These sentiments conflict with recent iterations of Republican health care reform. The “full repeal” bill is nothing of the sort — it preserves the regulatory structure of Obamacare, but withdraws its supports for the poor. The House version of replacement would transfer many from Medicaid to the private market, but it doesn’t ensure that those transferred can meaningfully purchase care in that market. The Senate bill offers a bit more to the needy, but still leaves many unable to pay for basic services. In the rosiest projections of each version, millions will be unable to pay for basic health care. This wasn’t acceptable to Reagan in 1961, and it shouldn’t be acceptable to his political heirs.

It is true, as Republicans argue, that health care costs too much. And it is also true that Obamacare has failed to take care of this problem. But if Republicans fail to accept some baseline provision of care, we’ll find ourselves mired in internal contradictions — arguing, for instance, that a bill that cuts subsidies for the poor somehow makes care more accessible. We’ll rail against the way the government has destroyed our health care market in one breath and resist the support offered to the poor and middle class to navigate this brokenness with the other. This is not conservative; it is incoherence masquerading as ideological purity.

Many problems — the monopolization of provider networks, a regulatory framework that forces Americans to overpay for generic drugs — require both a positive Republican vision and a more robust majority to carry it out.

But devising that vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.