excellent recent post in the Guardian by Clancy Sigal in which he defends 'Obamacare' helps illustrate the dramatic choice US voters are faced with in the forthcoming election. In simple terms, the gains made by the health care legislation Obama passed will be sabotaged and ultimately destroyed by Mitt Romney and the mad and bad members of the Republican Party, with the support of their equally loopy media allies.
It is true that victory for Obama will lead to more incremental victories, as another commentator put it, rather than major advances, but in part this is less a result of the current President's character than a product of the US electoral system. Put plainly, the USA has a constitutional and political system built to avoid strong federal government - it is designed to make the kind of social democratic advances made in Europe immensely difficult to secure.
One example of this is the frequency of elections in the US: every two years in the case of the House of Representatives. This alone provides a difficult hurdle for centre-left governments; it takes many years more than that to train a doctor or to complete a major construction project. Therefore, raising taxes on voters to pay for these things becomes very tough - come the midterm elections, many of those same voters will expect to see evidence of a return on their investment.
Conversely, things are made easier for those on the political right. It takes next to no time at all to cut taxes, very little time for voters to see the cut in their pay packets and an awful lot longer for the impact on public services to be felt.
With this in mind, it is worth reflecting on the scope that Mitt Romney, Paul Ryan et al have to decimate the US social security system, to attack womens' health care rights and to set back action to tackle global warming. And, of course, to reverse the small victories that are tempering some of the worst aspects of the US health care system - a hugely expensive bureaucracy in which the ill and very ill are left to haggle with their doctors and mighty insurance companies, over what in Europe most would consider a basic human right.