McCaskill's point is an important one that exposes the real nature of the underlying fight over how to fix health care. The progressive ideal is a single payer system, a la Medicare, but for everyone. The conservative ideal is a deregulated market-based system with a diminished federal role. The Affordable Care Act, despite the right's protestations of socialism, is a middle ground between the two. And the insurance exchanges mirror what the Ryan plan does to Medicare -- as Speaker John Boehner (R-OH) and Sen. John Cornyn (R-TX) have conceded.
These awkward admissions reveal that the broader fight is really about which direction to move vis-a-vis national health policy. Conservatives hate Obamacare because, by setting up regulated, subsidized exchanges for the public at large, it moves the existing system away from their goal of rolling back federal health care programs. Liberals hate Ryancare because, by replacing Medicare with a subsidized private insurance market, it constitutes a leap backwards from the current state of affairs.
As McCaskill did today, and as Boehner and Cornyn have done before, each side likes to point out, when convenient for them, that their reform proposal has been nominally agreeable to the other side in a different context.
But these details -- and indeed the broader fight over the role of government -- eludes many voters. As McCaskill said, "I don't think people realize -- I think they think it's a government plan, and it's all private insurance companies."