Nanny knows best: Kathleen Sebelius, Secretary of Health and Human Services, with President Obama as he announces his contentious "contraceptive mandate" in January (Credit: Joshua Roberts) 

Viewed from a distance, the 2012 US presidential election debate must seem very strange: at a moment of severe domestic economic dislocation, escalating national debt, dysfunctional governmental institutions and grave international danger, Americans are arguing about birth control.

Well, no: Americans aren't arguing about the appropriate means of family planning, despite the Obama administration's best efforts to convince Americans, and the world, that that's what's been going on since January — an effort in which the administration has been aided and abetted by a gullible media and often clueless Republican presidential candidates. Ever since the administration's January announcement that Obamacare — its healthcare reform programme — would require all employers to provide health insurance coverage that included such "preventive health services" as contraception, sterilisation, and abortifacient drugs, the American culture war has indeed heated up, to boiling point sometimes. But as one witty blogger put it in March, "This is about birth control the way the American Revolution was about tea."   

But if it's not about birth control, what has this argument — which will not go away between now and the November election, and which will continue if President Obama is re-elected — been about?

It may help to think of the debate as a series of concentric circles, in which questions of both public policy and democratic theory are engaged. The outermost circle is formed by concerns about Obamacare itself. The 2,200-page Bill that passed Congress in early 2010 — and which more than 60 per cent of the American people now say they regard as a bad idea — was alarming enough; there was probably not a single member of the US House of Representatives or Senate who had actually read and mastered this gargantuan piece of legislation. Worse, however, have been the opening gambits in the implementation of this vastly complicated reset of the American healthcare system and the American health insurance industry. For the implementation has been left to federal agencies like the US department of health and human services (HHS), where the statist tendencies of the Obama administration have been embraced by what is arguably the most left-leaning bureaucracy in the entire government. 

Here was a marriage made in Bevanite heaven: an administration seeking to tie the entire American population ever closer to the federal government, joined to a bureaucracy staffed by men and women whose political and social attitudes reflect the hard Left of American public life, with the newly weds suddenly given control of one-sixth of the US economy. Little wonder that the elixir of unprecedented power proved over-stimulating. For Obamacare's implementation was what those charged with designing it had been yearning for during their long exile in what they regarded as the vast wasteland of the Reagan and post-Reagan years — a desert sojourn that was not made easier by a Clinton administration that many of these people take to have been reprehensibly conservative. At last, the long march towards the full-blown social welfare state could begin anew, led this time by a president whose sense of self was little less than messianic and whose skills at bamboozling the public were of the highest calibre.

Over-stimulation, of course, leads to an ever-heightened sense of power: a conviction of invulnerability seasoned with a profound belief in one's moral superiority. Detached from political reality, however, that kind of hubris is a sure prescription for political over-reach. And that (plus no small amount of sheer political ineptitude) is a fair description of what led the Obama administration into the thicket of the culture wars in January.