Critics on the left often roll their eyes when conservatives proclaim a principled commitment to the timeless virtues of limited government and cultural traditionalism. To detractors, conservative rhetoric about values is merely a rationalization of, or mere window-dressing for, the right's actual motivation: the defense of existing social inequalities in the domains of economics, race, gender, sexual orientation, and so forth. Conservatives like to portray themselves as committed to a philosophical cause, according to this view, but they really just care about enacting policies that provide their supporters with financial or social advantage at the expense of everybody else.
As Matt Grossmann and I were writing our book arguing that the Republican Party is fundamentally an ideological movement while the Democrats are distinctively a social group coalition, some of our colleagues accused us of taking conservative ideology too seriously as representing something more than a publicly palatable justification of Republican-aligned groups' own collective self-interest. One attendee at the Midwest Political Science Association's annual conference responded to my presentation of some of our early work by complaining that we didn't understand that Republicans simply do whatever their corporate sponsors tell them to do. (She continued to rant about how ridiculous she thought the paper was in the hallway after the panel was over, personally delivering the kind of "spirited feedback" that we academics more commonly experience through the anonymous peer review process.)
It's surely true that citizens' relative degree of receptiveness to the tenets of small-government conservatism is strongly influenced by the extent to which they perceive a personal benefit from the enactment of conservative policies. But a conception of ideology as simply interests-in-disguise can't account for important elements of Republican Party politics, as demonstrated by the party's ongoing attempts to enact health care reform—the latest of which, the Graham-Cassidy bill, appears to narrowly lack sufficient support in the Senate now that John McCain has announced his intention to vote against it.
The Graham-Cassidy plan is opposed by the American Medical Association, by hospitals, and by patient advocacy groups. Despite the common assumption on the left that Republicans reliably carry water for the insurance industry on health care policy (a charge repeated by Jimmy Kimmel during one of his critical late-night monologues this week), major insurers are also strongly opposed. Though the bill was sold as a boon for state-level policymaking "flexibility," several Republican governors and the national association of state Medicaid officers do not support it. In fact, it's very difficult to identify any definable interest group or segment of the electorate whose material interests would benefit from the passage of Graham-Cassidy—even the wealthy, who gained a substantial tax cut under previous iterations of Republican reform, do not receive one here—and it's equally hard to argue that the American public at large is clamoring for its passage.
So why have Republicans made health care reform the centerpiece of their legislative agenda this year, returning to the issue multiple times despite failure after failure? The answer is that most of the key actors within the party are philosophically unreconciled to the use of government power to grant health insurance benefits to large swaths of the population. For some Republican politicians, reducing the public sector's role in the provision of health care has been a personal cause "since [they] were drinking from a keg"; for others, intense pressure from Republican activists and financial donors has spurred them to pursue repeated attempts at reform despite the considerable frustration and political risk involved.
The ideological basis of Republican behavior on health care also accounts for why the party has taken a slapdash approach to the crafting of legislation, pulling together bills affecting a major sector of the American economy in a matter of days without substantial public debate or favorable expert analysis. Most Republican officeholders are not invested in policy details or particularly curious about how their favored reforms would operate in practice. If any initiative that moves public policy to the right is desirable by definition, the specifics are much less important than the general directional thrust.
It's also noteworthy that while Republican health care reform initiatives are most commonly treated as efforts to "repeal and replace" the Affordable Care Act, each major bill—including Graham-Cassidy—has included cuts to Medicaid funding that go well beyond simply rolling back the expansion contained in the ACA. For all the public focus on Trump's supposed personal obsession with exacting revenge on Obama, the true aim of Republican policymakers has consistently been the achievement of a much broader and more permanent reduction of the federal government's health care footprint.
Whether one has been cheering or booing the results, this year so far has marked a clear departure from models of legislative action that emphasize transactional politics among interest-group stakeholders mediated by the application of policy expertise. Of course, such approaches have historically been open to criticism that they are insufficiently informed by broader ideological visions or values. The view that government-provided health insurance amounts to a normatively unacceptable implementation of a leftist or socialist belief system has only become more prevalent among Republicans in recent years, the pragmatic rhetorical patina of Trumpian "populism" notwithstanding. If politics were merely a battle of interests and not a war of ideas, the anti-government health care cause wouldn't keep springing back to life every time it appeared to be DOA.