Brooks concedes that it's natural in the course of history that nations will want more security for their citizens to make up for the "large amount of cruelty and pain" that came with dynamic economic expansion. He admits that "poor people living in misery" and "workers suffering from exploitation" were part of the price of early American vitality, and that it's inevitable that nations "use money to buy civilization" in the form of social welfare programs, (i.e. "security"). But he worries that drastically expanding health-care costs, despite the Democrats' honest efforts to control them, may undermine our economic vitality in some undefined way. His point is not that health-care reform will fail to provide what it promises; he actually believes that the current legislation "would almost certainly ease the anxiety of the uninsured ... without damaging the care the rest of us receive." He simply believes that, with rare exceptions in history like the U.S. in the mid-20th century, security (or "civilization") comes at a cost to vitality, just as vitality often comes at a cost to security.
There's an implicit premise behind the article, which is that security ultimately depends on vitality. Brooks would probably argue that the country acquired the means to make itself more civilized and offer more security to citizens only because of its early economic vitality, regardless of the costs it seemed to impose in the form of personal insecurity, cruelty, exploitation, etc. He would most likely also argue that security can be pursued by governments to a point when the expenses involved would sap economic vitality so badly that security, too, would be impossible. Would he go further and argue that some personal insecurity is the price we must pay to maintain the economic vitality necessary to guarantee at least some security? I think he might if he could phrase the argument in order to portray the perfect as the enemy of the good. But there's also an unexamined premise in his article, or at least a vagueness about what, exactly, constitutes desirable vitality. "The unregulated market," he notes, "wants to direct capital to the productive and the young." But productivity is one thing, youth another, -- and greed another thing yet. Brooks might ask himself whether greed directs capital to itself in the unregulated market in a way that has nothing to do with productivity and thus could be reformed or dispensed with to allow a sufficient flow of capital toward both vitality and security. He might not think so, but I'd like to see him address the point.
In any event, Brooks sums up the matter in a manner admirably free of the usual ideological cant. He doesn't call this a choice between "freedom" and its opposite, or between "personal responsibility" and "dependence on big government." Nevertheless, Brooks says we face what he calls a brutal choice:
Reform would make us a more decent society, but also a less vibrant one. It would ease the anxiety of millions at the cost of future growth. It would heal a wound in the social fabric while piling another expensive and untouchable promise on top of the many such promises we’ve already made. America would be a less youthful, ragged and unforgiving nation, and a more middle-aged, civilized and sedate one. We all have to decide what we want at this moment in history, vitality or security. We can debate this or that provision, but where we come down will depend on that moral preference. Don’t get stupefied by technical details. This debate is about values.
To see how people are responding to Brooks, here's a link to readers' comments on the article from the Times website.