Rep. Paul Ryan (R-WI), chair of the House Budget Committee–and potential running mate of Republican presidential hopeful Mitt Romney–told Breitbart News this week that the party’s leaders are “absolutely” committed to repealing Obamacare.

“It would have been nice for the Supreme Court to repeal it for us,” he said, “but it’s no harder today than it was the day before the decision. We win, we repeal. It’s just that simple.”

Earlier this week, according to WHAS-TV in Louisville, you predicted that it will be “a lot harder” to repeal President Obama’s health-care law. Why is that the case?

Well, I don’t know how they got that comment out of what I had to say. Let me give you my view, clearly and unambiguously. Repeal of Obamacare will be the first item up in the Senate if I am majority leader. If we have a president who will sign the bill, we will do everything we can to get it off the books, and we’ll be looking for every angle that could be pursued. There has been a lot of talk about reconciliation. The Chief Justice said this is a tax, and we take him at his word, so that certainly makes this eligible for reconciliation. But that may not be the only avenue that we pursue. Our goal will be to get it off the books. In my view, it is the single worst piece of legislation that has been passed in modern times, and I’ve said that on numerous occasions. It’s still my view. And just because the Supreme Court has decided it is constitutional doesn’t mean it’s the right thing to do…

On a final note, what’s your message to conservatives and tea-party activists who are suspicious of Republican leaders and their commitment to repeal?

Boy, I don’t know how they could be suspicious on this issue. Every single Republican in the House and Senate voted against Obamacare. I must have made 125 speeches about it on the floor. If there is any area where I don’t think conservatives of any stripe should be concerned, it would be this one. We’ve been clear and unambiguous about Obamacare from the beginning to the end — all of it. And I led the fight in the Senate, so I know what I’m talking about.

ObamaCare has been a war over the processing of insurance claims. It has been fought by institutional interests representing insurance, hospital and pharmaceutical firms. The doctor-patient relationship, or what used to be called “the practice of medicine,” has sunk beneath these waves.

Barack Obama, a savvy pol, understood from the start that rationalizing payments claims through the maw of these private and public bureaucracies was not what the average person thinks of as “health care.” To any normal person, health care means that when you or yours get really sick, the doctors and nurses who attend to you will push all else aside to give you medical help.

Thus, the constant Obama chorus that you can “keep your own doctor.” No one knows better than Barack Obama that his law sends the nation’s doctors on a voyage into an uncharted health-care world in which they are just along for the ride with their patients…

Mitt Romney needs a way to talk about health care in America. This isn’t just a fight over insurance companies. It’s about the people at the center of health care—doctors. The Affordable Care Act will damage that most crucial of all life relationships, that between an ill person and his physician.

The fact is that the incentives in our health-care system are all screwed up precisely because of government policies and programs. Medicare, the biggest player in our insurance system by far, is an arcane fee-for-service system that encourages volume over value and inflates (while shifting) costs. Medicaid, meanwhile, has a state-federal structure that makes cost-containment nearly impossible (by having state policymakers make spending decisions while the Feds pay at least half the cost in an open-ended way). And the tax exclusion for employer-provided coverage creates a huge incentive for high-premium insurance while shielding everyone involved from actual prices and costs. All the incentives point to cost inflation and away from outcome-based health economics, so we shouldn’t be surprised to have an inefficient system.

It is precisely conservative reformers who have proposed to change this, and it is precisely liberals who seek to avoid that change. Obamacare doubles down on all of these sources of inefficiency, and it does so on exactly Zakaria’s premise: that the chaos of the market would make things less efficient and only the centralized coordination of a benevolent bureaucracy can make the system work. It’s hard to believe we are still having this argument.

Via Gallup.

“I’ll work with anybody who wants to work with me to continue to improve our health care system and our health care laws, but the law I passed is here to stay,” Obama said at a campaign event in Ohio.