Conservative opposition to the Affordable Care Act degenerated into fantastically unprincipled nonsense almost as soon as it became a Republican organizing principle, but it worked in that capacity for so long because there was something real at the heart of it.

Republicans don’t have a single, defensible vision for the future of American health care policy, but they know it shouldn’t be a future in which the government provides insurance to as many people as it does today. That commitment, though politically troublesome and inhumane, is deeply held, which makes it a safe bet that the Obamacare’s weeklong reprieve from legislative assault won’t last forever.

But if Republicans were able to step outside of themselves for a moment, they’d see an opportunity in their recent defeat and seize it now, rather than drift along in the natural currents of health care politics until they arrive at the same place naturally.

A condensed version of the health care debate in America looks something like this:



During the campaign, Republicans promised to repeal and replace Obamacare with “something terrific” while Democrats fought among themselves (starting in the primary and continuing through the general election) over whether to fix and improve Obamacare or begin work right away on switching it out for a single-payer system like Medicare for all.