“Death panels” are a dominant motif in the debate over health care regulation, a fact that spins off political flares like a roman candle.

Extremists on both sides have taken their extreme positions: Some literally fear President Obama and his health regulation plans; others are outraged that anyone could possibly feel that way.

Charges of special-interest organizing meet counter-charges of unfairness and false accusation. Good video from town hall meetings and volleys of “Nazi” and “socialist” give cable news networks another short reprieve from their long slow decline. It’s all manna for the writers at Comedy Central.

But let’s talk substance: Health care is a scarce good, so it will always be rationed. The core question is whether government should take the dominant role in health care rationing over from insurance companies, or whether reform should restore rationing decisions to patients advised by doctors.

Though they would never have the name or the form, the “death panel” label roughly (and unfairly) describes what would happen if health decisions were turned over to government bureaucrats under the leading proposals today. The bureaucracy would do exactly what “reform” asks it to do(!): prioritize cost savings and efficiency over the unique, individual interests of patients and their families.

The bureaucracy would serve its own interests too. Bureaucracies are subject to capture by special interests, of course, and they can be corrupted. These things are easier when the people who might die look like statistics.

Many people feel very strongly that problems with health care today indicate the need for President Obama’s and Congress’ health care plans. But what’s wrong with health care doesn’t mean that these proposals would make things better. Because they would move control of health care in the wrong direction, they would make things worse.

Everyone has a personal story about health care, and I have one too. On the day my mother passed away, my family and I were called to the hospital and met by a social worker. He showed us to a small anteroom at the entrance to the intensive care unit, where he guided us through a lengthy conversation about my mother’s wishes and the family’s circumstances. He then called in the doctors to offer their prognosis and advice, which we took.

It was a death panel. It was our death panel — because my parents had fully prepared for this eventuality by buying insurance.

Just like health care will always be rationed, there will always be death panels. The question is who runs them. To the extent our public policy drives people away from financial responsibility for their own health care, it sets them up for death panels that are administered by government bureaucrats, not by loved ones and doctors.

Political debate is rollicking and unfair and full of inaccuracy. And in the terms of today’s health care debate, we don’t want “rationing” — meaning we don’t want government rationing. And we don’t want death panels — meaning we don’t want government death panels, because government death panels will deny people and their families an essential dignity of life: choosing how it ends.

In that sense I say with apologies to Patrick Henry: Give me liberty or give me death panels.