Even so, version No. 1 of that plan wasn’t harsh enough for the hard right. The version that passed last week is worse, as it includes state waivers that will allow insurers to get back in the business of pricing premiums based on people’s medical histories — i.e., ending guaranteed, affordable coverage for preexisting conditions.

But even as it’s essential to testify to the draconian nature of the replacement, I want to focus on something else that’s wrong with not just this replacement, but that I fear will also be wrong with whatever comes out of the Senate: They’re going to punt on “bending the cost curve.”

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That’s an admittedly obscure way of saying they will not build on the progress of the Affordable Care Act to slow the growth of health-care costs. To be clear, they’ll cut spending; specifically, government spending. That’s how they get the money they “need” for their tax cuts. But those spending cuts do not result from squeezing inefficiencies out of the U.S. health-care delivery system. They come from shifting costs onto consumers — i.e., taking us back to the pre-ACA days of lower coverage and less-affordable premiums.

First, some evidence regarding health-care costs. The table below shows how health-care price growth has slowed significantly since 2010, and has since been keeping pace with overall price growth. This slowing began before the ACA was in place, so there are other dynamics afoot as well, but projections of national health-care spending have come down significantly since the ACA’s passage.

Other important evidence comes from budget forecasts. Between 2010 and 2016, projections of public health spending as a share of GDP declined by four percentage points.

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The main reason that health care is so much more expensive here than in the rest of the world — they spend about half of what we do, per capita, often with better outcomes — is that we take such a muddled approach to it. On the one hand, and this is big for conservatives, we treat it as a private market good. On the other hand, half the system is public and, unlike an actual market good, hospitals must treat you if you show up at the emergency room.

This hybrid doesn’t work very well, in part because of unique characteristics of health care — most of us rarely use the system and we don’t have the knowledge to be informed shoppers. Drug producers, aided by the patent system, gouge the public, even while public dollars help pay for their research. Hospitals and providers are strongly incentivized to emphasize the quantity of care over quality.

At least, they were before the ACA. One of Obamacare’s primary goals was to clarify the muddle as best it could, given the fact that it keeps the private-public hybrid in place (yes, other countries keep that hybrid in place, too, but the private side is much more heavily regulated, often through aggressive cost controls). Its main tool in this regard has been a move toward different sorts of payment models, designed to move from fee-for-service to a more bundled approach. These include accountable care organizations, medical “homes” and payment changes that reward outcomes such as lower hospital readmission rates.

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Although it’s challenging to tie these ideas, aspects of which were in development before the ACA, to the slower price growth noted above, most analysts think they’re in the mix (the evidence re: lower readmission rates looks particularly strong).

What will happen if we abandon these still-embryonic efforts and go back to the pre-ACA world? Although providers making progress with bundled payment systems won’t shut them all down, the fact that states can opt out of coverage and pricing mandates in the ACA (if doing so remains allowable in the Senate’s plan) in particular seems awfully likely to thwart the progress we’ve made on cost controls.

Moreover, the Republican plans give little thought to the most demanding aspects of health-care spending: chronic diseases. Half of health-care spending is on the 16 percent of folks with chronic illnesses, so this is a critical corner of this debate.

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Under the ACA, we all pitched in through risk pooling: The healthy subsidized the ill. True, we did so whether we wanted to or not, and that has been a rallying cry of conservatives, whose preferred solution is to pool the chronically ill into inadequately subsidized “high-risk pools.”

But what happens when these expensive patients outspend the subsidies, as has been the case in virtually every high-risk pool experiment thus far? Good question, to which there is no good answer. Either sick people come up with the rest of the money, the rest of us do so, or these people go without coverage, an obviously disastrous outcome.