Outside the conservative movement, there are essentially two storylines about what conservatism is about. The first is relatively polite, which is why you hear it more often, although it's not clear how many people truly believe it. The second storyline is far less polite and widely believed in progressive circles.
The first storyline goes something like this: Conservatives share the same goals as everyone else — they want a beautifully flourishing society — but they just see it differently. They have concerns about the unintended consequences of radical change; they see the family and religion as much more vital institutions for society's flourishing. But overall, they basically share the same outlook as everyone else.
Then there's a second storyline, which you hear less often in polite discourse, but which has been given a boost by the stunning ascension of President Donald Trump, and which you hear a lot on social media and in the not-so-private discourse of many progressives. This second storyline is very simple: The reason why anyone is a conservative is essentially because they're a jerk.
There are different sorts of jerkiness, but they essentially boil down to the same thing in the progressive imagination. Maybe it's racial bigotry. Maybe it's Ayn Rand-inflected social Darwinism. Maybe it's religious intolerance or fundamentalism. Maybe it's a combination of some or all of those. But conservatism fundamentally is about being a jerk.
In health care, certainly, that narrative gets a lot of play. Recall former Democratic Rep. Alan Grayson's summation that the conservative view of health care is basically "Don't get sick, and if you do, die quickly." Or the Democratic attack that Paul Ryan's Medicare reform plan essentially amounted to pushing Grandma off a cliff. Certainly there are lots of reasonable criticisms that can be made against the GOP's Medicare reform plan, but those weren't the criticisms that were made, except at the margin. Instead, the assumption is that if Republicans want to cut Medicare, it's not to preserve its solvency (and thereby save it) or to make it more efficient, it's because, essentially, despite their protestations, they're jerks who get a private thrill up their leg from watching people suffer. This is also true when it comes to Medicaid and public schools.
Now, the point of this is not to complain about the progressive narrative; it's the opposite. Because conservatives have internalized this second (false) storyline.
When your debate opponent delivers a caricature of your position, the instinct is often to defend the caricature rather than reframe the debate. More profoundly, at some point all of us are tempted, when we are battened with a critique of ourselves, to internalize that critique, at least to some degree.
The GOP's health-care reform plan looks like a Democratic caricature of what a Republican plan ought to be. Does it take money from the poor to hand it to the rich? Yes. Does it make countless people worse off? Yes. Does it cut coverage? Yes.
So many conservatives have so internalized the progressive critique that they act it out. They've been told for so long by progressives that to be conservative is to be a jerk that they actually think that the way to be conservative is to be a jerk.
For literally decades, conservative heroes like Friedrich Hayek and Milton Friedman have set out ways by which a society can achieve a universal safety net in health care, while at the same time achieving conservative goals that I deeply believe to be paramount, such as consumer choice and innovation. You don't need to snatch people's health care away from them to achieve the conservative vision of health care. But, again, conservatives have internalized the progressive critique, and if progressives are for universal coverage, then conservatives must be against universal coverage. This phenomenon is most obvious in health care, because it is where technocratic considerations are so intertwined with our deeply held moral intuitions of fairness and empathy, but you see it in other areas, too. President Trump's budget guts "soft power" American initiatives, since progressives like soft power; this even though a great 20th century master of the use of American soft power was Ronald Reagan, whose unabashed rhetoric of America as a City on a Hill did as much to crack the Berlin Wall as his arms race with the Soviet Union.
The end result of this psychological cul-de-sac is bills like the AHCA, which seem almost specifically designed to turn Republicans into punching bags, and to vindicate the progressive critique of conservatism. During the 2016 Republican primary, anti-Trump conservatives darkly joked that surely Trump must be an agent, not of Vladimir Putin, but of Hillary Clinton, to discredit the Republican Party; one almost wonders whether Huma Abedin has infiltrated the staff that came up with the AHCA.
But this phenomenon, in turn, is only an avatar of a much deeper problem, which is that 30 years into the post-Reagan era, conservatives don't know what they stand for. The hostile takeover of the GOP by Donald Trump was only made possible because of deep rifts within the conservative movement and the Republican coalition about what it means to be a conservative in the 21st century. The Reagan vision of conservatism became a victim of its own success: Now that issues like crime, inflation, and tax bracket creep have been solved, what do conservatives have to offer to the American people? Internalizing the progressive critique of conservatism, conservatives responded, essentially, "Nothing. (Plus tax cuts.)" The virtue of Trump's answer of economic nationalism is that, at least, it is something, and something will usually beat nothing. Now Trump is backing (or at least pretending to back) a plan that goes against the vision of a health-care system that "takes care of everyone" that he ran and won on. And so the identity crisis of conservatism continues. To fix it, conservatives need to stop internalizing the progressive critique. It won't be sufficient; but it certainly is necessary.