti-logos, pirating, even sabotage (think WTO Seattle protest) and other clever and creative subversive tactics designed to reveal the invisible machinations, repressive logics, or hidden assaults of the market establishment.

There is no question that these countercultural tactics offer the public considerable insight into the market as a corporate mode of social control. And Harold is sympathetic to the critique of the political influence wielded by multinational corporations (and its marketing and branding discourse). But Harold eventually takes her leave from those who encourage “wholesale contempt” of incremental policy change or who possess “little patience” for people who find any political potential in working positively with establishment institutions.

She argues that these forms of social dissent often morph into media commodities themselves and, in the end, reinforce the very institutions and practices they are meant to oppose; that the “inability of such rhetoric to affirm any alternative beyond endless critique” is self defeating.

“(C)orporate and anticorporate rhetorics”, for example, do not “oppose one another so much as feed off and respond to one another. . . A rhetoric of negation must always encounter more boundaries that must be overcome. More transgression is always required, which inevitably produces more cynicism and resentment.”

Harold opts instead for a politics of “balance, in-betweenness, and proper proportion.” She looks to Debra Hawhee who promotes the notion of being ‘in the middle’. Hawhee: “The middle . . . at once combines and exceeds the forces of active and passive. In the middle, one invents and is invented, one writes and is written, constitutes and is constituted.”

These theoretical considerations are not so distant as they may seem at first from the politics of health care. There are numerous signs of the hardening of the countercultural aspects of the health care debate with Michael Moore’s movie, SiCKO, being only one example. The tactics of ACT UP in the early years of the AIDS epidemic may also preview what’s coming.

Countercultural tactics, however misguided or self-defeating, add intensity to any debate. As a cultural, economic, political and corporate sphere of higher and higher public interest, should health care expect more radical political action in the coming months or years? Will we in the industry become increasingly subjected to the countercultural energy we see, say in environmental politics or animal rights? And if so what will be our response?

The burden on us is to shepherd the politics of this debate in a positive way and learn as go along. We might want to do some thinking now, while the space to do so is still open to us. Being in the middle is not easy, but when it comes to getting the right things done, it is the only really effective place to be.