I understand the fundamental opposition conservatives have to healthcare reform. Really. No sarcasm. I recognize that a government-mediated system goes against the grain of their ideology and that most conservatives have a good faith belief that market-based alternatives are superior. I disagree, often in colorful terms, but I get it. There is one repetitive talking point, however, that I do not get. Here is a brief sample of the argument in the hands of D-list winger columnists and Congressmen:

Laura Hollis: "(Godless liberals) want to humiliate you into backing down while they take over your country, dismantle your constitutional protections, seize your assets, tax you into submission, and insert themselves and their appointed bureaucrats between you and your doctor."

Matt Barber: "It’s no longer you and your doctor deciding what’s best for you and your family; it’s Big Brother."

Chuck Norris: "…what is needed in Washington is a truly bipartisan group that is allowed an ample amount of time to work on a compromise health care law that wouldn't raise taxes (for anyone), regulate personal medical choices, ration health care or restrict American citizens."

Rep. Bob Latta (R-OH): "The last thing patients and doctors need is the government coming between them and guiding the choices made regarding their personal health care needs and treatment."

My puzzlement is complete and my question is simple: what insurance do these people have and where can the rest of us sign? What the hell is this fantasy world in which medical decisions are "between patients and doctors" without the interference of panels of dour bean-counters, a labyrinthine and faceless bureaucracy, and actuarial tables? These columnists, screaming protesters, and talk radio audiences apparently live in 1923. Their doctor makes housecalls with his leather bag of Olde Tyme medical instruments and is paid for his services in cash or To Kill a Mockingbird style with bags of apples left on his porch. Or if they do have health insurance, it is a silent and unobtrusive entity that lingers in the background for the sole purpose of shelling out money without question for whatever procedure Chuck Norris desires.

This isn't remotely about patients' rights or the sanctity of the doctor-patient relationship. It is, as wingnuts so often fail to grasp, about preferences. A panel of government bureaucrats denying coverage for a procedure deemed experimental is an image worthy of pant-shitting rage; a panel of "reviewers" at Cigna or Aetna doing the same is fine. Having to ask an Obama-appointed bureaucrat for permission to recieve certain procedures is unthinkable; that we routinely do the same thing with our HMOs and PPOs is irrelevant. The mental gymnastics of defending the status quo require either dubious reasoning about why Aetna red tape is better than Uncle Sam red tape or, as is the case with so many demagogues, fabrication of their own curious reality in which we are infinitely free to do as we please and in total control of decisions which affect our lives.