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A real conservative would say: "Government should stay out of health care. Let Americans meet their medical needs in the free market." I respectfully disagree, but thanks for being clear.

The political problem for Republicans is that this ideal stands at odds with what the public wants. Rather than admit it, they drag the issue through their hall of funny mirrors -- arguing that government shouldn't have a role in health care while simultaneously grumbling that government doesn't do enough.

Consider the Republican position in the not-at-all-funny matter of breast cancer treatments. The Food and Drug Administration recently denied approval of the hugely expensive drug Avastin for treating breast cancer that has spread to other organs. It cited stringent studies showing that Avastin does not extend life for these patients, while producing awful side effects.

Spending $90,000 a year on an ineffective treatment would seem enormously wasteful, would it not? It shouldn't matter whether the check writer is a private insurer, the government or an individual. But a Wall Street Journal editorial blasts the FDA's decision as "another way of imposing a blanket government abstraction over the individual choices of a patient and her physicians."

Thus, after having consistently opposed expanding Washington's role in health care, the Journal now demands that the government spend $90,000 a year on a useless drug regimen because a patient says she wants it. (Yes, these are the same guys who rail against "high taxes.")

You know the Republican refrain: "Do you want a government bureaucrat telling you what treatments you may have?" Well, it lacks all logic in a capitalistic system. Government can only tell you what the taxpayers will subsidize. You are free to buy any medical care you want with your own money.

The above would seem an exemplary conservative argument. Responsible people should save for such contingencies, it might add.

But Republicans oddly insist that if the government pays for anything in health care, it must pay for everything. And they push the fairy tale that while government may deny your wishes, private insurers will cover your every want. (Actually, skimping on care is how insurance executives become billionaires.) Here's the adult-world reality: When private insurers must cover treatments that don't work or cost more than equally good ones, they simply jack up premiums. Rising health care costs act as a virtual tax hike on employers and the workers they cover.

Now try to untangle the response of Rep. Sue Myrick, R-N.C., to the FDA's Avastin decision. "When a drug can help save patients' lives, they should be able to do that affordably," she told a reporter. "Insurers now could cut off coverage and not pay for the drug."

Never mind that Avastin does not help save these patients' lives, according to the studies, and its side effects may actually shorten them. What does Myrick mean by "affordably"? She presumably means forcing taxpayers and private insurers to subsidize unproductive treatments. Wouldn't the money be best spent developing treatments that could actually help these suffering women?

By the way, if Myrick believes that the free market preserves consumer choice, why is she worried that private insurers will deny coverage for a drug that patients "choose"?

Makes you miss the principled conservative who lays out the alternatives in a chilling but honest way. Republicans won't because, frankly, most voters aren't real conservatives. Better to confuse them.