“Universal coverage has never been a conservative goal,” said Young. “In other periods when Republicans had control of the entire government ... they never even attempted to tackle the uninsured or any of these things because it’s not been a priority for them.

“This is why I sort of half jokingly referred ... to this bill as a huge tax cut financed by Medicaid cuts, because tax cuts are something that they are unified about,” Young added.

And Ryan is unified in this as well. This is, in fact, the Rosetta Stone by which Ryan’s worldview is explained: Those who have achieved affluence have done so through proper moral choices and deserve rewards. Those who are struggling have made poor moral choices and require punishments to induce them back into prosperity. That’s the whole of it. And you can see how this is wholly incompatible with what “health care reform” seeks to achieve. In Ryan’s view, if you have come to the point in your life where you are incapable of simply financing your own health care, this is down to your personal failings, and you don’t deserve much beyond the barest of minimums.

So in the end, it’s not that Paul Ryan doesn’t understand health insurance. And it’s not that he doesn’t understand math well enough to know that the numbers don’t add up to a sufficient “replacement” for Obamacare. That’s because what Ryan is “repealing” and “replacing” isn’t a health care bill ― he’s swapping out the moral universe that gave birth to the Affordable Care Act with the one that he prefers. One in which the state rewards affluence and punishes those who fail to achieve it. One in which the very notion of redistributing money from the well-off to the poor for the purpose of health care provision is a mortal sin. Properly reconfiguring the universe along these moral guidelines is, to Ryan’s mind, an “act of mercy.”