Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed?

The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp.

First, the new Republican establishment leaders needed something they could call Obamacare repeal — anything that they could call Obamacare repeal.

It became clear as the legislative process rushed forward that there was no overarching vision in this legislation on how to reform health care or even an organizing thought about how to improve the lives of voters. There was no core health care priority that Republicans identified and were trying to solve.