I spent some time trying to puzzle out what the hell Ryan is doing here and I finally settled on this. He is completely incompetent. He is a shitty small time politician who has managed to constantly fail his way up. He is in over his head.
They are incompetent, but it's not just incompetence that drives this bill. The GOP legitimately believe that the people value the dollars in their pockets more than silly healthcare, and the Healthcare industry as it is has to be busted down completely and rebuilt to support anything even approximating Universal healthcare. They also hate Obama, and thought they could pin Obamacare on him then easily repeal it whenever they took back the government.
The problem was, even broken, they let him pass it. Now too many Americans can see clearly that while it may have flaws, it was FAR superior to the big fat nothing they were receiving, especially those with pre-existing conditions (and EVERYONE has a family member with a pre-existing condition). There are also the ones who have something seemingly routine happen to them (like breaking an arm or a leg or appendicitis) than then get slapped with thousands (and in some cases, tens of thousands) of dollars worth of hospital fees.
Now, surprise! This awful bill that the Republicans made sure to tie directly to Obama the American people don't want to give it up, despite the high premiums. Republican could easily take the easy road, add the public option, and be hailed as heroes, but the whole point of the witch hunt was to destroy Obamacare (and Obama's legacy by proxy) keep the pharmaceutical companies in their laps, and throw the poors a few bucks so they'd be happy and anoint the GOP as liberators for banishing the icky Obamacare.
Whoops.