ONLY a madman would build America’s health-care system from scratch. Its mix of private insurance, government-provided care and endless regulations is complicated, expensive and fails many vulnerable Americans. The Affordable Care Act, Barack Obama’s health-care law, is part of the mess. Yet those who passed it knew it was a grubby compromise. In America’s divided government, they reasoned, politicians must build on what already exists.

Following the travails this week of their latest attempts to “repeal and replace” Obamacare, Republicans must come to a similar realisation (see article). They are too divided to sweep away the status quo. Rand Paul, one of four senators who threatened to bring down the Senate bill, compared its continuation of parts of Obamacare to “German national socialism”. He wants to get government out of health markets. Susan Collins, another rebel, thinks the bill cuts Medicaid, government-provided health insurance for the poor, too deeply. These factions are unlikely to agree, however long the Republican leadership tries to find a compromise. One conservative gambit—to repeal Obamacare and worry about replacing it later—is a reckless gamble that would inflict crippling uncertainty on the health industry and those who rely on it.

Get over the name

Republicans have long spoken as if Obamacare is a burning house; those inside must be rescued, even if it means taking an axe to the walls. But it is a fallacious argument designed to provide political cover to a Senate bill that is more about reducing redistribution than rescuing Obamacare’s customers from disaster (see article). The law’s problems are real, but fixable—more like a leaky roof and botched plumbing than a fire. The holes can still be patched up, in three steps.