As a group of U.S. politicians prepared to vote on a measure intended to delay implementation of a federal effort to extend health care to uninsured Americans, one of them, a Republican Texas congressman named John Culberson, was quoted thus:

“I said, like 9/11, ‘let’s roll!’”

It is a reference to the words attributed to Todd Beamer, a passenger on the hijacked United Airlines Flight 93 on Sept. 11, 2001, as a group of passengers tried to overpower the hijackers and prevent the use of the aircraft in a suicide attack.

In discussing U.S. health care policy in a column back in 2009, I employed a different use of the 9/11 metaphor in an effort to help readers make sense of the 18,000 people who, according to an Institute of Medicine study, die each year in the United States because of a lack of health insurance:

I’ve struggled with ways of getting across 18,000 preventable deaths per year. It is a 9/11 attack every two months, year in and year out.

I’ve often found it useful to push metaphors to the breaking point. Thinking through their failure mode provides useful information. So I’d invite you, in considering Culberson’s words and mine, to think about who represents Al-Qaeda here – the people attempting to extend health care coverage to the uninsured, or the people attempting to stop them.

Or maybe we should all just stop with the 9/11 references.