YORK — As a piece of legislation intended to provide affordable, quality health care to the greatest number of Americans, the Affordable Care Act has failed miserably. Twenty million Americans remain uninsured and tens of millions more with insurance have trouble affording their co-pays or deductibles. Half a million Americans with health insurance coverage declare bankruptcy every year as a result of medical expenses.

The ACA has been a disaster for providing affordable coverage, but soon our health care system will be in worse shape. Far worse. The “death spiral” of health care coverage, stimulated by a Republican Party hell-bent on undermining any legislation promoted by Barack Obama, has accelerated.

Both the House and Senate versions of the American Health Care Act attempt to stall that death spiral, but the trade-off they offer is less coverage and a certain increase in pain, suffering and premature death to older Americans as well as those who struggle the most to pay their bills. The beneficiaries of the AHCA through tax cuts and subsidies are the super wealthy, the health insurance industry and Big Pharma.

Only weeks after championing the House version and then celebrating its passage in the Rose Garden, President Trump recognized that what House Speaker Paul Ryan, et al., had crafted was “mean” – a remarkable admission for a man who has a profound aversion for the truth.

The Senate version, crafted in secret by 13 hand-picked older white men, was finally offered up four days ago, giving the other 87 members less than a week to critique, discuss and amend before being asked to pass it. Any reasonable person would agree that this is not only unprecedented but also a dangerous way to legislate.

Though their version in many ways is even more “mean” than the House version, those 13 senators may have managed to make it more palatable by extending time lines and shuffling numbers. So it may well pass.

Regardless of how this plays out, whether we continue with the ACA or get some version of the AHCA, America in general and the poor, the elderly and the middle class in particular, will not do well in regard to having their health care needs met over the next several years.

It’s important to recognize that the United States pays nearly two times more in health care costs than any other industrialized country while having far worse outcomes on most measures of care, and still we leave over 10 percent of our citizens without access to care because of lack of insurance.

Being uninsured means being unable to treat chronic conditions such as diabetes, hypertension, chronic obstructive pulmonary disease, schizophrenia, addictions, Crohn’s disease – and the list goes on and on. Failure to treat these chronic conditions results in pain, suffering, expensive trips to the emergency room and premature death. The financial costs are huge to the taxpayers, but they pale in comparison to the emotional costs paid by individuals and families of those with pre-existing conditions.

Call it what you will, but “single-payer” or “Medicare for all” or “socialized medicine” would guarantee quality health care for every American, and it would provide it for a fraction of the cost we pay for health care today. Why? Because a single-payer system would not be burdened by financially supporting insurance or pharmaceutical industries that take advantage of our campaign finance and lobbying laws and in doing so manage to generate enormous profits through limiting patients’ access to care or life-saving treatment.

Our elected officials, on both sides of the aisle, have become intoxicated by the money poured into their campaigns and have become dependent on that money to get re-elected. Their primary focus is to stay employed, i.e., to get re-elected, and access to quality health care by their constituents can be damned.

We guarantee our children access to a quality education through high school for good reason: It makes for a better society and a more robust economy.

And you would not deprive your neighbors a quick response from the local fire department if their house were on fire. If you did, lives could be destroyed or lost and businesses and communities decimated.

Is it any less cruel or ill-advised to deprive those same neighbors access to health care?

Our country needs an affordable, effective health care system. Plans that are not single-payer, quite simply, are motivated by greed and fueled by ignorance. And they are cruel.

There is no question that the ACA needs to be repealed and replaced. It needs to be replaced with comprehensive, universal coverage that is affordable and compassionate. Single-payer.