While President Obama wines and dines them, the House Republicans and Budget Chairman Paul Ryan are making one more run at repealing Obamacare and “voucherizing” Medicare. Pretty much everyone, including their own caucus recognizes this is an exercise in futility, and even the Wall Street Journal calls it “provocative.” So why does Ryan keep flogging this dead horse?

Because to actually deliver the austerity budget the Tea Party demands, simple arithmetic forces him to pretend to kill Obamacare while cynically keeping the projected savings. He also has to assume keeping President Obama’s tax hikes, keeping Obama’s Medicare cuts, and keeping Obama’s “fiscal-cliff” deal. Unfortunately for Ryan and the Republicans, they already campaigned against all of these and got beaten pretty badly last year. Talk about denial.

So repealing Obamacare is a dead issue. We’ve heard from the Supreme Court, and we’ve had a national election. The Democrats won. Reform is the law of the land, and we’re not going back.

Except … out in the “Red States” where a hard core of true believers are living in angry “Tea-Party Denial.” In at least 20 states, governors or legislatures are balking at setting up insurance cooperatives. Just to spite Obama they are ready to turn down millions in federal money for their own states and deny tens of thousands of their neighbors access to adequate health care.

Even though the non-partisan Congressional Budget Office has estimated that exchanges will cut the deficit and save billions, these ideologues have dug in their heels and cried “no mas” to “socialized medicine.” They have chosen to deny the simple fact that Obamacare is neither socialized, nor medicine, but rather an innovative funding mechanism using private insurance companies.

But no matter. These willfully ignorant, recalcitrant obstructionists are doing the country a tremendous service. For this I salute them.

Because of their obstruction, the federal government must now step into the breach and create exchanges in each and every “State of Denial.” The feds will offer low-cost private insurance, while protecting children, people with pre-existing conditions or catastrophic illnesses, college students and those who can’t afford insurance.

Obamacare mandates things like electronic records, telemedicine, episodic billing, preventive medicine and managed care all of which will increasingly shift Medicare dollars from overhead and emergencies directly to doctors and better outcomes. If the experience of Medicare is any example, these federal exchanges will ultimately develop into a well-run, cost effective and popular national fixture.

Over time, lots of states will see this and want to join the federal program. This process could spark an evolutionary progression (or maybe we should say “intelligent design” for the States of Denial), toward national single-payer or a hybrid system of some kind.

Perhaps Medicare and Obamacare might eventually morph together and give us some version of “Medicare for everyone.” If you think that’s impossible, or believe ideology will trump common sense, just ask any senior or doctor, “Who do you hate more, Medicare or your insurance company?” The response is almost universal, even among docs who won’t take Medicare because of the low payments.

So you see, while the “States of Denial” now strive mightily to smother Obamacare in the cradle, they may unwittingly become the inadvertent midwives of national single-payer, or something very like it.

God bless them.