Protesters agains the Republican health care bill gather inside the office of Sen. Rob Portman, R-Ohio, on Capitol Hill in Washington, Monday, July 17, 2017. (AP Photo/Manuel Balce Ceneta)

It’s not hard to see how Republican disdain for the underlying structure of Obamacare combined with President Donald Trump’s ignorance and dramatic dependence have now created a toxic brew of health care Americans are sick of.

In the same way many House and Senate Republicans refuse to admit and act on the reality of global climate change, many in the Congressional GOP refuse to admit the hard facts and numbers of American health care.

This country not only spends more on health care dished out to fewer people, we spend considerably more than any other country in the world.

It’s perfectly logical and admirable that many Republicans see that the rising cost of Medicaid and Medicare are threatening to eat a massive hole in state and federal budgets. But the country has already tried and failed to play a shell game with providing medical services to the poor. Either hospitals and providers provide “free” health care to the poor, and pass those costs onto paying customers, or the government pays for indigent health care and passes those costs onto taxpayers.

Unless, as a nation, we’re willing to see poor people get sick and die from the lack of medical care, the cost of providing for sick, poor people will end up on a spreadsheet somewhere. Since there are federal laws requiring hospitals to provide emergency-room treatment to anyone, regardless whether they can pay, the cost of providing health care for poor people only goes up since that’s where the indigent will go instead of choosing to die or suffer.

But it isn’t just health care for the poor that Republicans just don’t get. It’s health care for the rest of us. If insurance companies are allowed to continue to hike premiums, co-pays and deductibles at the alarming rate they are while the government requires everyone to have insurance, what part of the real universe indicates that insurance rates would go down by no longer requiring young, healthy people to become insured and loading up the system with older, sicker Americans?

Republican plans to end that mandate, without regulating costs, can only mean that rates will not only go up, but they’ll go way up. The only thing that would change that equation would be if either insurance companies, hospitals, doctors, drug makers or other providers were to step up and say, “we will reduce salaries and profits for the good of the country to put pressure on the market to do the same.”

It will never happen. Trump and like-minded Republicans this week only made the situation worse by threatening to repeal the ACA with no alternative and a promise to figure something out in a couple of years. Every expert in the industry agrees that such a disruption and blind take-off into the unknown would mean disaster. It would mean even fewer insurance options for millions of Americans and guaranteed price hikes as insurers hedged their bets on covering losses.

The truth is, Republicans don’t have a better answer to Obamacare, and now it’s clear neither they nor Trump have any realistic or desirable alternative to the ACA at all. Obamacare looks like it does because we’ve already been through this drill, trying to create something better by accommodating all the current players at the table. We got here with 161 Republican amendments to the ACA.

While we have long warned that the ACA was not a sustainable solution to the growing American health-care crisis, it was a vast improvement in service over what Americans were suffering through before the ACA. There is no better alternative to creating a public option to provide coverage for Americans, reduce Medicaid spending and help push down market prices. But even if Congress creates some kind of ‘Medicare for everyone”, there’s little to do to sustain the system. Only some flavor of universal coverage will really reduce what we pay for health care as a nation and individually.

What won’t work is any of the proposed GOP plans and especially Trump’s notion of the health-care equivalent to nuclear winter.

Trump is now at best irrelevant to the discussion and is actually making a nearly impossible job even more difficult. He should be ignored.

It’s up to House and Senate Republicans to draw in Democrats for a real solution to the problem of Obamacare. Otherwise, it’s up to voters next year to choose representatives to replace those in Congress now who simply don’t get it or don’t care.