In the shouting match over the health care law, most have somehow missed another of its obvious virtues: it enshrines accountability — yes, another conservative idea. Under today’s system, most health insurers (and providers) are accountable to the wrong people, often for the wrong reasons, with the needs of patients coming last. With the transparency, mobility and choice of the exchanges, businesses and individuals can decide for themselves which insurers (and, embedded in their networks, which providers) deserve their dollars. They can see, thanks to the often derided benefits standardization of the reform act, what they are actually buying. They can shop around. And businesses are free to decide that they are better off opting out, paying into funds that subsidize individuals’ coverage and letting their employees do their own shopping, with what is, in essence, their own compensation, relocated to the exchanges.

Back when the idea of letting businesses and consumers pick their own plans — with their own money on an exchange — first floated around Washington, advocates called them “association health plans.” They, too, would have corrected for the lack of transparency, mobility and choice in local insurance markets by allowing the purchase of health insurance across state lines. They were the cornerstone of what would have been the Bush administration’s reform plan (had the administration not been distracted by other matters). After the rejection of “Hillarycare” in the mid-’90s, association health plans emerged as the centerpiece of pro-market, Republican thinking about health reform — essentially what would become Romneycare, extended via federal law to cover the entire country. So much for Mr. Romney’s argument that his plan in Massachusetts was an expression of states’ rights. His own party had bigger plans for the rest of the country, and they looked a lot like Obamacare.

But perhaps the clearest indication of the conservative economic values underlying the act is its reception by many Democrats. The plan has few champions on the left precisely because it is not a government takeover of health care. It is not a single-payer system, nor “Medicare for all”; it does not include a “public option,” a health plan offered by a federal insurer. It is a ratification of market ideas, modified to address problems unique to health insurance.

Mr. Obama’s plan, which should be a darling of the right for these principles, was abandoned not for its content, but rather for politics. Neither side is blameless here. The White House could not have been more ham-fisted in the way it rammed the bill through Congress. The Republicans in the House and Senate lashed back with a vengeance, sifting through the legislative colossus for boogeymen like “death panels,” and when they could not find things sufficiently alarmist, they simply invented them.

Clear away all the demagogy and scare tactics, and Obamacare is, at its core, Romneycare across state lines. But today’s Republicans dare not own anything built on principles of economic conservatism, if it also protects one of the four horsemen of the social conservatives’ apocalypse: coverage for the full spectrum of women’s reproductive health, from birth control to abortion.

Social conservatives’ hostility to the health care act is a natural corollary to their broader agenda of controlling women’s bodies. These are not the objections of traditional “conservatives,” but of agitators for prying, invasive government — the very things they project, erroneously, onto the workings of the president’s plan. Decrying the legislation for interfering in the doctor-patient relationship, while seeking to pass grossly intrusive laws involving the OB-GYN-patient relationship, is one of the more bizarre disconnects in American politics.

Obamacare draws fire from this segment of “conservatives” because it fortifies the other side in their holy war. Coverage for birth control and abortion has not been introduced by the law; but it has been neutralized economically across all health plans, as part of the plan’s systemic effort to streamline fragmented health insurance markets and coverage.

The real problem with the health care plan — for Mr. Romney and the Republicans in general — is that political credit for it goes to Mr. Obama. Now, Mr. Romney is in a terrible fix trying to spin his way out of this paradox and tear down something he knows is right — something for which he ought to be taking great political credit of his own.