On Thursday night, CNN hosted a Paul Ryan town hall, during which a man who identified himself as a small-business owner and longtime Republican told Ryan that Obamacare had saved his life. It was a compelling moment; you can watch it above. But besides just being dramatic (by CNN town hall standards), it spoke to three truths about the Republican Party’s current situation.

1. This is what Republicans are going to have to deal with, and for some reason they don’t seem to have planned for it. The GOP’s Obamacare repeal process, which it’s had six years to prepare for, was a mess from the get-go. Repealing the Affordable Care Act will take health coverage away from many millions of people, and any party that doesn’t want to lose all the available elections needs to have some sort of plan to keep at least most of those people covered. The Republicans currently don’t. And that’s related to the next item …

2. This is why a guy who was a Democrat 10 years ago routed all the actual Republicans in the Republican primary. Paul Ryan appears to be truly and deeply committed, when it comes to economic issues, to the free-market principles of Ayn Rand. But a free market doesn’t provide low-cost health insurance to cancer patients no matter how slick Paul Ryan’s riff about high-risk pools is. Obamacare isn’t unpopular because most Americans are Randians who believe that publicly subsidized health care is an insult to the philosophical principles of total human freedom; it’s unpopular because the premiums people pay through Obamacare are going up (and because many people don’t know that pre-existing condition coverage, the extension of parental coverage to kids in their 20s, etc. are part of the ACA). But many Republican politicians and pundits are, in fact, Randian ideologues. Which is how you had the moment in a February primary debate in which Ted Cruz thought he’d scored a point against Donald Trump by catching Trump promising not to let people literally die in the street because they couldn’t afford health insurance.

Trump’s success revealed that Republican leaders had, for years, been misinterpreting their voters’ antipathy toward infuriatingly ineffective bureaucracies (and, in some cases, their feelings of resentment that certain other types of people were getting government $$$ before they were) for an ideological opposition to basic welfare-state functions like making sure people don’t die in the street. But the bad news for Republicans on this note is that Donald Trump doesn’t actually understand the health care market, so it’s not like he’s going to come up with a plan for them. And, at the same time, he’s out in public making ACA-related promises that neither he nor anyone else will be able to keep.

3. The centrist media’s perception of Paul Ryan as a charismatic wonk genius may last forever. The Washington Post’s conventional wisdom correspondent, Chris Cillizza, thought Ryan’s town hall went great.

You should watch this Paul Ryan town hall on CNN. The guy is extremely impressive. — Chris Cillizza (@CillizzaCNN) January 13, 2017

He loved it! Paul Ryan, who was repeatedly proven during the 2016 election to be completely irrelevant to actual Republican voters, and who, in an effort to defend his floundering agenda, was being told to pull his head out of his ass by a cancer patient on national TV. An impressive showing.

Cillizza’s feelings about Ryan actually speak to a potential Republican solution to its repeal-and-??? problem. That solution: mostly leaving Obamacare alone, tweaking a few things about it that would lower premiums, and pretending they’ve completely replaced it while BS-ing up some budget projections that make it look like the whole process has saved money. To do this, you’d need some slick salesmen, a gullible press, and a gullible public. And in Ryan, the Cillizzas of the world, and a certain serially bankrupt real estate heir who just rode in into the White House by convincing tens of millions of people that he is a genius businessman, doesn’t the GOP have just what it needs?