“The old order changeth,” Tennyson wrote, “yielding place to new.”

For three-quarters of a century, Americans have been debating whether the state should guarantee health coverage for all. With the passage of the Affordable Care Act, the “yes” side seemed at last to have prevailed, or nearly so. Obamacare is not quite a universal health-care program, but it shifted the U.S. closer to that outcome. For seven years, Republicans have vowed to shift it back. Now the moment for reversal has arrived. If Paul Ryan’s version of health-care reform prevails, the speaker will have accomplished something that Ronald Reagan and Margaret Thatcher never could: Repeal a fully operational social-insurance program.

But it looks increasingly unlikely that Ryan will prevail. Monday’s Congressional Budget Office estimate that 14 million Americans will lose coverage in the first year after repeal—with 7 more to lose it just in time for the 2020 presidential election—must spread panic among already nervous Republicans. Paul Ryan, a true believer, accepts that toll as the price of principle. It seems doubtful that very many other Republican officeholders will long agree.

Unlike Health and Human Services Secretary Tom Price, who absurdly promises that not one person in the United States will be rendered worse off by the GOP bill, Ryan has been commendably frank about the choice before the country. Here’s what he told CBS’s John Dickerson on Sunday, March 12.

Dickerson: How many people are going to lose coverage under this new— Ryan: I can’t answer that question. It’s up to people. Here—here’s the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country. So the question is, are we providing a system where people have access to health insurance if they choose to do so? And the answer is yes. But are we going to have some nice looking spreadsheet that says we, the government of the American—of the United States are going to make people buy something and, therefore, they’re all going to buy it? No. That’s the fatal conceit of Obamacare in the first place. So it’s not our job to make people do something that they don’t want to do. It is our job to have a system where people can get universal access to affordable coverage if they choose to do so or not. That’s what we’re going to be accomplishing.

Ryan’s forthright remarks reveal the assumptions on which his policy is founded. Health-care coverage, his comments suggest, is a good that comes with a cost primarily borne by the covered individual or family. If individuals or families assesses that the good is not worth the cost, then they should be free to forgo the coverage. If that decision should ruin them financially—or expose them to life-threatening medical risk—then that is the price of freedom. As Ayn Rand wrote in The Virtue of Selfishness: “No man can have a right to impose an unchosen obligation , an unrewarded duty or an involuntary servitude on another man.” And what is a mandate but an unchosen obligation?