Did Clinton's health care reforms perish in the glare of the TV lights? ask Edwin Diamond and Robert Silverman. At one point in the mid-1990s, the number one and number two bestselling books in the United States were by radio talk-show hosts Rush Limbaugh and Howard Stern. These were not humourous books, not deliberately so anyway.

They were the political pensees of, arguably, the two loudest mouths of American culture. Meanwhile, the US president marked his anniversary in office by taking calls on a TV call-in show-the same Cable News Network programme on which H. Ross Perot announced his candidacy for president in 1992. As a climax of sorts to this implosion of realms, Newt Gingrich, the congressman from Cobb County, Georgia, and host of a cable TV college course, became the new speaker of the House of Representatives and perhaps the most powerful politician in America.

Some call this democracy, the triumph of "plain-talking" populism. These five men could not be more different, yet they share an ability to use the new-media formats that have become the electronic hearth around which Americans gather. Our political leaders have learned how to entertain us, and our entertainers know how to politicise us.

The rise of talk radio and cable call-in shows - and most recently, the Internet and its world wide web and other computer based media - thrills many. Traditional media have been organised on a one-to-many communications model: editors typically decide what should go into their newspapers; consumers pay their penny and make their choices. Now the talk culture and network of computer services stir visions of a brave new world of many-to-many communications. Politics, enthusiasts say, can be made democratic, participatory, open, exuberant . . . enjoyable. The triumph of politics-as-entertainment and entertainment-as-politics speeds the transformation of the national landscape. A place is emerging that looks like a real democracy, but is in fact a construct: a "virtual America".

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The legislative fate of the Clinton health care plan in 1994 illustrated the limits of political power in the new interactive culture. When the corpse of health care reform was found sprawled on Capitol Hill after Congress scattered for the November 1994 elections, the Washington press wanted to know, whodunit? Hillary Rodham Clinton blamed unnatural causes: shadowy "special interests" using specious television advertisements to misrepresent the proposals. The bluntest of these instruments were the "Harry and Louise" TV spots paid for by the Health Insurance Association of America - the insurance companies' trade group. (The actors playing the affluent-looking, fortyish "Harry and Louise" sat in their den, pouring over the Clinton health plan, and noting troublesome "hidden costs" and the loss of "provider choice" - all in 30 seconds.)

According to The New York Times, several suspects "had their hands on the knife at one time or another", including the beaverish wonks of the Clinton administration; divided Congressional Democrats; natural-born killer-partisans of the Republican leadership, as well as the cold-eyed capos of the health insurance industry. Others stressed the part played by the media themselves. In a Public Broadcasting System special, The Great Health Care Debate, host-commentator Bill Moyers pointed accusingly at the talk show culture itself. Moyers described how - recovering from major heart surgery and listening to hours of radio - he was dismayed to hear that "almost every talk radio host was 'anti' the Clinton proposals". Another critic, the political scientist Thomas Patterson of Syracuse University, pointed his finger at the mainstream press. According to Patterson, the modern Washington reporter aspires to being "anti": such journalism instinctively "magnifies the bad and underplays the good" that politicians do.

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The idea of snarling, judgemental - and, ultimately, unreliable - newshounds has a certain appeal in the search for Washington villainy. In fact, the role of talk culture and Washington journalists in Clinton's apparent inability to govern was more ambiguous. Perversely, it was also more worrisome, not just for the fate of health care but also for the future of all political communications.

The talk shows and the TV ads were (mildly) amusing side shows during the health care story. In the midst of intense attention to health care, only one in seven Americans could recall ever hearing of "Harry and Louise". But the insurance companies' ads were "narrowcast", to produce stories and commentary seen by a Washington policy audience. The ads signalled that the health care industry intended to spend big money to defeat plans it did not like. The proposals were not defeated "because of" the TV talk shows or ads. The real killing ground was a more familiar one.

Most Americans received most of their information about health care from their newspapers, and tv network newscasts. These channels all rely on journalism's traditional narrative mode, and that proved enough to speed the demise of reform.

Once a story achieves a critical mass of attention coverage follows two predictable patterns. First, "developments" get regular attention even when there is no real news ("This is John Cochran, NBC News, on Capitol Hill, where the noise level over health care is rising . . ."). Second, stories are fitted into a political campaign narrative (charge-rebuttal, attack-counterattack, who is winning and losing in the metaphorical "horse race"). In USA Today, "the nation's newspaper," 41 articles about health care appeared during a two-month period in early 1994. One dealt primarily with cost; another offered a good explanatory guide . . . and 29 were principally about health care "battles", "challenges", and who was for or against the plan. Similarly, in a sampling of 35 articles that appeared in Time and Newsweek during 1993, ten were concerned with Clinton's approval ratings and how the fate of health care would "make or break" his administration.

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Could the Clintonites have avoided this media frame for health care, or blunted its effects? Yes, but only to a limited extent. The administration made some fateful decisions at the outset. The reform plan, for example, rejected a single-payer scheme, featuring government as national insurer. Single payer had been tested and proved workable in other countries; but it was vulnerable to easy, albeit false, caricature as "socialised medicine".

There are indeed "losers" when the public dialogue is set by the new communications culture. While an already fearful electorate was pumped up with constant, dire bulletins on the health care "battle", it got relatively little information about the actual content of the proposals. To this day, for example, only one in five citizens can define for public opinion pollers the term "managed care". Like everyone else, we were transfixed by the race; we mourned - or cheered - the result. In all the excitement, though, it was easy to lose sight of what the process was all about.

The old media habit of choosing conflict over context, the new media addiction to monomaniacal rant, may make it all but impossible for even the most adept White House to govern effectively. America, in fact, may actually become the nightmare place imagined by the talk show blatherers: an ungovernable mess. We can envision a hapless line of one-term presidents stumbling into the millennium: first, Bush, now Clinton, next, his successor. Virtual leaders instead of real leaders.

Edwin Diamond is a professor and director of the News Study Group at New York University. Robert Silverman has followed new media for Variety, National Journal, and Interactive Age.

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Adapted from White House to Your House: Media and Politics in Virtual America, Edwin Diamond and Robert Silverman, MIT Press.