The most interesting policy argument in America right now is the debate between conservatives’ real position on health care and their fake position.

The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative — an alternative that crashed and burned when it came clear that it would lead to more people with worse (or no) health insurance and higher medical bills.

Conservatives’ real, but unpopular, position on health care is quite different, and it explains their behavior much better. Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed.

This view provided the actual justification for Ryan and Trump’s Obamacare alternative — it’s why they designed a bill that led to more people with worse (or no) health insurance and higher medical bills, but that cut taxes for the rich and shrank the government’s role in providing health care.


There was, for decades, a logic to the GOP’s dual positions: the fake but popular position was used to pursue the ends of the real but unpopular position. But in the post-Obamacare world, the chasm that has opened between conservatives’ fake and real positions has become unmanageable, and how — or whether — conservatives resolve it has become perhaps the most interesting public policy question going today.