In “2012 or Never,” Jonathan Chait spends far more time on what he takes to be the psychic distress of conservatives regarding the transformation of the U.S. electorate than on the policy concerns of conservatives. The following passage gives some indication of Chait’s take on the right’s substantive critique of President Obama’s domestic policy:

That the struggles over the economic policies of the last few years have taken on the style of a culture war should come as no surprise, since conservatives believe Obama has pulled together an ascendant coalition of voters intent on expropriating their money. Paul Ryan, the House Republican budget chairman, has, like many Republicans, cast the fight as pitting “makers” against “takers,” with the latter in danger of irrevocably gaining the upper hand. “The tipping point represents two dangers,” he announced in a speech at the American Enterprise Institute, “first, long-term economic decline as the number of makers diminishes [and] the number of takers grows … Second, gradual moral-political decline as dependency and passivity weaken the nation’s character.”

In my decidedly unrepresentative corner of the world, there is a real concern regarding the deterioration of the labor market position of less-skilled workers, among whom labor force participation has been declining for decades, and the concomitant increase in the number of people living on the margins of the mainstream economy and drawing on social transfers. The sharp increase in the number of prime-age adults disabled by mental illness, which we’ve discussed in this space, is just the tip of the iceberg. Others fret about the effective marginal tax rates facing the very poor, and whether or not increases in eligibility for SNAP over the last decade — not just under President Obama — have been excessive. Most of all, however, there is concern regarding the Patient Protection and Affordable Care Act, which many conservatives believe will not restrain cost growth but rather exacerbate it.

I asked Yuval Levin, editor of National Affairs, to write for us on this theme. Though I imagine left-of-center readers won’t share Yuval’s take, which is very similar to my own, I hope that they’ll read it to get a somewhat better understanding of how “the other side” thinks about this election. To get a broader sense of Yuval’s thinking on domestic policy, I recommend reading “Beyond the Welfare State.”

People who care about politics always think the next election is the most important of their lifetimes, and we should always regard that view (even in ourselves) with some suspicion. There are no lost causes, because there are no gained causes, and no election ever really settles any truly significant question in a permanent way. But, having now told you why you should question my judgment in this regard, I do think the 2012 election could decide an extremely important set of questions regarding the coming several decades of American life: It may well determine whether we are going to become a model of unsustainable welfare-state economics or whether we are going to become a model of how to put market competition at the center of a new way of thinking about what government does.

This question is going to be decided because one way or another the 2012 election will set the course of America’s system of health-care financing. If President Obama is re-elected, it is very likely that we will see the implementation of Obamacare truly get under way, and it is very likely that we will not fundamentally reform the structure of the Medicare system in time to save that system from fiscal catastrophe. If a Republican is elected president, it is very likely that Obamacare will not be implemented, and it is very likely that we will fundamentally reform the structure of the Medicare system (and quite probably of our under-65 insurance system) in the direction of premium-support in a competitive insurance market.

Implementing Obamacare and doubling down on fee-for-service Medicare would mean putting our government finances on a path to disaster, with health-care spending at the very core of the problem, and it would mean putting the micromanagement of health-care funding decisions at the heart of our domestic politics for the foreseeable future. Abiding the bankruptcy of the Medicare system would mean resigning ourselves to a painful politics of scarcity in which the potential for a genuine transformation of the role of government dramatically narrows. Centralized health care systems, meanwhile, come to dominate the politics of the nations that adopt them, and create a situation in which it is very difficult to argue about the basic size and role of government.

On the other hand, averting Obamacare and replacing it with a set of market-centered reforms of our health-insurance sector (for instance, transforming the tax exclusion for employer-provided care into a universal insurance credit) and transforming Medicare into a premium-support system that allows seniors to make choices in a competitive market would make for the first serious attempt to control the growth of health care costs through competition rather than price controls. It would stand a chance of allowing our health-care system to get out from under the immense inefficiency of fee-for-service financing and so of enabling a badly needed burst of efficiency in our health sector. And it would give us a chance to avoid a debt crisis, and instead to offer other developed nations a model of how to balance quality, affordability and access in health care. It would in that sense also be a model of how to think about the transformation of our broader welfare state.

Maybe it’s peculiar to suggest that one election should offer so stark a choice of alternative paths, but the fact of our fiscal crisis does suggest to me that we face just such a choice. It should be no wonder, therefore, that so many conservatives think this election is terribly consequential.