Overpricing and overcharging minorities and the poor in hospital ERs; health care specialists are driving up the cost of care; Mylan is waiting out the outrage over its high-cost Epipen and continuing its price gouging, and major health insurance companies settling multi-million dollar Medicare and Medicaid fraud cases with the government. The American health care system is a disaster and a disgrace. Greed and self-interest are its fuel. It's opaque. It's irredeemable.

And, the Affordable Care Act (aka Obamacare) trying to work with and maintain the American health care system, only highlighted all its ills. But at least the Democrats engaged in a comprehensive and intensive effort to improve one of America's biggest problems. Unfortunately, you can't say the same about the Republicans. From the start, and I'll give them credit for not lying about how vile the process would be, Republicans engaged in health care reform sausage making. Their health care reform plan consists of a three-step sausage making process—gut as much of Obamacare (cut taxes) via reconciliation, eliminate health care reform regulations, pass general health care regulation through the normal legislative process.

And like most sausage making, the Republican health care reform work is occurring out of sight. There are no experts to advise on the combination and impact of different policy options. In fact, Republicans in the Senate decided not to send their reform proposals through committees and instead assigned 13 Senators to review the House bill for further tweaking. This not-at-all discriminating approach to health policy reform all but guarantees an unappetizing product for millions. There should be no expectation of a Senate health care reform bill that is much better than the bill signed by the House. In fact, the Senate bill may be even worse than the House bill.

Initially, House Republicans were transparent about their health care reform bill. They made it clear that the Obamacare repeal law, the American Health Care Act (AHCA) was step one of a 3-step process to replace Obamacare. They collaborated with the Health & Human Services Secretary, Tom Price, to sell the proposed law to the public. And, lastly, they waited for the CBO score before deciding not to vote on the legislation. In the end, transparency was political poison for the House, and they resorted to secret meetings and hiding drafts of the revised proposal. The result was a reform bill that was just as bad as the first one but easier to pass politically. Republican senators have no desire to repeat the mistakes of their House colleagues. There will be no false starts on voting and no or little sharing of policy details before the vote, and there will be a vote and the bill will pass.

A Senate version of the AHCA will look a lot like the House version, but with a longer timeline to implement its awfulness. Expect,

• Medicaid to lose billions in funding,
• A decrease in financial assistance for the poor to purchase insurance and pay for medical care, Limitations on coverage for people with pre-existing conditions,
• A weakening of required benefits coverage, Support, via regulatory changes or financial incentives, for health savings accounts and to sell health insurance across state lines, and
• A small dash of dollars for high-risk pools.

Tags: Mylan, obamacare, AHCA