So in the end, it’s not that Paul Ryan doesn’t understand health insurance. And it’s not that he doesn’t understand math well enough to know that the numbers don’t add up to a sufficient “replacement” for Obamacare. That’s because what Ryan is “repealing” and “replacing” isn’t a health care bill ― he’s swapping out the moral universe that gave birth to the Affordable Care Act with the one that he prefers. One in which the state rewards affluence and punishes those who fail to achieve it. One in which the very notion of redistributing money from the well-off to the poor for the purpose of health care provision is a mortal sin. Properly reconfiguring the universe along these moral guidelines is, to Ryan’s mind, an “act of mercy.”
IOW, the moral universe of an Ayn Rand acolyte.