It's interesting to recall that a big reason for the last government shutdown, the one of 1995-96, was...Republican opposition to health care. The following is from Bill Clinton's radio address of December 9, 1995:

Nowhere is this choice clearer than in our different approaches to Medicaid. For three decades the Medicaid program has meant that if your child was disabled in an accident or your husband got Alzheimer's or your parent needed nursing home care, you would get the help you need. The Republican budget would cut Medicaid by $163 billion. It would repeal the guarantee of health care for poor children, people with disabilities, pregnant women, and older Americans.

Now, this repeal was not an afterthought or an unintended consequence. The Congressional Republican majority is actually insisting on it. What would this mean? Well, in 2002 alone, the year the budget's supposed to be balanced, the Republican budget could deny quality health coverage to nearly eight million people, deny meaningful health care to over a million people with disabilities, even to 150,000 veterans, and to tens of thousands of people with AIDS, many of whom are able to keep working or who can get the help they need without their families being forced into poverty because of the assistance they get from Medicaid.

So they've pretty much always felt this way about health care for people of modest means. They just hate it. And they've proven themselves willing before to shut the government down over it (although there were other issues in '95 as well). What's different about this time is that they, or some of them, are trying to undo a new law that the Supreme Court upheld.

Meanwhile, over at Business Insider, Josh Barro reminds us of the cold truth of the matter, which is that it's not exactly as if Republicans have ideas about health care that they want to implement:

The failure of conservative politicians and think tanks to advance serious alternatives on health policy reflects their complete lack of interest in fixing health policy: They don't want to spend money, they don't want to change Medicare in ways that affect elderly Republican base voters, they don't want to cut the incomes of Republican-voting doctors, and they don't want to change the (often overly expensive) health coverage situations of the overwhelmingly insured Republican electorate.

The last words are the key ones. Their voters are overwhelmingly insured. So what should they care about the people who are overwhelmingly uninsured? But in fact, I might say: Well, even if they can't be bothered to care for humanitarian reasons, they ought to care for reasons of fiscal prudence. Uninsured people who get sick cost society a lot of money.

There was a time when that sort of reasoning would have appealed to the average Republican brain. They would, yes, be somewhat disapproving of "giving" something to someone who hadn't "earned" it (these words are in irony quotes because I think you earn health care by...being born!), but they would nevertheless be governed in their decision-making process regarding public policy by this fiscally driven definition of a common good.

But now? They're just driven by rage against people they don't like. They don't even care if it costs their own people more money, which it does. And their own people don't even care. Punishing "freeloaders" is more important than making any fiscal sense. Clinton's address is a good reminder that this started a couple of decades ago. Gingrich was no slouch at stirring up white rage either.