Raleigh, N.C. — Americans are jeering and ranting at lawmakers' health care forums in North Carolina and across the country.

Many of those raising their voices and fists at the town halls have never been politically active. Many opponents say their frustration was born earlier this year with government bailouts and big spending bills, and has simmered in the recession.

President Barack Obama has proposed a government-sponsored health insurance plan aimed at providing all Americans with coverage, but opponents say it would increase bureaucracy and raise the costs of private insurers.

"It is direct democracy, even though it is not perhaps pretty democracy,” Peace College political science professor David McLennan said of the bitter sessions.

A lot of the contention centers over government involvement and what McLennan calls the "two worlds of health care."

"The people who have good health care really don't want it to be toyed with. On the other side, you have people who are under-insured or have no insurance at all who will take anything,” McLennan said.

Donald Taylor, an assistant professor of public policy at the Duke Sanford School of Public Policy, said the government already has a role in health care: Medicare. Taylor also said there is confusion over what changes reform would bring.

“There are really five plans in Congress right now,” he added.

Taylor said Obama will have to lay out specifics on what he wants health care reform to look like if he wants to save it.

"He is probably going to be wise to go ahead and be a little clearer about what he wants,” Taylor said.

The health care debate has also picked up steam due to organized opposition. The insurance industry lobby, America's Health Insurance Plans, is encouraging workers to attend town halls, as is the group Conservatives for Patients' Rights.

Another group, Americans for Prosperity, has two buses emblazoned with the slogan "Hands off our Health Care!" that are traveling around the country to rallies and town halls. At the town halls, volunteers circulate petitions opposing any legislation allowing greater government involvement.

The Americans for Prosperity group recently wrapped up a week-long campaign called "Patients First" in Raleigh.

Crowd gathers at town hall in Lillington

In Lillington, Second District Congressman Bob Etheridge faced a raucous crowd of more than 200 people Wednesday night at Central Carolina Community College.

"It is a work in process; it is not completed," Etheridge said of Obama's plan.

Tensions quickly rose as people from opposing sides took to the podium.

"None of you have ever had to look in the face of somebody dying and they got to worry about a (medical) bill," a reform supporter told the crowd.

Others left little doubt that they are not happy with what's on the table.

"Why can't we let free-market solutions work instead of having government interference in the market?" a reform opponent said.

Hundreds of other people who showed up for the town hall were turned away when the room reached capacity.  Those people started an impromptu debate in the parking lot.

“If people can't make a profit, who is going to pay taxes?" Anthony Mangum asked.

“You can make a profit on some things, but my health should not be at the benefit of your profit,” Josh Wynne said.

McLennan said he is not surprised by the shouting that has dominated the meetings.

"Policy is shaped by even angry reaction,” he said.

McLennan said the reform being discussed is a costly and far-reaching task.

"People are seeing this as hundreds of billions of dollars, on top of hundreds of billions of dollars, and it's becoming difficult for people to really comprehend,” McLennan added.

Etheridge agreed that revamping the nation's health care system is not easy.

"I think it is very difficult,” he added.

Fourth District Congressman David Price will hold a town hall meeting Thursday at the Miller-Morgan Building on the North Carolina Central University Campus in Durham.

Eleventh District Congressman Heath Shuler will also hold a telephone news conference on the subject Thursday.

Thirteenth District Congressman Brad Miller said he plans to meet with small groups on both sides of the debate instead of holding a public forum after a death threat was phoned into his office.