If you actually believe that Paul Ryan cares about balancing the budget and lifting people out of poverty, you’re probably ignoring the fact that he’s about to do the exact opposite of both.

A full repeal of Obamacare would blast a $353 billion hole in the deficit, while kicking millions of Americans near the poverty line off their insurance, with plans to uninsure millions more by “block granting” Medicaid. (Which is just another way to cut coverage for more poor people, including senior citizens in nursing homes and families of the disabled, who benefit from 60 percent of current spending on the program.) And then there is Ryan’s plan to “modernize” Medicare, mainly a scheme to privatize the program and pass the costs on to seniors, many of them already struggling financially.

Leaving people to get sick and die is just another way Republicans remind us that we’re a Christian nation. And they’ve got to cut like this if they intend to give the richest, who have never been richer, trillions of dollars in additional tax breaks. Which they certainly do.

But Paul Ryan’s wettest dreams start with his number one priority, along with defunding Planned Parenthood: Obamacare repeal.

How about a plan to replace it? That can wait. Then why the rush to repeal? And why put off a replacement like you’re a scamming teenager, trying to work out a payment plan with a grandparent you expect to die?

It’s because none of this has to make sense.

The Huffington Post‘s Jonathan Cohn flagged this quote from Ryan last week to highlight the cognitive dissonance behind the “Repeal and Delay” strategy:

“We want to make sure there is an orderly transition so that the rug is not pulled out from under the families who are currently struggling under Obamacare while we bring relief,” the House Speaker said in a press conference last Wednesday.

Cohn points out “With one breath, he’s saying that the people who have Obamacare insurance are ‘struggling.’ With another, he’s saying that taking away their coverage would be like pulling a rug from under them.”

If Obamacare were so terrible, it would be easy to replace and you’d do so immediately.

“Repeal and Delay” only makes sense if your priority is to give millionaires tax breaks and you’re sure you can uninsure millions — up to 30 million Americans — without exposing the costs of repeal. Then you give yourself plenty of time to figure out how to get voters to blame Democrats for the mess.

Why would you believe that you can pull off shifting the blame for uninsuring millions on the party who insured 20 million?

Simple: Republicans have already gotten away with denying millions of Americans the Medicaid expansion in Obamacare, essentially premium-free coverage, in states they control, including Texas, Florida and Georgia, all with the highest uninsured rates. Yet Donald Trump won all three states and all three states still have Republican governors. Actually taking away insurance is a bigger challenge — ask the Republican governors of Kentucky and Arkansas who haven’t rolled back Medicaid expansion, completely. But the GOP has a formula it knows works.

Obamacare is a modern miracle that has expanded coverage to record levels, cut the federal deficit and expanded the life of Medicare, while adding benefits and protections for every insured American. Yet the GOP has managed to make it an entirely polarized issue, with voters who rely on the law voting against Democrats out of spite.

Opponents of the law spent half a billion dollars or so savaging it, while Democrats spent a fraction of that amount defending it as they fled the complications of “owning” the health care system. Republicans think they can escape the political consequences of repeal in 2018 pretty easily, even if the health care marketplaces begin to fall apart — which seems probable — because they know how fragmented voters have become. Thanks to Fox News and Facebook, their supporters will mostly get good news about repeal. And Democrats will likely fail to match the GOP’s assault on the law because Democratic policies that benefit a wide swath of the American public just don’t have the same appeal to billionaire donors who now anticipate billions in tax breaks by betting on red.

But “Repeal and Delay” is so inherently nonsensical that several Republican Senators have already expressed doubts about it. All we need is three GOP Senators to say no and it’s dead. Is that likely? Are there three Republicans who will vote against giving their donors tax breaks? Not so likely, but definitely possible.

How do you do it?

Exposing the almost unimaginable hypocrisy behind what the GOP is doing probably won’t accomplish anything except to give you an ulcer, as right-wing media and donors prepare an onslaught to blame Democrats for ever trying to pass nearly universal coverage and end discrimination against the sick.

Forcing the GOP to pass a replacement as they pass repeal is the only hope of exposing the massive damage they’re about to do. No delay can be acceptable, given that we know they’ve had seven years to come up with a replacement — and the best they’ve got is Paul Ryan cheerfully reading The Fountainhead to uninsured kids.

The Washington Post‘s Paul Waldman offers the Republican retreat on gutting the Office of Congressional Ethics as path forward.

“They had the votes to do it, so they did, in the belief that the political fallout would be limited enough to make the whole thing worthwhile,” he wrote. “What they didn’t count on was that the news media would be drawn to the story and give it front-page treatment, or that Democrats, liberal organizations, and individuals using social media would quickly mobilize to get people to contact their representatives to express their outrage.”

Trump got credit from credulous news sources for opposing the timing of that move by House Republicans, but the real story is we have a president-elect who is extraordinarily pliable — except in his undying affection for Vladimir Putin — and extraordinarily susceptible to what he sees in cable news.

Trump doesn’t want CNN talking about anything but what he wants them to talk about. That’s a weakness we must seize upon relentlessly.

Massive resistance, as described in the Indivisible Guide, is one way to make this happen organically. But Democrats will always be at a disadvantage because they lack the propaganda and PR infrastructure of the right. Unless both the grassroots and the liberal donor class decide that this is a fight that can’t be lost, thousands of Americans will die each year lacking coverage that Democrats had won for them.

Many Americans spent the last year imagining the worst couldn’t happen. We don’t have that luxury anymore.