And therein lies the rub, because you can’t actually have a conservative alternative to Obamacare if you can’t recognize that “managing” the health care system requires changing the way it (already, pre-Obama!) subsidizes health care, which in turn requires increasing the subsidies available to at least some people (the sick, and Americans who don’t get insurance through their employers) even as you reduce them for others (by capping the deduction for health insurance, as a first step). It’s true that this kind of change is a “big government program” relative to the libertarian utopia, but relative to the status quo it’s nothing of the sort, and anyway I don’t see many Republican congressmen casting bold votes to actually eliminate the health-insurance tax exclusion. Instead, they’re happy to just pretend that the existing system represents some sort of free-market ideal in order to score points against the new health care law and avoid taking on any policy risk themselves — and then happy, as in this case, to demagogue as “big government” any constructive steps toward a world that’s actually more consonant with free market principles than the status quo.

This, this, is the Republican Party’s health care problem. It isn’t that conservative ideas about health policy don’t exist, and it isn’t that they won’t work. It’s that right now the feasibility question is purely academic, because even after five years of debating these issues, and despite Eric Cantor’s best efforts, there still aren’t enough Republican lawmakers willing to take even the smallest of steps toward putting those ideas to the test.