Listen carefully to Paul Ryan about health care bill. Beneath that squeeky clean, good guy image is the soul of Ayn Rand.

Sometimes it's important to listen carefully and literally to what people say to hear the underlying message that sneaks in between the lines.   A clip of Paul Ryan trying to sell the American Health Care Act to his Republican colleagues has been played repeatedly on TV.  Here it is:

"This is the closest we will ever get to repealing and replacing Obamacare."

He doesn't say "this is how we will do it."   He says it's the closest we'll ever get.  At first, I read that to mean he doesn't expect that it will pass.  Then after hearing more from Paul Ryan in an interview -- hearing his excitement about the historic moment this would be if it does pass -- here is what I think:

Ryan is saying that this is huge and will be historic if we can pass it.   But, if we let this moment pass and don't, we'll  never get the chance to pass it.   Because if people really understand what we're doing, they'll never stand for it.

And that was borne out last night, when Rep. Joe Kennedy III was on Chris Hayes MSNBC show.   Kennedy is on one of the committees that had to sign off on this bill.   They stayed in session for 37 hours -- throughout the night, doing the process that's called "marking up" the bill.   Kennedy finally did understand what it does, but it took his aggressive questioning of the lawyer representing Ryan to the committee.

First, listen to Ryan in an interview with conservative radio host Hugh Hewitt.  He seemed jubilant at what they are about to do, saying that:   "We're talking about hundreds of billions of dollars a year. . . .  This is so much bigger, by orders of magnitude, than [the 1993] welfare reform."   He sees it as "a historic opportunity to reduce the welfare rolls. . . .  Welfare reform is a $16 billion program. . . [but] this will be trillions in the end.   Let me just describe what this does for conservatives. . . .  This is why I am so excited about it and why I think people need to see the forest for the trees.  We are de-federalizing an entire entitlement, block-granting it back to the states, and capping its growth rate.  That's never been done before."

Ryan was asked if he was concerned about the predictions that it will knock 15 million people off Medicaid [and therefore off their health care].  Here's Ryan's response:  "You're never going to win a coverage beauty contest when it's free market versus government mandates. . . .Our goal is not to show a pretty piece of paper that says we're mandating great things for Americans."

In fairness to Ryan, he went on to state what their goals are:   to shift to free market health care, to give people more choices, first about whether to buy insurance, and second a market that will offer more choices -- plus small government, reduce regulations, and lower taxes.

What's not answered is:   what if the market doesn't offer affordable choices for millions of people?   What about them?  Does government have any obligation to help them?   Apparently not, in the Ryan view.  For him, it's about his conservative ideology, not about what people need.   Which is why, in my headline, I mentioned the "soul of Ayn Rand," who was the proponent of a hard-nosed, free market materialism.

Let me state this more starkly.   Ryan avoids even addressing the human aspect of this -- the real humans who will suffer and, some, who will die.   He's saying, well, the free market can never match a government mandate -- if what you're measuring is how many people get health care.  But what we really care about is cutting government programs and letting the free market operate, even if it can't cover as many people.

Chris Hayes then turned to Joe Kennedy, who was in his studio, who was shaking his head, as if in disbelief, who said:   "That's not who we are as a nation.  It's not what health care is about.  Health care at its most basic is about taking care of those among us in their time of need.   That's what health care is.  That's what health care does.

"And why so many of us are so upset is we've got what is essentially a massive tax cut to the wealthy on the backs of hard-working families that are living paycheck to paycheck, and costing 15 million people their health care.    And all in the service of health care reform.  It's outrageous.  It's not who we are as a country."

In discussion Chris and Joe clarified that this will represent a huge cut in Medicare over time.  It will phase in gradually so that it won't be so obvious at first -- and won't be fully phased in until after the 2020 election.   But it will be the people who need it most and can't afford it who are going to "take it on the nose so the wealthy can have their tax cut."

Kennedy further said that it was very apparent to him, during those 30 plus hours in the committee, that most of his Republican colleagues didn't really understand what this does, even though they voted for it.  That is, it passes off a tax cut as health care reform, and it takes away needed benefits from those who can least afford them to give the tax cut to those who least need them.

Now I'm even more outraged than I was before I heard what it was like for Joe Kennedy, being there in the middle of this debacle.    Paul Ryan doesn't seem to give a thought to what effect it's going to have on those who lose their Medicaid.   He's excited at the prospect of being the one who does something historic.   He's assuaged his conscience by turning the money into bloc grants to the states.   So now it's not his problem.  Let the states handle it.   He's got the tax cut he promised his wealthy donors.

This is not an abstract argument about theory of government, although that is at the base of this.   This is about life and death for millions of people.

Ralph