The health care debate this time is focused on numbers, but a subtle psychological fear is pervasive: If the government in its “goodness” decides it can pay for end-of-life counseling, it can later on determine the content of the counseling. If the government in its “goodness” is concerned with the enormous cost of health care, looking everywhere for places to cut those costs, the elderly become an attractive budget item. Nevertheless, the insurance companies, imperfect and fallible though they are, depend on us to pay the freight. That leaves us in control of our choices, limited though they may be.

Trying to allay Mary’s fears, the president offered a flippant answer: “We just don’t have enough government workers to send to talk to everybody to find out how they want to die.” But what if it did? What kind of Big Brother government have we created that makes us feel so small? Collecting information about how the elderly want to die is not the problem; who manages that information is the crucial part.

The health care debate is valuable as part of the search for ways to cover the uninsured, but it gives a lot of us the creepy feeling that we’re losing the argument with the politicians, who are more concerned with creating a salable “product” than with thinking through the complexities.