Rhetorically, GOP hard-liners such as Paul claim that they are implacably opposed to federal subsidies for health insurance, that they’re taking a brave stand against big government. Operationally, however, they support subsidies for the rich, and only oppose subsidies for the poor and the sick. That comes across not as a principled stand against statism, but as a political stand against Americans whose votes they don’t need.
Real conservative reformers, who have been studying this problem for years, understand that the way to make our health-care system freer and fairer is to rectify that imbalance between how we subsidize health insurance for the wealthy and how we do it for the poor. That would involve reorienting Medicare away from the wealthy and toward the middle class and the poor. It would involve reforming the tax subsidy for, yes, Cadillac health insurance plans. It would involve helping vulnerable and poor Americans buy private coverage and build health savings accounts.