If Republicans or general election voters wanted Obamacare repeal to look like Rand Paul or Ted Cruz, they would be President right now and not Donald Trump.  Sorry.  That’s the way it is.  Winners and – not the people they defeated – get first dibs on nice things.

Some conservatives may think they made a deal with the devil to back Donald Trump.  They’ve actually got a lot of nice things.  They got a strict constructionist for Supreme Court nominee.  They got a cabinet that can’t deregulate away the Obama era fast enough. Executive orders – love them or hate them – which have been almost entirely friendly to the right’s principles and would have taken Congress forever to pass, if ever.

And that’s the point.  Republicans in Congress have dithered on defunding or at least derailing Obamacare for six years.  They voted to repeal it altogether dozens of times, perhaps knowing they were spared defending that in earnest by a certain veto from its namesake, Barack Obama. Now, Republicans won’t even advance the same bill to repeal they passed overwhelmingly only months ago.

Donald Trump, on the other hand, owns the moment on Obamacare.  Like it or not, he is the face of Obamacare repeal.  He just won a national election on repealing and replacing Obamacare and intends to do so before the mystique of his first one hundred days slips away. Republican majorities in congress had their one hundred days – three times.  The Republican Senate had their first one hundred days – two times. What did we get?  Lots of bloviating about Obamacare repeal, but mainly excuses that it could not be done until a Republican is in the White House.

Now, there’s a Republican in the White House, but the Republican Congress can’t coalesce around a plan to repeal Obamacare when it really matters.  The pressure for a bona fide conservative repeal of Obamacare from movement conservatives is enormous, from Rand Paul to the Freedom Caucus to all the think tanks and foundations.

The true believers on the right may have to accept delayed gratification, just as the single payer true believers did eight years ago when Obamacare came up short on their end game.  See, making the perfect the enemy of the good is peculiar to the right.  Conservatives prefer polishing their purity to coalescing around a winning strategy to get most of what they want now.

Donald Trump’s notions of Obamacare repeal fall short of movement conservatives’ “pay for your own damn health care” mantra.  But that didn’t win in 2016 and he did.  That’s not to say the Ryan bill or whatever Trump may get behind to replace it, if anything doesn’t set the table for conservatives ultimately getting what they want.  In fact, if some conservatives got their way and Hillary Clinton beat Trump, we’d be staring at a single payer health care system, in all likelihood now. There but for the grace of God we are not.

The past is a pretty good predictor of the future, and Donald Trump’s admittedly short past as President is to give his cabinet a green light for reform and the rollback of regulations. There’s no reason to believe Tom Price won’t follow suit and eviscerate as much as he can of what’s left of Obamacare until and unless Congress works up the nerve to codify it.

The alternative is, more dithering, the status quo, and nothing.