Conservative winners and losers in the GOP health insurance program

We are now talking about the GOP health insurance program.  NBC News has the story of how Mr. Trump is convincing extra-pure conservatives to get on board Paul Ryan's plan:

"I want to let the world know, I'm 100 percent in favor," Trump said before the meeting. "These folks – and they are tough and they love their constituents and their county – these folks were nos, mostly nos, yesterday and now every single one is a yes."

Scott Walker brought nine members who were also opposed to the bill with him to the White House Friday morning and afterward said all of them are now on board, including Rep. Gary Palmer of Alabama, who voted against the bill Thursday in the House Budget Committee.

The promised changes to the bill focus mostly on Medicaid and provide states with the option to block-grant the health care program for the low-income, giving a specific sum of federal money to states to implement their own programs.  The bill currently would implement a structure that caps Medicaid funding based on population.  Conservatives say this change gives states more flexibility.  Opponents say it will severely limit the number of people who will have access to Medicaid because once the money runs out, it's over.

The other change imposes optional work requirements for Medicaid recipients.  While the program is optional, it provides incentives for states to implement it.

A third change is the assurance that tax credits for people who purchase insurance in the independent market won't be used for abortion.

Rep. Andy Barr of Kentucky is also now on board after the changes promised at the White House meeting.

One senses some wins and losses on the conservative side.  It used to be that a third gigantic health insurance program, on top of Medicare and Medicaid, was anathema, but now the GOP is fighting over which gigantic government program is better: Obamacare or the GOP plan. 

Ambiguities abound because of human nature.  After eighty years of government programs, people like the programs, as expressed in this simple formula:

Self-interest + government handouts = love for government.

Extra-pure conservatives don't like any element in the formula.  But do they believe they can smash it and convince people to walk away from a new government program that benefits them?  The Conservative Media "Establishment" believe it.  Their self-confidence, even with quasi-conservative Trump, is astounding.  The Freedom Caucus believes it.

But is it realistic to persuade people to reject the formula?  Not after eighty years of the normal growth of government.  It's in the air we breathe and the water we drink.  Conservatives will simply have to live with the paradox and perhaps the internal contradiction of market-driven government programs.  Does this mean conservatism has lost?  It all depends on which conservatism one advances.  So many conservatives campaigned on repeal and replace, not just repeal. 

The final results of the revolving wheel of fortune won't become obvious for years to come.

James Arlandson's website is Live as Free People, where he has posted "Deconstructing Roe v Wade."