Former New Jersey governor Chris Christie has a theory for why Republicans are under a lot of pressure in the suburbs.

“In some of these competitive House seats in suburban areas, the pre-existing condition issue is one that’s really cutting. And the Republicans to this point, I think, have been pretty ineffective in terms of making their case on why they weren’t going after the pre-existing condition coverage and that we’re going to maintain it. I think you’re being drowned out by the amount of money that Democrats are spending on the issue.”

I kind of love that formulation: “pretty ineffective in terms of making their case.”

The issue itself really isn’t very complicated. No one will sell you fire insurance after your house has already burned down. You can’t get an insurance company to repair your car if you don’t purchase collision coverage until after you’re in an accident. So why would a health insurance company give you an affordable policy after you’ve been diagnosed with diabetes or cancer?

If you’re guaranteed to cost them more than you’ll ever pay in premiums, then they’re not going to insure you, and if you represent a substantial risk, your premiums are going to be astronomical. This is what happens when you use a for-profit industry to address a human right to health care. So, if you tell these companies that they have to give insurance to everybody and you cap how much they can charge, that’s going to bankrupt the entire industry. The only way to make it work is to make young and healthy people buy coverage, too, and then to offer substantial subsidies to make those policies affordable. As a group, the young people will pay much more in premiums than they consume in health care, which basically makes it possible to make a profit even while insuring people who are already sick.

This is the model for Obamacare, and any effort to repeal the law by making it optional to have health insurance will torpedo the entire concept. Your options are to make the Affordable Care Act work, abandon the insurance model of health care completely, or go back to the way things were when millions were denied coverage and access because of cost or preexisting conditions.

The Republicans refuse to take any of those three positions, which makes it very hard to be effective in making their case for anything. They oppose a national health care system and they oppose a mandate that requires people to have insurance. By default, their position is that what we had before is preferable to what we have now, but that’s so unpopular that they’re not willing to admit it. But they voted to undermine and repeal Obamacare several dozens of times and then failed to pass any kind of replacement when they had the chance. Now they’re out on the campaign trail saying that they’re no threat to people’s health care even though they have no plan at all that would make it possible for a corporation to insure sick people without going broke.

Normally, the Republicans are pretty good at obfuscating and they can finesse situations like this by confusing people about the details, but they have spent their time focusing on baseless conspiracy theories rather than health care policy, leaving the entire playing field on the issue to the Democrats.

Public opinion polling has shown consistently that health care is at the top of the voters’ concerns this year, but the GOP is talking about George Soros and Central American rapists who have smallpox and leprosy. Apparently, Chris Christie has recognized that this was a mistake and that you can’t fool people about preexisting conditions unless you put in at least a little effort.