The John McCain brain tumor drama is everything that’s wrong with the GOP’s insane health care push.

It’s impossible to overstate just how flagrantly Republicans are flouting basic democratic norms when it comes to health care reform. Mitch McConnell is forcing his caucus to hold a procedural vote sometime on Tuesday on the House-passed health care bill, following weeks of Donald Trump threatening Republicans publicly if they don’t repeal Obamacare. If McConnell manages to get 50 votes, it will open up the debate and amendment process, in which the leadership will likely then take up one of two complete substitutes—the Better Care Reconciliation Act (the repeal-and-replace bill Senate Republicans have been working on for months) or the Obamacare Repeal Reconciliation Act (the more recently introduced repeal-only bill). The problem is that none of these garbage rats even know which bill the leadership will choose, which means they have no idea what they’re voting to proceed on. 

And even if they did, major provisions of the BCRA may violate parliamentary rules. This means the bill isn’t even finalized yet, leaving more questions up in the air. This also means there is no up-to-date CBO score for the bill.  

John McCain announced late Monday night that he would be returning to the Senate just in time to “continue working on important legislation,” such as the mystery health care bill. 

It’s worth underscoring just how messed up this is. Less than a week ago, McCain was diagnosed with glioblastoma, an aggressive form of brain cancer. As the tumor grows, it affects thinking and behavior. It’s impossible to know if McCain’s erratic, nonsensical interrogation of James Comey at his Senate hearing in June was due to his cancer, but as a brain tumor expert told NPR, “I do usually suggest to people who have a very intellectual job that they may want to go out at the top of their game rather than continuing to work.” Now McCain, a decorated veteran, is flying across the country to vote on a bill that will take away health care from millions of Americans (how many? we don’t know!), including many veterans who depend on Medicaid. 

McConnell—who is holding together his fractured caucus together by the tips of his fingers—needs McCain’s vote. John Cornyn even volunteered to drive McCain across the country in an RV. But the rush is entirely of the Republians’ own making. They could, of course, just wait until they hammered out actual details of the bill and give McCain more than a few days to recover. 

The rub is that they know that the only way to pass McConnell’s monster is if they do it as quickly and opaquely as possible. McCain’s return is another plot point in the sick drama that health care repeal has become. The only costs are the health care coverage of millions of people and the legislative integrity of the United States Senate.