The basic issue is that they've run on opposition to an existing thing, not on the championship of a hypothetical thing. And while it's easy for their base to oppose "Obamacare" because it has the word "Obama" in it, that same base has neither the understanding nor the appetite for health exchanges, risk pools, unified billing or any of the other moving parts that make up our half-successful medical policy in the United States.
Krauthammer thinks we'll be on single payer by 2025. The CEO of Aetna thinks we should be debating single payer. The way to make healthcare in the United States more efficient, less expensive and not grenade 16% of the economy is to expand Medicare to the whole goddamn country. Which both New York and California are in the process of legislating.
It's funny. I've got fire-breathing liberal friends that don't understand that Medicare is insurance. They don't understand that there are dozens of different insurance companies that administrate Medicare (Aetna among them) and that the only difference, from a consumer standpoint, is that the government pays the bill. Same network problems, same deductible problems, same insurance bullshit we all take for granted except the money comes out of taxes.
If I were Paul Ryan? I'd say "Fukkit, we're just expanding Medicare" and declare victory. Let the insurance companies battle for contracts (as they do), let the states administer them (as they do) and throw a giant sop to the elderly in the form of prescription drug benefits. And if I were Republican, I'd pay for it by raiding Social Security for people under 40, raising the retirement age for people under 40 and let the Democrats raise taxes to cover the shortfall.