The gory details of the Congressional Budget Office’s report onthe House legislation to “repeal and replace” Obamacare are, inmany ways, superfluous. The bill’s flaws, substantive andotherwise, have long been evident. Less clearly understood, thoughequally disturbing, is the larger political context.

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That’s not to say the particulars of the CBO report, releasedWednesday, are irrelevant: far from it. The report says theRepublican effort would increase the number of uninsured by 14million in 2018, rising to 23 million in a decade.

Millions would lose coverage due to the bill’s cuts to Medicaid.Others would lose it because people who are older, sicker or bothwould find they are priced out of useful insurance. People withpre-existing health conditions would, once again, be at theactuarial mercy of insurance companies that were never organized tobe charities.

These numbers fill in the big picture, which looks somethinglike this: Health care, which depends on highly skilled labor andsophisticated technology, is expensive. Insurance to pay for thatcare, therefore, is also expensive. It is especially expensive forpeople who are, due to misfortune or advancing age, prone to costlyillnesses.

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Providing health insurance to more people, then, requires moremoney. A lot more. The Affordable Care Act imposed a range oftaxes, including a special Medicare surcharge on high earners, topay for these costs.

The Republican plan, the American Health Care Act, repeals thoseand other taxes, totaling some $662 billion over 10 years. It alsocuts Medicaid funding by $834 billion over a decade.

The bill would provide some funding for tax credits andhigh-risk pools. But mostly it transfers money currently used topay for care for the sick and poor to the nation’s wealthiesttaxpayers. (According to one estimate, the bottom 80 percent ofincome earners would see little or no benefit from the plan’s taxcuts.)

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Because that upward redistribution of money is politicallyunpopular, and literally deadly, House Republicans sought tocamouflage the basic trade in which they are engaged -- reducingaccess to health care in exchange for tax cuts for the wealthy. TheCBO report merely exposed what was obvious all along.

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