It is not just health care for 30 million people at stake these days. Democracy is hanging by a thread too — in Raleigh and in Washington.

First, consider the spectacle of Sen. John McCain, arriving back in Washington Tuesday for the first time since being diagnosed with brain cancer.

McCain received a standing ovation from his colleagues as he dramatically made his way on to the Senate floor as the vote was underway on proceeding with debate on massive health care legislation that no one had seen, a proposal that had never been before a committee or discussed at a public hearing and one that could take health care coverage away from as many as 26 million people.

One longtime national reporter noted that she’d been covering Congress since 1984 and had never seen a breach of legislative process as serious as the one on display this week.

McCain, who in many ways is undeniably an American hero, made a blistering speech in which he blasted the unusual way the health care debate was proceeding in the Senate — but the remarks came after he cast the deciding vote to allow the extraordinarily undemocratic process he was criticizing to proceed.

The motion to begin the debate passed after Vice-President Mike Pence broke the 50-50 tie that McCain’s vote created. Sen. Thom Tillis and Sen. Richard Burr were both among the 50 senators who voted to proceed without knowing what they were proceeding on, and both told the media that they would vote for almost anything that would pass.

No profiles in courage there.

In Raleigh this week, North Carolina Attorney General Josh Stein is scrambling because of last-minute budget cuts made by state lawmakers last month that will literally make it more difficult for him to keep rapists and murders behind bars and to protect seniors from fraud and predatory financing schemes.

The $10 million budget cut that could force Stein to lay off more than 100 attorneys was not in the budgets passed by the House or Senate, it just magically appeared in the final budget agreement negotiated in the backrooms by legislative leaders.

There has still been no real explanation for the cuts, other than Senate President Pro Tem Phil Berger saying that Republican leaders did not like the way Stein was doing his job.

Not too long ago in Raleigh, people in both political parties would howl if something appeared in the final budget that was not in either the House or Senate spending plan.

It is against the rules of the General Assembly and it violates a fundamental principle of the legislative process by allowing a handful of lawmakers to make important decisions in secret, away from the media, away from the public and even away from rank-and-file senators.

The media would traditionally howl, too, back in the day. If there was one thing folks in Raleigh and Washington could agree on in our democracy, it was that everyone should have their say.

That was especially true in the U.S. Senate, that used to be described as the greatest deliberative body in the world. Maybe that was always a bit of an exaggeration but it is not close to true anymore.

The fact that Sen. Tillis voted to proceed with the wildly undemocratic process this week comes as no surprise. Just a few years ago as state House Speaker, Tillis engineered the passage of restrictions on abortion rights by a last-minute maneuver attaching them to a motorcycle safety bill.

Say what you want about Obamacare, one of the most unfairly maligned laws in a generation, it passed in 2009 after the Senate Health Committee spent more than 60 hours of public debate over 10 days modifying it.

The Senate Finance Committee met 53 times to consider the proposal, took up 130 amendments, and had 79 roll-call votes, all out in public where everyone could see. As a recent story in Fortune Magazine pointed out, there were also 44 public hearings on Obamacare held in the Senate alone.

President Obama himself once answered questions in public about the ACA for 90 minutes. President Trump has yet to explain any of the details of the health care law that the House has passed and the Senate is considering to replace it.

Instead, the Senate this week debated legislation affecting 1/6 of the national economy — not to mention the lives of 50 million people — without even so much as a fake public hearing or staged committee hearing. They do not want to talk about the details of what they are proposing. They would rather people not know.

But democracy does not work like that in the long run, with people locked out of participating in it. Sen. McCain has made that point powerfully in the past and he made it again this week, his dumbfounding vote on Tuesday notwithstanding.

Many folks on the Right used to join with progressives to make the same point, that transparency and open debate and thoughtful consideration of important issues are all essential ingredients of a thriving democratic system of government.

Not anymore. The allies of the folks running the legislative branches of government in Raleigh and Washington are not the least bit concerned with the democratic means.

It is all about their ideological ends that justify everything, including people suffering without health coverage, and the crumbling of a once vital democratic process.

Chris Fitzsimon is founder and executive director of N.C. Policy Watch.

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Chris Fitzsimon

Contributing Columnist