After a weekend of protests over reform, the Obama administration has, in fact, created a change that many Americans can now see and feel. The new bill, though imperfect, represents progress in a new direction. However, it seems that for this step forward some Americans have taken two steps back.

The first step back took the form of angry racist and homophobic rhetoric aimed at Rep. John Lewis (D-GA) and Rep. Barney Frank (D-MA) last Sunday. Lewis was called a “nigger” and Frank was called a "faggot," as Tea Party protestors shouted, “Kill the bill.” Lewis recalled his experiences as a civil rights activist saying, “it reminded me of the ‘60s. It was a lot of downright hate and anger and people being downright mean." Frank was unsurprised but “disappointed” by the incivility. In a related incident, Rep. Steve King (R-IA) stood on a balcony during the protests and slapped a picture of Nancy Pelosi in the face. Should we be surprised and disappointed? Probably not. We’ve seen this kind of action before: In 1994, then-First Lady Hillary Clinton was burned in effigy by Kentuckians who were against reform.

The second step back came as a fax sent to Rep. Bart Stupak (D-MI) Wednesday with a drawing of a noose and gallows, labeled "Bart (SS) Stupak." Stupak is not alone. House Majority Whip James Clyburn reported that he has received several faxes of nooses on gallows along with letters filled with racial slurs at his office. Rep. Anthony Weiner (D-NY) was sent a package containing a menacing letter and a white powdery substance. These symbolic threats have forced many to ask for an acknowledgment of these actions from the GOP and Tea Party spokespeople – not to mention the sort of strong condemnation they require. Many more are asking what race and sexual orientation have to do with it. The answer? A great deal.

Even without a public or single-payer option, the reform bill represents a disruption of hierarchy, a need for some extremists to place blame and an important form of identification for all Americans. By extending what has been a privilege of only those who work or can pay independently to roughly 40 million “others” as a right, the Health Care Reform Bill has flattened out a social hierarchy that enables some Americans feel and behave as though they are superior to others or that they have done something, other than being alive, that earns them the privilege of proper health care. Those who feel superior may say, “I or my company can pay for health care, therefore I am.” But now that the reform bill has become law, many more Americans can say, “I am, therefore I have the right to affordable health care.” By making health care available to more people, those who believe it’s a privilege they’ve earned are now placed on the same hierarchical rung as others whom they believe don’t deserve or haven’t earned it.

Tied to this sense of hierarchy and privilege is the impulse to place blame. Those who have been fiercely protesting against health care reform may not necessarily see anything wrong with the former status quo. As a result, many, like Newt Gingrich, argue that the U.S. government is guilty for stepping into an arena in which it does not belong, and their response is “hands off my health care.” Some are planning to make this position personal by protesting this weekend at the home of Rep. Steve Driehaus (D-OH), who has already seen a photograph of his children used in an ad published by reform opponents.

And there’s more fault-finding to go around. Countering Obama’s inclusive slogan “Yes we can” is John Boehner’s divisive and condescending remix response, “Hell no you can’t.” The intent is to make Democrats pay for violating the sanctity of a system that supposedly wasn’t broken and to punish the government for overstepping its bounds. RNC Chairman Michael Steele echoed this sentiment when he told Fox News that it’s time to start “getting Nancy [Pelosi] ready for the firing line.” Sarah Palin also did her part to raise the rhetorical stakes, telling her Twitter followers, "Commonsense Conservatives & lovers of America: 'Don't Retreat, Instead - RELOAD!'" Palin continued by referring her supporters to her Facebook page, where she once again makes use of gun imagery and produces a list of 20 potentially vulnerable pro-reform Democrats in Congress. Coincidentally, angry healthcare reform opponents associated with the Western Rifle Shooters Association are planning an open arms rally to Restore the Constitution at Ft. Hunt and Gravelly Parks. This rally is scheduled to take place on April 19th, the anniversary of both the Waco siege and Oklahoma City domestic terrorist attack.

Finally, there’s the issue of identification. Those who are hurling hateful words, drawing hateful pictures and carrying deadly weapons are also implicitly sending the message that homosexuals and people of color should not be able to walk around feeling safe. According to Frank Rich, "it’s not happenstance that Frank, Lewis and Cleaver — none of them major Democratic players in the health care push — received a major share of last weekend’s abuse. When you hear demonstrators chant the slogan 'Take our country back!,' these are the people they want to take the country back from." Precisely because our President is multiracial the underlying fear is that Obama is out to empower minorities to the point of discriminating against an emerging minority, white heterosexuals. Thus, for extremist health care reform opponents the mere presence of people of color and homosexuals with political clout poses a threat – hence the threats of violence coming from the extremes. The threats are real and have been taken to heart by at least 10 members of Congress who have now requested increased security.

So, what should be done? It seems that our present health care debate is making the choice clear. We can seek to eliminate those Americans who do not conform to the status quo -- whether actively, through acts of violence and intimidation, or passively, by not giving them access to care that could save or prolong their lives. Or, we can actually create a more perfect union that includes, empowers and involves more Americans and work on healing some old and stubborn scars in our nation’s constitution.