It's really not that black and white. There's a line between the government deciding the optimal allocation of all resources and you retaining some degree of personal freedom. Techies in the SF Bay Area are very quick to draw that line in a way that affects other people's lifestyles, but doesn't affect their own. Guess what - pickup drivers in Texas have critical opinions about your consumer choices too.
If you think the math for cars is uniquely bad, I think that's a reasonable position, although I suspect it's pretty myopic. The externalities of cheap consumer goods from China, or of a clothes dryer or an AC unit, are pretty terrible too.
The math aside, there is a huge risk to this sort of hyper-rational accounting. It's probably not cost-effective for the society to medically prolong the lives of people over the age of 50. There are many squishy, hard-to-parametrize overriding considerations for policy decisions, and if we accept it for our lifestyles, we should probably at least try to understand what they are for other lifestyles too.
Do you also have a problem with commercial trucks or just the people that chose personal trucks because they don't agree with your ideology?
It comes down to: "I want to drive big, loud, smelly, dangerous car free of any consequences for fraction of the cost". We don't tolerate such desires in other areas but cars somehow get free pass still.