A rule in politics is that when news coverage isn’t going well and you control the agenda, simply change the subject.

So it’s no surprise the Obama administration, facing falling approval ratings from playing defense from “pulling the plug on grandma”, simply tweaked its rhetoric on a “public option” for health care overhaul, signaling a willingness to consider instead a co-op plan proposed by Sen. Kent Conrad , D-N.D.

Thus, the administration dodged a bullet, but also ignited a civil war in the Democratic ranks. The conflict pits liberal, often-colorful, typically urban House Democrats opposite their more moderate, bland, rural-state Senate Democratic colleagues — it’s the single payer advocates vs. the Democratic Leadership Council — with a young first-year president as referee.

The stakes couldn’t be higher, substantively and politically – since who knows when the political landscape will be as favorable to Democrats as they are in this cycle. Meanwhile, the Republicanscan afford to sit back, throw rocks and see their election prospects improve. And don’t overlook those pleading special interests and their billions spent on fear-based TV ads and spreading falsehoods through fake Astro-turf letter-writing and phone bank campaigns.

This is all catnip for cable TV and talk radio, keenly aware how much the needle moves when senior citizens or suburban moms are alarmed about unspecified changes in their health care. And any time Sens. Max Baucus , D-Mont., Conrad and Charles E. Grassley of Iowa are on the verge of becoming household names, it’s time to get a scorecard to keep track.

Besides, public policy now seems driven as much by social networking as by the mainstream media. Consider that all it took was former Alaska Republican Gov. Sarah Palin to post a loopy, factually inaccurate Facebook message about bogus “death panels” to completely alter the health care landscape.

Although it probably cost her reputation with some political elites, it was a tactically brilliant move by Palin. With but a few keystrokes Palin demonstrated how to speak to the badly misinformed, the rigidly ideological, and the actively hallucinating, those millions of conservatives convinced that ObamaCare aims to “put the Washington bureaucrats in charge of health care.”

Now we’re on to a genuine dispute, perhaps an inevitable one, centering on whether the federal government should — and can — serve as a health insurance administrator for tens of millions of working Americans who otherwise will be denied access to affordable care.

But the status quo is unacceptable. Premiums for private health insurance have risen 119 percent nationally over the past decade while wages have stayed flat. Meanwhile, more than 10 million more Americans are without insurance, bringing the total of uninsured to 47 million and growing. And when uninsured Americans get sick they get treated at hospital emergency rooms, at considerable cost and largely funded by either taxpayers in the form of local property or state income taxes or passed along in a “hidden tax” to those with private insurance.

Sure, most Americans get their insurance through their employers, around 60 percent actually. There may be 1,300 insurance companies chartered in the United States, but in 314 of the largest metropolitan areas, a recent study found that 94 percent were controlled by one or two companies, defined as “highly concentrated,” according to Justice Department guidelines. Health insurance is one of the least competitive markets in the United States, which may which may be why premiums are rising.

With virtual monopoly status, health insurers have little incentive to provide quality customer service. Who hasn’t spent hours filling out paperwork or on the phone dealing with a rejected claim or reimbursement?

God forbid if you have individual insurance and ever file a claim; your health insurer will drop you.

Still, while Americans may hate their health insurance provider, a large percentage don’t trust their government either — including those who want the government to keep its hands off of their Medicare.