Donald Trump hosted a celebration in the White House Rose Garden for House Republicans after they passed their party’s health care plan by the thinnest of margins. They were celebrating what Trump called a “win,” without any thought about consequences. None of them had read the bill, which was released only a couple of days before the vote and rushed to the floor. The vote took place before the nonpartisan Congressional Budget Office could issue a revised assessment of its costs and effects. House leaders and Office of Management and Budget Director Mick Mulvaney dismissed criticisms, saying that Senate Republicans planned to start all over anyway. This bill addresses one-sixth of our national economy, and an industry that has been a leading source of jobs growth. Don’t worry, say House Republicans, we just had to get the win; forget about the substance. Americans shouldn’t just be worried; they should be furious. The Republican bill will throw literally millions off health care, put people with pre-existing conditions at risk and raise premiums particularly for workers aged 50 to 64 – in order to give a massive tax break to the very wealthy. At the annual shareholders meeting of Berkshire Hathaway, billionaire investor Warren Buffett called it for what it is: “a huge tax cut for guys like me.” The richest 400 people in America will get a tax break estimated at about $7 million a year. To pay for that, millions will lose their coverage, and millions more – the elderly and those with pre-existing conditions in various states – will see premiums soar and insurance become unaffordable. You can’t sugarcoat this. It’s not enough to say the Senate will fix it (the 13 white men – no women, no people of color – on the Republican Senate Working Group certainly will not). It’s not acceptable to say, “We don’t mean it; we just had to pass it.” Why did they have to pass it? This is complicated, but if you follow it, you can understand the backroom plunder that is taking place. As Peter Suderman explained in the New York Times, Republicans have to pass it because the top-end tax cuts in the health care bill are vital for their central goal: to deliver to their corporate and wealthy donors another massive tax cut in the next budget reconciliation vote. They have to do the tax cuts in what’s called “reconciliation” because that allows them, under the obscure rules of the Congress, to pass the bill with only 50 votes – with only Republican votes. But the reconciliation rules only allow tax cuts if they don’t raise deficits after a 10-year window. So to get what Trump calls the mother of all tax cuts, Republicans want to cut the taxes out of Obamacare in the FY2017 reconciliation (that only lasts until next September) and then have a lower baseline for cutting taxes in the FY2018 reconciliation (the budget that begins on October 1). Tax cuts for the wealthy will be paid for by sickness and death by millions of the uninsured. Republican Sen. John McCain criticizes the House for proceeding without a CBO estimate of the costs, saying, “I want to know how much it costs.” Republican senators vow not to act until the CBO reports. The CBO’s estimate will show what we already know from its last estimate: Millions will lose their insurance, and the wealthy will pocket millions in tax cuts. A former insurance executive, Richard Eskow, did the real math. He took the best estimates of how many avoidable deaths come from not having health insurance with the rollback of Medicaid and taking away protections for pre-existing conditions. He compared that to the tax cuts that would be pocketed by the 400 richest Americans, people who, like Buffett, make on average over $300 million a year. Here’s his estimate of the real cost: Ten people will die under the Republican bill to give each of the 400 richest people in America a tax break. For every person who dies, they’ll pocket about $787,151. As Eskow noted, those rich beneficiaries aren’t likely to know anyone who will lose his or her life as a result of being stripped of health insurance. And while the $787,000 isn’t much for a multimillionaire, it’s just the appetizer for the big take they will get out of the Trump tax cut plan that will follow. Thirteen white, rich men will now create the Republican plan in the Senate. They’ll decide how many millions to strip from health insurance to pay for tax cuts many of them will enjoy. They’ll decide whether to deprive low-wage women of Planned Parenthood’s health care services. They’ll decide just how many deaths are needed to cover the tax cuts for the very rich. Ugly language? No this is a morally indefensible, ugly piece of work. It is simply obscene to choose consciously to condemn low-wage workers or older workers to unnecessary illness and death in order to afford tax cuts for the already wealthy.