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This combination of file photos shows Democratic Senate candidate John Fetterman, left, and Republican Senate candidate Dr. Mehmet Oz.The Associated Press

Pennsylvania has produced only one president, James Buchanan – consistently ranked one of the worst in every poll of historians. It has produced only a handful of national figures (the only one you’ve likely heard of, Benjamin Franklin, died 232 years ago). It is the fifth-largest state, but its politics are considerably less consequential and far less colourful than the top four (California, Texas, Florida and New York).

At least until about two weeks ago. Suddenly, Pennsylvania is the playing field of perhaps the most consequential and almost certainly the most colourful Senate race in the United States, one that, after a brutal debate Tuesday – possibly the most remarkable in U.S. political history – suddenly raises the question of whether a disability is a disqualification for high office.

The two candidates are cartoon characters, their ripostes are repellent and the quality of the debate beggars description, even for a state whose political culture ranges somewhere between risible and rancid. One of the candidates has dispensed quack medical advice; the other is struggling to convince voters that the stroke he suffered five months ago may be affecting how he talks but not how he thinks. Among the topics of debate – along with inflation, crime and abortion – is whether one of them actually lives in the state and whether the other was so aimless that his parents supported him until he was on the cusp of 50.

But health – rather than health care policy – has emerged as a vital sign in the campaign to fill the seat of retiring GOP Senator Pat Toomey.

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John Fetterman, the Democratic nominee, had a pacemaker with a defibrillator installed in his chest shortly after his stroke in mid-May. His use of a computer monitor to help him see and understand verbal communication has, with the help of Mehmet Oz’s Republican supporters, prompted many to question his fitness for office, even as it has raised awareness of disability issues in a state where, according to the Centers for Disease Control and Prevention, fully a quarter of the population has a disability. The World Health Organization describes disability as “part of being human,” asserting that “almost everyone will temporarily or permanently experience disability at some point in their life,” and Mr. Fetterman’s aides are hoping his vulnerability will reinforce his image as an everyman, albeit one in shorts and a grey hoodie with a shaved head.

The two sparred in a televised debate Tuesday, with a couple of large monitors scrolling the text of questions and transcribing his rival’s remarks for Mr. Fetterman, who clearly struggled, his answers halting and sometimes incomplete.

As voters and pundits digest the impact of his performance, one element remains incontrovertible: the race between Dr. Oz and Mr. Fetterman is one of the handful of contests that will determine the power balance in the Senate. And for all its eccentricities and diversions, for all the shortcomings of the candidates, for all the peculiar twists and turns in this struggle to represent a state that sprawls across almost 120,000 square kilometres of territory, much of it practically empty, this contest remains a reliable case study in the dynamics of the 2022 midterm congressional elections.

“This race reflects all the crosscurrents in American politics today, from issues to ‘brand’ to the nature of political communication,” said Christopher Borick, the director of the Institute of Public Opinion at Muhlenberg College in Allentown, Pa. “Everything in American politics is in this one race.”

There is a sense of urgency surrounding this contest; already, almost 500,000 people have voted early. And aside from the atmospherics, the issues at play are the same ones animating contests across the country. The economy, specifically inflation, is the principal concern of 44 per cent of likely voters, according to a CNN poll released this week, with the two candidates taking positions on that matter – as on others, including crime – that are indistinguishable from those their party allies are emphasizing nationwide.

Plus this: Mr. Fetterman portrays his rival as a stooge of former president Donald Trump, while Dr. Oz portrays his opponent as the very model of President Joe Biden’s “liberal agenda.” This is a surrogate war.

It may not be the case that – to adapt an aphorism often applied to Maine for more than a century, beginning in 1820 – as Pennsylvania goes, so goes the nation. But it is not inaccurate to say that as Pennsylvania goes, so might the Senate, which is split 50-50 between Democrats and Republicans.

While Dr. Oz may have outsized television advantages, and while Mr. Fetterman is the same height as basketball star Kawhi Leonard, they represent the small-bore nature of contemporary U.S. politics. Mr. Fetterman’s main calling card is that he is a man of the people (he’s a former mayor of downtrodden Braddock, Pa., where a third of the population of 1,721 lives below the poverty line). Dr. Oz’s principal attribute is that he has the endorsement of Mr. Trump, who, among other things, was flattered that the TV doctor once described him as a “healthy specimen.”

In Tuesday’s debate, Dr. Oz said his rival’s advertisements were “a figment of his own imagination,” while Mr. Fetterman said of Dr. Oz, “If he’s on TV, he’s lying.”

They entered the debate under rapidly changing political circumstances. Mr. Fetterman held a strong lead early in the campaign, Dr. Oz enjoyed a late-summer surge, and now the race is a toss-up: the Democrat now leads the Republican by a 51-49 margin, according to a CBS/YouGov survey concluded the day before the debate.

There are two unknowns: will Mr. Fetterman’s difficulties in the debate undermine his prospects? Conversely, how much will the likely gubernatorial victory of Democrat Josh Shapiro – who has a commanding lead of 11 percentage points, according to the CNN survey, over Trump-backed Republican Doug Mastriano – help Mr. Fetterman? The answer to these questions may provide the key to much of the next few years in U.S. politics.