The passion was real and, at times, deafening Monday morning as hundreds of area residents sought to give U.S. Rep. Russ Carnahan an earful about the current state of the nation's health care system.

For more than two hours, advocates and opponents packed a large room at Forest Park Community College for a town-hall forum organized by Carnahan, D-St. Louis. The session featured a variety of healthcare experts who offered medical, political and governmental angles of the debate expected to soon to consume Washington for the rest of the summer.

Although the speakers generally agreed with Carnahan that change was needed, those in the audience -- who lined up to ask questions -- spanned the spectrum.

They ranged from Lew Moye, president of the St. Louis Coalition of Black Trade Unionists, who asked why a government-run single-payer system was off the table, to industrial salesman Tim Magary of Crestwood, who believes that increased government involvement will make health care more costly and likely lead to rationing.

"I've got a hole in my tongue from biting it,'' said Magary, who held a sign declaring: "Obama care = Hurry up and die, Grandma."

Meanwhile, Moye was among several single-payer advocates who asserted that a single-payer system seemed the most affordable and practical approach. Carnahan sounded sympathetic but emphasized that such an idea was dead in Washington. "You can't let the perfect be the enemy of the possible,'' he said, touching off murmurs of protest from all sides.

Other voices of discontent came from:
-- Stephanie Rubach, a nurse, who predicted that "patient care will jeopardized'' by the proposed cuts in Medicare and Medicaid payments to doctors and other providers;

-- Lydia Lewis, a retired government worker from Affton, who accused private insurance companies of "destroying this country by milking it for profits."

-- Dr. Patricia Wolff, a pediatrician and forum panelist who said she feared a single-payer system would cause "an economic tsunami'' by tossing tens of thousands of insurance-company workers out of work.

-- Steve Hollis, with the American Federation of Public Employees, who ignited applause when he asked Carnahan if Congress was seeking to tax his health care benefits, which -- like those for most working Americans -- are now tax-free.

Hollis' query was among the few to get a direct answer. Carnahan said he opposed taxing such benefits, adding that he suspected a majority in the U.S. House likely agrees with him.

But it's less clear whether that view is shared in the U.S. Senate, where some oppose the likely House proposal to raise taxes on the wealthy. Carnahan suggested any tax hike OKed by the House would only affect people earning $350,000 or more, with some plans now calling for increases only on millionaires.

The congressman repeatedly emphasized that most details of the latest package of health care proposals crafted by Democratic House leaders remain in flux and won't be unveiled until next Monday. The rest of the week is to be devoted to floor debate, he added.

 Carnahan drew lots of jeers and cheers -- the noise at times drowning him out -- each time he said he was committed to change because, in his opinion, the nation can't afford the status quo. The congressman said he believed the current health care system was becoming unaffordable for most Americans and most companies.

  Watching from the forum sidelines were lots of health care players, including Leann Chilton, director of government relations for BJC Healthcare. Without committing herself to a point of view, Chilton said that Carnahan deserved credit for holding such a no-holds-barred gathering.

 "He's got guts by putting himself out there,'' she said.

Afterwards, as he rushed into his van to dash to the airport (missing most of the protesters who were camped outside another door), Carnahan seemed pleased with how his Monday morning had turned out.

"I love these kind of forums,'' the congressman said. "It's so important for me to get feedback."

There should be no debate, he added, that he heard tons of "excellent and passionate comments."

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 Carnahan clearly takes an opposing view to the GOP's most visible critic -- U.S. Rep. Roy Blunt, R-Strafford, who was featured on CNN last week laying out his concerns about some of the Democratic proposals, most notably the so-called "public option."

Here's part one of Blunt's appearance on CNN. (Click here for part 2 and part 3)

Here's Carnahan offering a video invitation this weekend  to Monday's town hall.