In the seven years since the Patient Protection and Affordable Care Act became law, its opponents have threatened to repeal it and craft a replacement. Speaker Paul Ryan at long last revealed this purported replacement on March 6. Like Samuel Johnson’s famous dog walking on its hind legs (“It is not done well, but you are surprised to find it done at all”), the American Health Care Act has so many defects and unrealistic assumptions that it would scarcely seem appropriate for debate. But it was done at all!

The ACA – also known as Obamacare – has problems for which remedies exist. But the proposed replacement bill preserves many problems and creates new ones. One criticism of the ACA concerns co-pays and deductibles that sometimes cause patients to avoid care. But the replacement plan allows higher co-pays and higher deductibles.

The ACA limited the differential cost of premiums based on age, assuring that older people did not have to pay more than three times what younger people were charged for the same policy. The replacement permits insurance companies to charge older people five times more.

But the single worst feature of the current proposal undermines the fundamental nature of Medicaid, changing it from guaranteed coverage for those meeting criteria to per capita spending caps.

Per capita caps inevitably means covering fewer people or fewer services, and this will become more critical in times of economic downturn.

The American Health Care Act would decrease the number of Americans with insurance by as many as 15 million to 20 million. For Maine, it would not only hurt our citizens, it would damage hospitals. Fewer than half of Maine hospitals turned a profit in 2016, and that was with the ACA in place. That percentage would decline even more under the replacement plan.

Larger, more secure hospitals would get hurt, but smaller and rural hospitals could suffer a fatal blow.

Less coverage for patients wold mean more uncompensated care, which in turn might force hospitals to lay off workers and reduce services. Some hospitals may have to close with incalculable consequences for both the health of the population and the health of the local economy.

So the American Health Care Act doesn’t cover more people, doesn’t lower premiums and doesn’t lower the cost of health care. Does it have any virtues? It certainly does if you’re the CEO of an insurance company. Under the ACA, insurance companies could deduct no more than $500,000 of an executive’s salary as a business expense. The new proposal has no limits. Pay them anything they want, and send taxpayers the bill.

There are others who benefit from the proposed plan. Me, for instance, and those like me in the top 1 percent of income earners. The 1 percent will average a $33,000 tax break. The breaks accelerate for those farther up the income ladder.

The top 0.1 percent will get $197,000, and the top 400 taxpayers in the country will have their taxes reduced by approximately $7 million.

Under the ACA, nobody in those income categories receives any tax credits for buying insurance, and nobody needs them. But the Republican plan gives up to $4,000 in tax credits to everyone, including Bill Gates, Tom Brady – and me.

But I have a problem with that because I’m a heart surgeon. My generous salary puts me in the 1 percent, albeit in the lower end of that range. So perhaps I would find my taxes lowered by $10,000 or $20,000. Still a nice chunk of change, and I like lower taxes as much as anyone.

But to take a five-figure payoff at the expense of my poorest, sickest, most vulnerable patients would be accepting blood money. I would have to look at my patients knowing that I profited from their loss. Conscience demands that I resist this cruel and destructive proposal.

Please join with me. Call, write, and email your senators and members of Congress to inform them of your disapproval of the American Health Care Act. Visit your elected representatives’ offices to express your displeasure. Demand and attend town hall meetings to let them know how you feel.

We can defeat this. And we must.