At Bloomberg View Megan McArdle phrases the alternatives that Republicans face about the Affordable Care Act slightly differently but arrives at the same place:
You do not fix a concrete eyesore in stages. You either knock it down, or you leave it where it is and learn to live with its flaws. If Republicans want to actually do a radical renovation of our nation’s health policy architecture, then they should get a reasonable estimate of the costs, grit their teeth, and go ahead and actually build something sound, and enduring, while demolishing substantial portions of the ugly and unsustainable mess we currently have.
If Republicans cannot get up the will to bear those costs, then they should do nothing, and start preparing their rebuilding strategy while they wait for the flaws in Obamacare’s structure to bring down the individual market on its own. Neither strategy is painless, because the ossified mistakes of earlier policy making have taken all the cheap and attractive options off the table. But either is better — for America, and for the Republican Party — than setting new mistakes in stone.
For Democrats the alternatives are slightly different. They must choose which they value more: President Obama’s legacy or the welfare of the American people. And their own.