In case anyone was wondering what would happen if a handful of fairly wealthy, well-insured men gathered in a room and quietly tried to reinvent the $3-trillion U.S. healthcare system without any input from medical experts, patient advocates or others who know what they're talking about, the U.S. Senate stepped up Thursday with the answer.
After weeks of secret negotiations focused primarily on political considerations, not public interest, Republican lawmakers unveiled a 142-page healthcare-overhaul bill that seems scientifically designed to reduce or eliminate coverage for millions of people, jack up premiums and all but invite insurance companies to stop offering individual plans.
Senate Majority Leader Mitch McConnell unwrapped this steaming pile of legislative manure with his oft-repeated falsehood that Obamacare is "on the edge of collapse." It isn't. But Republicans, including President Trump, have done everything possible to destabilize the Affordable Care Act and cause jittery insurers to rethink participation in the system.
Given all this uncertainty in insurance markets, McConnell said with a straight face, Republicans have "a responsibility to act."
This isn't about undermining former President Obama's signature achievement and cutting taxes for the rich, he suggested, although that's precisely what this is about. "We are for our constituents, our states and our country," McConnell declared.
If so, they have a funny way of showing their love.
"This bill basically says that they don't care about the sick and the poor," Geoffrey Joyce, director of health policy for USC's Schaeffer Center for Health Policy and Economics, told me. "Under this bill, those who are sick are going to pay through the nose."
At its core, the Senate bill is a craven attempt to keep all the good stuff from Obamacare — protections for people with pre-existing conditions, covering young people on their parents' plan until age 26 — while doing away with the bitter medicine that made everything else possible — higher taxes, the mandate.
"They want their dessert but not their spinach," observed Katherine Hempstead, senior advisor for the healthcare-focused Robert Wood Johnson Foundation.
Meanness remains the defining characteristic of Republican healthcare legislation.
The Senate bill trims the financial assistance lower-income people get through Obamacare. Those subsidies also probably would buy less because the legislation allows insurers to provide less-comprehensive coverage.
Moreover, higher monthly premiums would be all but certain. Under the Senate plan, insurers still would have to cover people with pre-existing conditions and charge them the same as what they bill healthy people. That's what's known in healthcare circles as guaranteed issue.
But no other developed nation provides guaranteed issue without a mandate because it's a surefire recipe for higher premiums. Someone has to pay for treating the sick, after all. If only the sick have insurance, then their policies will cost a fortune.
What Republicans consistently fail to acknowledge is that insurance — health, car, property, whatever — is about managing risk. The basic idea is that everyone will need a helping hand at some point, so you spread the expense of that assistance among the entire population to achieve the lowest possible cost.
It's futile to argue that people should have a choice whether to be insured. That's both shockingly selfish and completely irresponsible.
Allowing people to wait until they get sick to buy coverage, which is what the Senate bill effectively does, means insurers would face an endless cycle of expensive claims, rather than balancing out the needs of the sick with premiums from the not-yet-sick, i.e. healthy people.
"We live in a very unusual time," Hempstead said. "The fundamental concept of risk pooling is getting lost in the conversation."
Also lost in the conversation is a sense of decency and humanity.
The Senate bill, like its companion legislation approved by the House, includes deep cuts for Medicaid, the federal-state insurance system for kids, the disabled and low-income people. Hundreds of billions of dollars worth of federal funding will be cut from the program, which covers a third of all Californians.
Whereas Obamacare prevented insurers from charging older individual policyholders more than three times what younger people paid, the Senate bill would allow insurers to charge older people five times as much as younger ones.
Like the House bill, the Senate version also would defund Planned Parenthood for a year, which undoubtedly would play well among the Republican base but makes no sense from a public-policy perspective. All it does is make healthcare less accessible to women.
A full analysis by the nonpartisan Congressional Budget Office isn't expected until next week. But the CBO's scoring of the House bill determined that the number of people without health insurance would grow by 23 million as a result of the legislation becoming law.
It's telling that Republicans in the House and Senate refused to expose their legislation to the same rigorous democratic process that Obamacare underwent — the months of hearings and testimony from experts, the extensive, bipartisan negotiations on what would and wouldn't be in the bill.
The notion that the Affordable Care Act was rushed through Congress in the dead of night is a shameless lie perpetuated by conservatives unwilling to admit they had a seat at the table for the entire discussion.
Only after they succeeded in watering down the bill (adios, public option!) did they circle their wagons and vote against it for political gain.
USC's Joyce said Trump, in prodding Republican lawmakers to repeal Obamacare and come up with something new, "doesn't really care about healthcare. He just wants a win."
The president and conservative lawmakers seem oblivious to the fact that they're messing with a sixth of the nearly $18.5-trillion U.S. economy. Their recklessness borders on insanity.
In case you're wondering, though, coverage for Trump and members of Congress would return to how it was before the Affordable Care Act was signed into law in 2010 if the Republican approach is adopted.
That means 75% of their health insurance would be paid for by taxpayers. It also means Trump, Vice President Mike Pence and their families would continue enjoying a White House clinic containing exam rooms, hospital equipment and supplies.
It means lawmakers would be able to pay an extra $600 a year for access to the Office of the Attending Physician in the U.S. Capitol, staffed by Navy doctors, nurses, technicians and a pharmacist. All treatment, including the services of specialists, is included in the annual fee.
In other words, they're covered.
Even for the pre-existing condition known as heartlessness.