The positions in the health care argument are now well established. Republicans believe in “Just Say No” on all things health care related.

They talk about incremental change, but they don’t mean it. Sen. Tom Colburn (R) made several smart suggestions about the costs and concerns of end of life care.

But then his friends translated that argument to the Democrats wanting “death panels.” Such has been the tenor of the conversations with Republicans.

Republicans say they favor the popular idea of ending pre-existing conditions exclusions to health coverage by insurance companies, but they know that, lacking a large pool of newly insured, there is no way to end the exclusions.

So the Republicans frankly don’t really want much change or believe in much change in health care. That is their position.

And, fundamentally, they oppose health care for another reason, a distrust of government.

Sen. Judd Gregg, writing Thursday in an Op Ed in USA Today wrote that the current bills would constitute “… a massive government takeover of the U.S. health care system.”

Sen. Gregg’s words suggest both a distrust of government as an implication and that the health care bills would generate a massive change.

Neither premise is accurate, but he and many others believe at least part of their claim.

First, if you are concerned about government getting involved in health care you are very late to the party. Government, through Medicare, Medicaid, S-CHIPS, federal employees benefits and the Veterans Administration, already control directly more than 50 percent of health care in America.

And the balance of health care is regulated by the government. So if you are concerned about a “massive government takeover” it has already happened.

But the good news is the Veterans Administration hospitals provide excellent care; Medicare is highly popular, and Medicaid works well.

S-CHIPS provides insurance coverage for working families who do not have access to group insurance, and it too is popular. Federal employees have some of the best care in the nation.

Not only are these “government” programs effective and popular, they also have administrative costs far below the 20 percent of for profit insurers, averaging between 3 percent and 5 percent administrative costs overall.

In short, government health care works, and works on a very large scale. So if you want to claim that government having a role in health care represents a danger to health care, the facts indicate otherwise.

The second issue Republicans raise is the “massive” nature of the current bills in terms of change.

Well, yes, insuring an additional 31 million people through public plans is indeed a pretty large scale change.

Except right now the government is paying for the uninsured who stroll into the emergency room with subsidies to hospitals and inflated billings from hospitals to cover their expenses in caring for the uninsured.

With the new law these uninsured deadbeats would be required to buy their own insurance, not ride for free on the taxpayers, an idea Republicans once embraced.

Finally, the distrust of government by Republicans is both sincere and cynical. The truth is government does some things very well … the military, Social Security and Medicare are obvious examples.

The postal service is another example, with 97 percent of Americans rating its service good or great. Republicans sincerely are distrustful of even these successful government entities. They are just wrong.

But Republicans are also cynical, and their anger over Democratic methods to pass health care is simply anger over the Democrats finally defeating Republican obstructionism. Republicans loved reconciliation when they used it. Not so much now.

Jim Crawford is a contributing columnist for The Tribune and a former educator at Ohio University Southern.