Presidents possess the power of life and death. A recent joint study by researchers at Stanford and New York University law schools makes that point especially clear and provides depressing new detail about the consequences of President Obama’s drone program in Pakistan.

The new report shows that, in addition to killing Pakistani civilians, drones have subjected many more to a constant reign of terror. From the report: “Drones hover 24 hours a day over communities in northwest Pakistan, striking homes, vehicles and public spaces without warning. Their presence terrorizes men, women and children, giving rise to anxiety and psychological trauma among civilian communities.”

In response to these and other national security abuses, Atlantic columnist Conor Friedersdorf recently penned a widely read article, “Why I Refuse to Vote for Barack Obama.” The piece has attracted more than a million readers and been intensively debated. I will end the suspense nowthough I share Friedersdorf’s disgust about drones, I disagree with his conclusions, which I will return to below.

Friedersdorf is a self-described libertarian who supported Obama in 2008 in part because as a senator, Obama vigorously denounced national security excesses that occurred under the Bush administration. These included mass surveillance conducted without search warrants, prisoner abuse, torture and rendition. But President Obama has mostly embraced policies he once rejected. Warrantless surveillance is more widespread than ever. Obama has greatly stepped up drone attacks and green-lighted unconscionable practices, such as the targeting of funerals of victims of those attacks. And he’s done something Bush never did: authorized the assassination of American citizens without due process of any kind. For Friedersdorf, these policies constitute “deal-breakers” that make a vote for Obama beyond the pale of moral acceptability.

Friedersdorf has been intensely criticized. He’s been denounced for being naïve about politics in a two-party system, in which refusal to vote for one major party candidate is a tacit endorsement of the other. Critics have derided his childish pretensions to moral purity. Many have also noted that the perfect should not be the enemy of the good and that voting for the lesser evil is, in fact, a moral act that will prevent greater evil.

Friedersdorf has countered that, if confronted with a different set of deal-breakers, many of his liberal interlocutors would flinch. He proposed one hypothetical: What if President Obama were caught on tape making exceedingly offensive comments about Mexican Americans and secretly delighting in the record numbers he’s deported? While plenty said they’d vote for Obama regardless, many others admitted they’d find such behavior to be egregious.

Friedersdorf found that many progressives and other erstwhile civil libertarians didn’t, after all, have a philosophical problem with the concept of deal-breakers or purity tests, per se. Instead, they simply don’t regard the specific practices Friedersdorf abhors as deal-breakers. For Friedersdorf, this is a damning indictment of those progressives who, while professing concern for out-groups in general, simply aren’t overly exercised by the killing of Muslims in distant places.

Of course, one needn’t overlook the scourge of drones to evaluate it alongside other policies with life and death consequences. Obama has, for example, supported policies at home that are life-saving. Warts and all, the Affordable Care Act (ACA) is Exhibit A. The extension of health insurance to perhaps 30 million more people could save thousands of lives per year. Because bombs don’t literally go off when an individual lacks the means to afford the medical care adequately to treat serious illness, there’s a tendency not to think of such circumstances in such stark terms. But in their ultimate effects, those are, indeed, matters of life and death.

Obama’s record on inequality is mixed. On the positive side of the ledgerassuming you favor reducing inequalityare increased taxes on the wealthy to help finance the ACA, as well as tax reductions that have specifically targeted the working middle class. Again, warts and all, the Dodd-Frank bill establishing a new consumer protection agency will mitigate some abuse of consumers by big financial interests.

On the other hand, Obama has been notoriously weak in confronting the worst excesses of Wall Street. For example, his Justice Department has failed to prosecute a single individual for fraud related to the financial catastrophe. More broadly, since Obama has become president, wealth has further concentrated at the top.

How is this relevant? A slew of research, including the noted book The Spirit Level, suggests that inequality itself has clear and adverse consequencesincluding mortal onesfor those on the wrong side of it. Recent data reveals that among whites with less than a high school diploma, life expectancy has dropped by four years since 1990, a shocking development in a wealthy country in peacetime. That decline is not, of course, Obama’s fault. The point is simply that there is reason to believe that inequality kills. And as our society has become more unequal, we may witness wider disparities in life expectancy. Some Obama policies have or will ameliorate these problems. Others won’t.

Health care and inequality are, of course, only two of many relevant issues one could discuss in this context. To circle back to the discussion sparked by Friedersdorf, we don’t make political choices in a vacuum. Obama’s record on life-and-death issues is subject to criticism on some vitally important counts. On others, he deserves praise.

But compared to the other guy? Unfortunately, it’s not a close call. Romney’s promises to kill the ACA on “day one,” gut Medicaid, cut food stamps and more will have inescapably adverse and, indeed, life-threatening consequences for many vulnerable Americans.

He’d be more Wall Street-friendly than Obama and more aggressive in cutting environmental and safety regulations. He’s not indicated that he’d be anything but eager to perpetuate Bush/ Obama “national security” policies, including drones. And he has hinted he would reverse one clear Obama positive on national security: the ban on the direct use of torture by United States service personnel (though yes, we still outsource it).

You might think we don’t have ideal or even good choices. But that doesn’t mean we lack clear ones. Whereas Obama’s record is a mix of profound good and bad, there is almost nothing redeeming in Romney’s own stated vision, which will certainly leave more and more Americans susceptible to the depredations of fate while offering no hint of hope for the vulnerable elsewhere.

This article appeared in print with the headline “Life, death and the president.”