Last month, President Donald Trump made a statement that was truthful — health care is complicated. While Republicans in the House were crafting their replacement for the Affordable Care Act, also known as ObamaCare, Trump said of health care: “It’s an unbelievably complex subject. Nobody knew health care would be so complicated.”

Really?

Anyone who has taken a serious look at the U.S. health care system understands it is complicated. In producing the complex ACA legislation, congressional Democrats and President Obama revealed how complicated health care is, particularly in the United States, where big business and corporate profits drive up costs.

While the ACA was being debated, we learned that Americans spend nearly twice as much on health care, on a per-person basis, than people in nearly any other advanced country. This fact was barely mentioned in the debate when Democrats and Obama were crafting their plan, and it’s not being discussed now as Republicans and Trump try to produce an ObamaCare alternative.

But it should be discussed, and debated, because runaway cost is at least part of the reason why health care legislation is “unbelievably complex,” as Trump discovered.

Lawmakers should explain, and defend, why Americans must spend twice as much for health care as citizens in other countries.

Big drug companies lobby incessantly to maintain sky-high profits while many also game the patent system to extend monopoly pricing power. In other countries, government health care programs negotiate for lower drug prices. But not so in the United States, where the Medicare Part D expansion for drug benefits prohibited Medicare from negotiating for lower drug prices. This revealed the leading role drug company lobbyists played in writing the legislation.

While the ACA has many faults, particularly in failing to bring down health care costs, it did expand coverage to tens of millions of the most vulnerable Americans.

Last fall, Candidate Trump called ObamaCare a disaster and promised health insurance for all, with lower costs and better care. Now that he’s in the White House and Republicans control both chambers of Congress, it’s Trump and the GOP who own health care and all the associated problems of rising insurance premiums, costly co-pays and high drug prices.

The Republican-led House has introduced an ACA replacement that will, according to the nonpartisan Congressional Budget Office, push tens of millions of the poor off Medicaid, leading to a dramatic rise in the number of uninsured Americans. It’s well understood that uninsured people face more sickness more frequently, because they can’t get regular treatment in doctors’ offices and are forced to seek treatment in emergency rooms, usually when their health is in crisis. This leads to higher costs for all because hospitals cannot refuse care, so they must charge all other patients more to subsidize care for the uninsured.

This is how it was before ObamaCare, and it would be a mistake, for financial and moral reasons, to go back to leaving low income people with only emergency room care.

The Republican plan is out there now, and the CBO estimate of 24 million losing health care coverage within a decade is just the start of the troubles for Trump and the GOP. Critics also note that the House Republicans’ plan does nothing to address high drug costs or high insurance company profits. The GOP legislation is seen by many critics as an assurance of continued profitability for the insurance companies, with minimal corresponding responsibility.

The GOP legislation as it now stands is a gift to wealthy Americans, drug companies and health insurance CEOs, while stripping away health care coverage from 24 million people. That’s a political problem for Trump and the GOP.

Many of those expected to be hurt by the Trump plan are Midwesterners who voted for Trump, after supporting Obama in the two prior presidential elections — people who believed candidate Trump when he promised wider coverage, lower costs and better care.

House members are up for re-election in two years and they know they could be facing angry voters if the GOP proposal becomes law as it is.

Some leading Republicans in the Senate are speaking out against the House plan. Sen. John Thune, R-S.D., wants it to be “more helpful to people at the lower end.” Sen. Bill Cassidy, R-LA., said it will hurt people over age 60 years because of the planned rollback of subsidies, adding, “That’s not good.”

Trump and Republicans are now where Democrats were for the past seven years. They are planning major changes to health care and they will own all the problems tied to health care in America — complaints and criticisms about coverage and costs and the harsh reality that health care is not affordable for millions of Americans.

And as Trump has recently discovered, health care is complicated. There is no easy fix, no silver bullet — and it’s all on Republicans going forward.