Dionne: Can we avoid a health care horror?

It is difficult to decide which is the worst aspect of the Republicans' latest try at repealing Obamacare: the irresponsibility, the cruelty or the lies.

There is only one reason the Senate is even considering a vote this week on the catastrophically flawed proposal from Sens. Lindsey Graham and Bill Cassidy. The GOP base wants repeal. So never mind what happens to Americans with modest incomes who have cancer, diabetes or heart trouble. Politics matters more than giving serious thought to a bill that would upend one-sixth of our economy.

It has been two months since the last repeal bill was defeated. Did the GOP's House and Senate majorities use the time to hold hearings on the bill that's being considered? Did they bring in doctors, nurses and insurers to help craft something sensible?

Of course not. They scheduled a quickie, last minute hearing this week for show. Since this vote is all about appearances, who cares about expertise? President Donald Trump and his party want “a win.” They're willing to wreak havoc on the insurance markets, state governments and people's lives to get it.

If they had engaged in any serious deliberative process, they would have had to grapple with the views of the bipartisan National Association of Medicaid Directors on Graham-Cassidy's approach of marrying block grants to severe cuts. The association's statement last week called the bill “the largest intergovernmental transfer of financial risk from the federal government to the states in our country's history.”

”Any effort of this magnitude,” the Medicaid directors added, “needs thorough discussion, examination and analysis, and should not be rushed through without proper deliberation.” No kidding.

This was Sen. John McCain's admirable rationale for voting against the last repeal bill. And even though Graham is his best friend in the Senate, he stuck to principle and announced Friday he was voting against this bill, too.

Here's hoping he eased the path for other Republicans to oppose this legislative contraption whose cruelty is obvious. There has always been something deeply wrong about our country's failure to provide health insurance for all our citizens, which every other wealthy industrialized nation does. It's not OK for people to face bankruptcy simply because they are doing everything they can to stay alive. Obamacare was a cautious, market-friendly attempt to make the system a bit kinder.

Since the Republicans launched this year's repeal offensive, many Americans who thought of the Affordable Care Act as a vague sort of failure have heard the compelling stories of those with pre-existing conditions and serious illnesses who are far better off today because of the law. . A Washington Post-ABC News poll released Friday showed Americans preferred Obamacare to Graham-Cassidy by 56 percent to 33 percent.

Many who believed Trump and other Republicans when they promised to pass something better than Obamacare now know that this pledge was a sham. What the GOP really wants is to spend a whole lot less government money helping people get health care. But they can't admit it because it sounds heartless.

So instead, they lie outright about what their bill does. Slate's Jamelle Bouie provided one of the best compendiums of falsehoods being offered on behalf of this bill. Jimmy Kimmel called out Cassidy for failing to live up to what the senator himself called the “Jimmy Kimmel test.” Kimmel described this as a pledge that “no family should be denied medical care, emergency or otherwise, because they can't afford it.” Cassidy, Kimmel charged last week, “lied right to my face.”

Trump insisted in a tweet: “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does!” Actually, it lets states undermine this coverage.

Then there is the much-repeated lie that Affordable Care Act repeal bills are about giving states and individuals more “choice” in health care. Right, and I have the “choice” of buying a fleet of Rolls-Royces. The bottom line: No money, no choice.

And if Obamacare is so bad, why are Republicans reportedly trying to buy the vote of Sen. Lisa Murkowski with a special provision that would, in effect, allow Alaska to keep the Affordable Care Act pretty much as is? Why not give every state this option by killing Graham-Cassidy altogether?

This week is a testing time. It's a test of whether the movement that successfully defended the Affordable Care Act this summer can rally once more. And it's a test of a handful of Republicans who claim to take the health care issue seriously. No one who votes for this bill can ever make that claim again.

E.J. Dionne is a columnist for the Washington Post.