Robert Reich / RobertReich.org

Shame on every one of the 217 Republicans who last Thursday voted to repeal the Affordable Care Act, and substitute basically nothing.

Trumpcare isn’t a replacement of the Affordable Care Act. It’s a transfer from the sick and poor to the rich and healthy.

The losers are some 24 million Americans who under the Affordable Care Act get subsidies to afford health insurance coverage, including millions of people with pre-existing conditions and poor people who had access to Medicaid, who may not be able to afford insurance in the future.

The winners are wealthy Americans who will now get a tax cut because they won’t have to pay to fund the Affordable Care Act, and healthy people who won’t have to buy health insurance to subsidize the sick.

House Republicans say they have protected people with pre-existing health problems. Baloney. Sick people could be charged premiums so high as to make insurance unaffordable.

America has the only healthcare system in the world designed to avoid sick people. Private for-profit health insurers do whatever they can to insure groups of healthy people because that’s where the profits are. They also make every effort to avoid sick people, because that’s where the costs are.

The Affordable Care Act puts healthy and sick people into the same insurance pool. But under the Republican bill that passed the House, healthy people will no longer be subsidizing sick people. Healthy people will be in their own insurance pool. Sick people will be grouped with other sick people in their own high-risk pool – which will result in such high premiums, co-payments, and deductibles that many if not most won’t be able to afford.

Republicans say their bill creates a pool of money that will pay insurance companies to cover the higher costs of insuring sick people. Wrong. Insurers will take the money and still charge sick people much higher premiums. Or avoid sick people altogether.

The only better alternative to the Affordable Care Act is a single-payer system, such as Medicare for all, which would put all Americans into the same giant insurance pool. Not only would this be fairer, but it would also be far more efficient, because money wouldn’t be spent marketing and advertising to attract healthy people and avoid sick people.

Paul Ryan says the House vote was about fulfilling a promise the GOP made to American voters. But those voters have been lied to from the start about the Affordable Care Act. For years Republicans told them that the Act couldn’t work, would bankrupt America, and result in millions losing the healthcare they had before. All of these lies have been proven wrong.

Now Republicans say the Act is unsustainable because premiums are rising and insurers are pulling out. More rubbish. Whatever is wrong with the Affordable Care Act could be easily fixed, but Republicans have refused to do the fixing. Insurers have been pulling out because of the uncertainty Republicans have created.

The reason Republicans are so intent on repealing the Affordable Care Act is they want to give a giant tax cut to the rich who’d no longer have to pay the tab.

Here we come to the heart of the matter.

If patriotism means anything, it means sacrificing for the common good, participating in the public good. Childless Americans pay taxes for schools so children are educated. Americans who live close to their work pay taxes for roads and bridges so those who live farther away can get to work. Americans with secure jobs pay into unemployment insurance so those who lose their jobs have some income until they find another.

And under the Affordable Care Act, healthier and wealthier Americans pay a bit more so sicker and poorer Americans don’t die.

Trump and House Republicans aren’t patriots. They don’t believe in sacrificing for the common good. They don’t think we’re citizens with obligations to one another. To them, we’re just individual consumers who deserve the best deal we can get for ourselves. It’s all about the art of the deal.

So what do we do now? We fight.

To become law, Trumpcare has to go through 4 additional steps: First, a version must be enacted in the Senate. It must then go a “conference“ to hammer out differences between the House and Senate. The conference agreement must then pass in the House again, and again in the Senate.

I hope you’ll be there every step of the way, until Trumpcare collapses under the weight of its own cruelty. House Republicans who voted for this travesty will rue the day they did. Any Senate Republican who joins them will regret it as well.

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Robert B. Reich has served in three national administrations, most recently as secretary of labor under President Bill Clinton. He also served on President Obama’s transition advisory board. His latest book is Aftershock: The Next Economy and America’s Future. His homepage is www.robertreich.org