So we've arrived at an impasse.  I think fiat will screw up the health care system even worse than fiat has already screwed up the health care system, and that this will be bad for everyone in the long run.  I think that any program enacted now is likely to be the tipping point--once the government controls more than 50% of the health care system (it's over 45% now), it crowds out private health insurance for most people.  I think that this is what the people behind the system want it to do, largely because that's what they keep saying they want.

I think probably most people would agree that if Rand is right, and price controls shave, say, almost a year off of average lifespans, this is not necessarily a good deal for even the squishiest bleeding heart liberal--for the same reasons that socialism turned out not to be a good idea.  No, I'm not calling you a socialist.  I'm saying that if nationalizing companies and 90% tax rates on the very wealthy had worked well anywhere, a lot more liberals would be in favor of those things, because if you take away the unintended consequences that they turned out to have, they seem to conform to a lot of progressive priorities about justice, distribution, and so forth. But they didn't, and so most progressives have (or so I devoutly hope) abandoned these sorts of ideas in favor of a less intrusive agenda.

So ultimately I'm saying, I think this is the way that our government works, and this is the way that markets work, and for all the screaming, these are not crazy positions.  There's plenty of evidence for government crowding out.  There's plenty of evidence for price controls.  There's plenty of evidence for what happens to markets that are largely governed by price controls.

You may disagree. You think government works better than I do.  You think we'll be able to draw a line in the sand and keep the government from crossing over it to take over more of the market.  You think government spending can substitute for R&D, because you don't find the socialist calculation debate compelling. Or maybe you say, hey, yeah, well, 0.7 years off the average lifespan isn't a bad tradeoff for covering the uninsured. 

I can't talk you out of it.  You can't talk me out of thinking that 0.7 years of life is a whole lot of life when you apply it to 400 million people.  Numbers like that seem kind of meaningless-it's just eight months!--but this is composition fallacy.   Some people won't live longer.  Some people will die sooner, because treatment is iatrogenic in at least some cases.  And some people will get extra decades of healthy life to hug their children or compose symphonies.

It's a judgement call.  Not all values are commensurable.  There are multiple theories of politics.  And justice.

So why talk any more?  I can't believe how nasty this debate has gotten.  I can't believe that people who claim to value a classically liberal market society, on the one hand, and people who say that all they want to do is help people, turn into such screaming, hate-filled lunatics when the subject comes up.  A debate over health care should not remind me so much of a debate over the Iraq War.  I write thousands of words on innovation, and John Holbo boils my concerns about lost years of life down to "indifference to the poor"--as if, first, the poor will not be helped by new treatments, and second, we should do anything at all, no matter how horrific the results, as long as it helps the poor.  Well, and third, as if the poor weren't on Medicaid, but that's another rant.  This is about as useful as my saying that John Holbo's basic philosophical premise is a desire for my grandchildren to die young.  I devoutly hope that if any of his freshmen said anything remotely this silly in a paper, Mr. Holbo would flunk them.

I'm actually happy to be at the impasse, which I knew was coming.  All I wanted to do was get some liberals to admit that there might be some reason that someone with basically progressive ethical priorities might be worried.  I don't think we'll go beyond that, because progressives also have a lot of priors about the market that I don't share, to wit that it rarely produces anything really useful. 

But I'm sad about what's happened along the way.  I'm sad that people are carrying guns to protests, even though I think they have a right, and I'm sad that so many liberals have caricatured the opposition to the health care agenda as legions of astroturfed militiamen who accuse Nancy Pelosi of appointing Hitler to a death panel, or something.  I'm sad that libertarians and conservatives are casting this as some sort of massive conspiracy of power-mad idiots, when there's obviously a very large left-wing policy apparatus built up around health care that knows a thing or two, and virtually all of the progressives advocating this are for it because they are worried about people who can't get basic health care.  I'm sad that liberals are casting their opposition as being mostly about racism and hatred of the poor. I'm sad that the debate has taken place 95% at the level of the gut revulsion Red and Blue Americas are actively nurturing for each other.

So I'm not sure it's much worth continuing beyond this point, unless there's some interesting economic side issue.  But it's certainly been interesting, and most of the commenters have remained reasonably civil most of the time.  Thanks for that.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.