Schrödinger's ElephantThe brain-twisting paradoxes facing Republicans on health care reform.

One reason health care is so hard to talk about sanely is that it's full of paradoxes. How does the United States have one of the best health care systems in the world, yet also one of the worst? Why do regions with the shoddiest health care pay the most for it? If we're trying to save money on health care, how come we're gearing up to pay roughly $1 trillion for reform?

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Similar paradoxes plague both parties. But the questions facing Republicans as they navigate the health care debate are especially difficult. Here are some of the trickiest ones. If you really want to rattle a conservative's mind, ask these:

Do you think health care reform is necessary?

The message on all sides is that yes, our health care system needs to be fixed. The United States already spends way too much on care—$1 out of every $6—and costs will only keep trending upward. More than 40 million Americans still don't have health insurance. And many of those who need it are denied treatment for pre-existing conditions.

Republicans get this. The GOP alternative plan released in May hit all the right rhetorical notes, talking about the "broken" system in which patients feel "trapped" while doctors feel "torn" between business and medicine.

But when pushed, some conservatives will admit they don't think it's that big a deal. As Missouri Rep. Roy Blunt, the House minority leader, put it at a press conference last week: "About 83 percent of the American people think that their current effect coverage is either good or excellent; 83 percent." He also challenged the notion that more than 40 million Americans lack insurance. "That number may be 45 million, but an awful lot of them could get insurance at work if they wanted to. An awful lot of them are healthy people under 30. But we're not satisfied. Ten million people can't get to the system now. We want everybody, including those 10 million people that don't have access, to have access." Translation: It's a problem, but it's not as big a problem as some people say. Still, I'm not saying it's not a problem!

That view has policy implications, too. If you think we need to help only 10 million as opposed to 45 million, then an individual mandate—which would oblige even healthy young people to get insurance—doesn't seem necessary. Even with a mandate, a small percentage of people slip through the cracks. (In Massachusetts, for example, 2.5 percent of people still don't have insurance.) Blunt also manages to play down the urgency by citing customer satisfaction. Eighty-three percent—that's pretty good! But it ignores the problem of rising costs necessary to achieve that satisfaction. The 83 percent figure Blunt cited refers to Americans' satisfaction with the quality of their health care; when it comes to cost, satisfaction drops to 52 percent.

Aside from who's right, the Republicans are in a fix. On the one hand, 77 percent of Americans say they think health care costs are too high—so the GOP wants to be seen as supporting reforms that reduce costs. But on the other, they don't seem to think health care reform is all that necessary—it certainly wasn't a priority in the last eight years. The result is a set of solutions—incentivizing prevention, choice, and accountability but requiring none of them—that may improve the system but don't treat it as a crisis.

Doesn't a public option actually increase competition?

Conservatives love markets. Markets require competition. So more competition is better, right? That's essentially the Democratic argument for a public option: It would improve the health care market by providing competition for private companies and thus forcing them to make cutbacks they wouldn't otherwise make. "Competition is good," said Health and Human Services Secretary Kathleen Sebelius on Sunday. "You can write the rules for a level playing field."

The conservative response is a combination of "No, you can't" and "No, Congress won't." Government-run health care, they say, would have all sorts of unfair advantages. It wouldn't have to advertise, so it would be able to offer lower premiums. Its insurance pool would be nationwide, giving it more leverage to negotiate prices. It wouldn't need to create a massive reserve fund, which private companies maintain in case they go belly up. Plus, the government would never let its heath care plan fail, so people will feel more confident about it. (If these sound like arguments for a government plan, then you see the depths of the conservative logic vortex.) Unfairness, therefore, is inevitable.

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Christopher Beam is a Slate political reporter. Follow him on Twitter.

Illustration by Mark Alan Stamaty.

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