Mr. McConnell’s strategy belies the disingenuous Republican complaint that Democrats jammed the A.C.A., or Obamacare, into law in 2010 without sufficient analysis or discussion. The Republican effort to undo the A.C.A. bears no resemblance whatsoever to that much more thorough exercise. Congress and the Obama administration spent a year on health care reform from March 2009 to March 2010. The House and Senate came up with several competing bills, held dozens of hearings, accepted Republican amendments and spent countless hours soliciting feedback from public interests groups and the health care industry. The Congressional Budget Office produced several reports to analyze the various proposals and the legislation that ultimately became law.

By contrast, instead of public drafts and hearings, we now have to settle for a series of leaks from Capitol Hill about what is or isn’t in the bill. On one day, news organizations might be told that Mr. McConnell’s health care working group (which happens to be composed entirely of men) has found ways to win over more moderate senators like Rob Portman of Ohio by agreeing to phase out the expansion of Medicaid more slowly than the House bill would. Such a policy would mean that millions would still lose coverage but not as quickly as in the House version.

But on another day, the public might learn that conservatives like Rand Paul of Kentucky are furious because the draft does not do enough to turn the American health care system into a facsimile of “The Hunger Games.”

In other words, the country is getting only glimpses of half-formed policies and mere hints of the back-room deals offered to win support for them. The Washington Post recently reported, for instance, that Mr. McConnell might cobble together a slim majority for his bill by offering senators from Appalachian states a fund for the opioid epidemic. He might also have to come up with something to accommodate Lisa Murkowski of Alaska because her state has high health care costs and stands to lose a lot if Congress reduces spending on health care by $1.1 trillion over 10 years to give the wealthiest American families a fat tax cut.

It would be tempting to find all this negotiating a purposeless charade if it didn’t have the potential to hurt millions of people and wasn’t already taking a toll. In recent weeks, health insurers have ended coverage in some parts of the country for next year and proposed raising premiums substantially elsewhere. The companies say they are trying to protect themselves from the uncertainty around the A.C.A. Blame for that rests with Congress and Mr. Trump, who has threatened to destroy Obamacare through administrative changes.