If it passes, the Republican health care bill currently being debated in the Senate will kill people. Over the past few months, the party has made several attempts to repeal and replace the Affordable Care Act passed under Obama, all of which share one key feature: they leave millions more people without healthcare.

Data indicates that every year, one in every 830 Americans who lack healthcare insurance will die unnecessarily. A report by the Congressional Budget Office suggests that the newest “skinny repeal” plan will leave an extra 16 million individuals uninsured. That’s an estimated annual body count of 19,277. Many more will be forced to live with treatable painful, chronic and debilitating conditions. Some will develop preventable but permanent disabilities and disfigurements - losing their sight, hearing or use of limbs.

This is upsetting to think about as an observer - thousands of miles across the Atlantic, in a country that has had universal, free at the point of delivery healthcare for almost seven decades. It is monstrously, unfathomably traumatic if you’re one of the millions of Americans who stand to be affected. If you’ve got loved ones who stand to be affected. If you’ve got an ongoing health condition and have no idea how you’ll afford treatment if this bill passes.

I’ve got friends who’re in this situation. They’re petrified, furious and increasingly exhausted. This process has been going on for months. Repeatedly, people have been forced to phone their elected representatives and beg for their lives. There is absolutely no ambiguity about consequences of the legislation. Every senator who supports the health care bill does so in the knowledge it will cost tens of thousands of lives - and having taken calls from its terrified potential victims.

They consider this justifiable because it will enable them to cut taxes for the rich. This might sound like an over simplistic or hyperbolic assertion, but it’s factually true. Past versions of the bill have included tax cuts for healthcare corporations and for individuals with incomes over $200,000 per year, or married couples making over $250,000. The current “skinny repeal” plan has dropped some of these changes, but does remove the employer mandate - which requires medium and large businesses to provide affordable health insurance for 95 per cent full-time employees.

On Tuesday, Senator John McCain took time out from state-funded brain cancer treatment to vote to aid a bill that will deny that same medical care to millions of poorer citizens. In response, ordinary US citizens cursed and insulted him and in some cases wished him dead. This backlash provoked a backlash of its own, with commentators in both the UK and US bemoaning the lack of civility in contemporary discourse. The conflict revealed a fundamental divide in the way we understand politics, cause and effect, and moral culpability.

Over 170 years ago, Engels coined the term “social murder” to describe the process by which societies place poor people in conditions which ensure “they inevitably meet a too early… death”. Morally, it’s hard to see what distinguishes voting to pass a healthcare bill you know will kill tens of thousands from shooting someone and stealing their wallet. The only difference seems to be scale and the number of steps involved. It’s not necessary to wield the weapon yourself to have blood on your hands.

In normal murder cases, few people would even begin to argue that killers deserve to be treated with respect. Most us would avoid lecturing victims’ on politeness and calm, rational debate, and would recognise any anger and hate they feel towards the perpetrator as legitimate emotion. We’d accept the existence of moral rights and wrongs. Even if we feel that two wrongs don’t make a right, we’d understand that when one wrong is vastly more abhorrent and consequential than the other, it should be the focus of our condemnation. Certainly, we wouldn’t pompously insist that a person who willingly took another’s life is “wrong, not evil”.

Knowing the sheer, frantic terror many of my friends in the US are currently experiencing, I’ve found it sickening to watch them be scolded about politeness by individuals with no skin in the game. If it’s not you our your family at risk, it’s far easier to remain cool and detached. Approaching policy debates as an intellectual exercise isn’t evidence of moral superiority - it’s a function of privilege.

Increasingly, I’m coming round to the idea that incivility isn’t merely justifiable, but actively necessary. Senators voted 51-50 in favour of debating a bill that will strip healthcare from millions of people. It’s unpleasant to wish that John McCain was dead—but is it illegitimate to note that, had he been unable to vote, legislation that will kill tens of thousands of others might have been blocked? Crude, visceral language can be a way to force people to acknowledge that this isn’t simply an abstract debate—it’s a matter of life and death.

As Democratic congressman Keith Ellison has argued, merely resisting efforts to cut healthcare isn’t enough. Millions of Americans already lack health insurance and tens of thousands die every year as a result. The Affordable Care Act was a step in the right direction, but the coalition of resistance that has been built to defend it must also push further, for universal coverage. Righteous anger is necessary fuel for that fight.