After all, the opposite of the A.C.A. is not a free market. The Emergency Medical Treatment and Labor Act, a 1985 law, requires that hospital emergency departments treat all comers. So, while some uninsured patients will forgo care after repeal of the A.C.A., others, especially the seriously injured and mortally ill, will secure the care they need even if they can’t pay for it, even if they know they will never be able to pay for it. And in the end, all of us pay for that care through higher insurance premiums, increased hospital costs and overtreatment of the (paying) insured.

This is important, because Republicans are championing a free-market health care system unencumbered by strong government interference. As we know from decades of debate leading up to the A.C.A., the only way to rein in health care costs in a system without some form of universal public health insurance is to place limits on care for those without insurance or the ability to pay for it outright.

I remember a recent case, here in Pittsburgh. A woman, young and fit, moved to the city to be with her boyfriend. She didn’t have health insurance because she was new in town and hadn’t yet found a job. But she wasn’t worried; her youth, she thought, guaranteed her health.

But it turned out she had A.M.L. — acute myelogenous leukemia — a killer disease, the medical version of a high-speed collision. The first round of curative treatment required a six-week hospital stay, multiple infusions of chemotherapy and intensive round-the-clock nursing. And that was just the start.

I was this patient’s nurse at the end of her six-week stay, after we’d successfully put a brake on her disease. She was eager to return home, and her pale face radiated a diffuse hope. Her main preoccupation was not whether her cancer would return, but how to sufficiently thank the hospital staff who had saved her life. A registered nurse care coordinator had signed the patient up for Medicaid immediately after she received the diagnosis, so she didn’t pay for her care. In fact, she couldn’t have. Treating A.M.L. can cost upward of $100,000. Neither she nor her boyfriend had that kind of money.

If the A.C.A. is scrapped and Medicaid is converted to per capita caps, partly to ensure that everyone who gets care pays her fair share, I worry about what will happen to patients like this young woman. Abandoning this patient to her terrible disease simply because she couldn’t pay for the cure feels sad and wrong. Just as sad and wrong as abandoning an injured patient at a crash site.

House Speaker Paul Ryan and others would take mock offense at the idea that they’re willing to let people go without care, but it’s the unavoidable logic of their drive to undo Obamacare — the part that Republicans would rather not talk about, even as it drives them to ram through the legislation without debate.

People without insurance and little money are still going to need care, some of it very expensive. To deny these people care by restricting their access at the source — ambulances, emergency departments, hospitals — would reflect equity in a you-get-what-you-pay-for model. But the human cost of limiting health care to those who can pay would be higher than any of us should be willing to bear.