Go read Ed Morrissey's defense of "practical conservatism." I'll add this: Morrissey should be careful to distinguish between Social Security, which only needs modest reforms, and Medicare/Medicaid, which will bring serious problems in the medium term. The GOP will give itself credibility by shoring up the program that works and seriously attempting to fix the one that doesn't.
In practical terms, the entitlement programs we have cannot be dismantled, as Randian purists would prefer. Medicare, Medicaid, and Social Security are too popular for repeal, and more importantly, deliver a level of living standards on which millions of Americans rely — standards that would plummet in these programs' absence. Instead of denying that, practical conservatism would embrace that — because on the trajectory of current policy, these programs will utterly collapse at some point. There is, after all, nothing compassionate about a default, or about sticking succeeding generations with the bill for benefits we enjoy in the present.
Conservatives have good ideas for reforming these programs, and practical conservatives can point to the massive pain that failure will cause future generations. The same is true of programs such as food stamps and other programs that lift the truly needy, but which need to be better targeted so that those who can lift themselves will have to do so.
If nothing else, the past few months should have made it clear that in practical terms, talking about "the 47 percent" and "makers versus takers" won't win elections for Republicans. It's in our nature to care about the poor and struggling among us, and that impulse speaks well of Americans. Practical conservatism would also embrace this impulse and form policy around the goals of a robust but practical safety net that doesn't require massive borrowing, ensuring that limited resources only go to those truly in need while building a fair and free economy that creates true prosperity across all income classes.