If it's true, as the late U.S. Rep. Tip O'Neill once said, that all politics is local, then you have no better example that the current debate over national health care reform.

President Obama has proposed a grand national plan for health care that involves a sophisticated blend of national policy and local control. But whether anything happens depends on what happens on the battlegrounds of individual states, perhaps even individual counties across the U.S.

Where could that be more true than in Hawai'i, where Gov. Linda Lingle has injected herself firmly into the national debate? The issue of the moment is the series of town hall and community meetings about health care that are being held around the country, usually hosted by members of Congress.

Opponents of federalized health care have been aggressive at these meetings, often emulating the tactics of an unlikely role model: AIDS activists of the group called "Act Up." The idea is to disrupt public meetings in an unruly manner because that is the only way you will get any attention.

There has been considerable public muttering about these demonstrations, often focused on their rudeness and disruptiveness.

This week, Lingle by implication defended the activists. She was rolled out on the national stage to defend the health care "reform" opponents and their passionate actions.

"I think you see a heightened emotion and passion and, you say anger, because people are scared," Lingle said during a conference call with reporters organized by the Republican Governors Association.

"You're talking about hundreds of billions of dollars in cuts in spending on Medicare, and that's why you see members of the AARP separated from their leadership on this issue, because they're scared," the Hawai'i governor said. "The heightened anger is out of fear for what it's going to mean for their lives and the lives of their families."

So Lingle has made herself perfectly clear: She believes the health reform program — at least as it is being currently characterized by Sarah Palin and others — is a dangerous and even frightening proposal to many Americans.

That has led to some spectacularly unpleasant events as members of Congress return home during their summer recess and seek to take the public pulse on health care. Federal officials have been assaulted by angry, stirred-up constituents who believe they need to put the bolts to their representatives in Washington.

The other (one might say liberal) side is not giving up. The offshoot of Obama's presidential campaign ("Organizing for America") has sent an e-mail blast to its massive database of contributors and supporters, urging them to mount a counter-offensive.

They have set up a sophisticated Web-based program called "Office Visits for Health Reform" which sets up Obama supporters with visits to their local Washington representative or senator during the recess.

At each visit, they are supposed to drop off materials and jaw directly with their member of Congress if they get the chance.

Does this make sense? Sen. Daniel K. Inouye, D-Hawai'i, thinks not. Of course he will meet with anyone he can, Inouye says. But by sending people off on a mission to beard their members of Congress, the Obama step-group is facing the possibility of alienating the very people it needs most, Inouye said.

As virtually the most senior member of Congress (and a health reform supporter), Inouye says the case should be taken first to Congress rather than to an unfocused and somewhat unidentified public.

"If this was going to be a massive movement, the least they could have done was connect with us," Inouye said.

Which makes the basic point. If health reform is to come, will it come from the grass roots or will it come from Congress, where most of the decisions are truly made?