James Antle describes in the Washington Examiner a critical challenge for conservatives who hope to repair damage created by the Affordable Care Act.

On Obamacare, Republicans once again find themselves uniting the country — against them.

Conservatives believe their party’s congressional leaders have sold out. Non-conservatives think they are dangerously right-wing.

Conservatives say Republicans are creating a new entitlement without paying for it, a reckless expansion of the welfare state at a time when the country is going broke. Non-conservatives claim the recklessness lies in the GOP’s evisceration of the social safety net and health insurance programs on which millions rely.

We’ve seen this movie before. …

… The Obamacare replacement bill is as good an example as any of what Republicans are up against. The GOP needed to satisfy their base’s demand to repeal Obamacare without upsetting too many other voters’ existing healthcare arrangements; win votes from lawmakers who want to curb Medicaid spending and lawmakers who want to maintain Obamacare’s Medicaid expansion; cut spending and regulations while maintaining comparable benefits; cut taxes without letting costs get out of control; all with many fewer votes to spare than when Democrats passed Obamacare in the first place.

So it is not surprising that the end result does not reduce the federal government’s role in healthcare as much as conservatives would like while probably failing to cover anywhere near as many people as Obamacare did.

The dilemma for conservative Republicans is that the country tends to vote for them for the same reason a circus hires people to run with brooms behind the elephants. Somebody has to clean up the mess left by Democratic excess.

But the people running behind the elephants don’t get to write the program for the circus and conservative Republicans don’t often get to plan the default path of the federal government.