Speaker Paul Ryan and the House of Representatives passed their American Health Care Act yesterday. It was immediately lambasted by opponents, and tweaks various things that were a part of President Obama’s Affordable Care Act. I think Pascal-Emmanuel Gobry gets at the heart of the problem with both the Democratic and Republican attempts to reform healthcare, which is in essence that neither achieves universal healthcare—something that a majority of conservatives, liberals, and independents want Congress to achieve:

Republicans are in denial about a central truth of the post-ObamaCare landscape: A health-care bill that doesn’t cover everyone will be highly unpopular. If Republicans want to pass a bill that won’t cost them at the ballot box, they need to reconcile themselves to the idea of universal coverage.

I unapologetically support universal coverage — and I’m a conservative! I share my fellow conservatives’ concerns about the size of government, but the size of government is out of control thanks to other entitlements. In and of itself, universal coverage wouldn’t be very expensive. The United States is still the most fantastically wealthy nation on Earth.

Conservatives care deeply about dignity, responsibility, and don’t want government to encourage bad behavior. I wholeheartedly agree. But getting cancer or a chronic disease is not bad behavior. Conservatives don’t want the government to help those who can help themselves, but we also agree — or we should agree — that people who can’t help themselves should be helped. National solidarity is an important value, and this should translate into a system that protects people from the worst. I don’t want the government to control or manage health care, but I do want government to protect people from the expenditures of catastrophic health problems.

But never mind the substance, what about the politics? Here, the picture is even starker. We’re talking about health issues — life and death issues. This is something about which people are rightly very emotional, and understandably very risk-averse. You can’t just take away people’s safety net and replace it with fairy dust. The winning message isn’t “ObamaCare is big government and big government is bad.” The winning message is “We’ll make sure everyone is covered for health-care catastrophes, and moreover, we’ll make it happen in a way that uses common sense and puts you, not hospitals and insurers, in control of your health care.”

This is a winning message. And in terms of policy, it can be done. By shifting power away from middlemen and towards consumers, through health savings accounts and regulatory reforms, Republicans can make American health care more streamlined, more innovative, and less expensive. But for that to happen, they need to pass a bill and make sure that bill doesn’t destroy their majority. Before they can do that, they must come to grips with what is politically acceptable in today’s America.