Like Chait, Josh Barro argues that the "alternative to PPACA is nothing." Reihan counters:

[C]ontexts change. For example, Josh could have written a very similar post in 2010 arguing that congressional Republicans would be strongly disinclined to endorse something like the Wyden-Ryan plan, as Republicans are wedded to seniors. Indeed, many conservative commentators argued that the GOP embrace of premium support was politically suicidal. For a variety of reasons, congressional Republicans moved away from strategic ambiguity on entitlement reform towards a broad architecture that was vulnerable to political attack.

Douthat seconds Reihan:

[W]hat would [Chait and Barro] have conservative health wonks and pundits do? Its leaders’ preference for non-action and evasion notwithstanding, the G.O.P. remains the most plausible institutional vehicle for conservative ideas about health care, and Republican politicians are (for the most part) the only political figures capable of delivering the kind of reforms that right-of-center wonks and commentators want. So what Chait describes as the peculiar conservative pretense that “Republicans really are going to formulate some other plan” would be better described as the much-more-understandable conservative desire to persuade Republicans to embrace some other plan.