Tom Price, the orthopedist and  foe of the Affordable Care Act, may have been jettisoned from his job as Health and Human Services secretary,  but his agency’s effort to sabotage Obamacare smolders on.

Politico, the  online site, deserves a taxpayers’ salute for its dogged pursuit of Price’s self-entitled obsession with feeding at the public trough, traveling to swanky resorts in Aspen, Colo., Maine, and Georgia on the priciest public dime possible—private charter jet flights that cost thousands of dollars a pop. He purportedly did so in the people’s interest, with his agency initially claiming he was jetting off to combat the opioid drug abuse epidemic or woes connected with the recent, catastrophic hurricanes.

But over a few weeks his fabrications unraveled. Politico caught the secretary—who knew the media were scrutinizing his profligacy—jetting to Philadelphia, rather than taking a fast, cheap, and easy train. Price claimed he needed to attend a parley of health care swells in Georgia but also made tracks to a coastal resort area where he owns property. He publicly defended his travel by saying it helped him avert missed, key duties as HHS chief, only to have Politico debunk that tale by discovering Price became angry and started flying private jets because a storm-canceled commercial flight caused him to miss a stay at a session of health care execs at a luxe Ritz Carlton on the Southern California coast.

And, of course, he popped over and into a Nashville program put on by a physician who happens to be a big donor to President Trump. His surprise appearance was a bit of a mystery to attendees. Until, of course, Politico revealed that Price left the parley quickly and managed to lunch with his son, a Vanderbilt alum.

Even the golf-obsessed Trump, who is busting the public piggy bank with his weekending on links he owns, couldn’t overlook Price’s air caprices, especially when the former congressman stuck it to the White House by getting officials there to approve he and his wife riding in dubious fashion on costly military transports in Europe, Africa, and Asia. One 95-minute hop (Berlin to Geneva), on which there were abundant, significantly more affordable options—as Politico reported almost always was the case—cost taxpayers $16,000, when commercial flights might have been had for as little as $60.

Price had offered a halfhearted apology and a risible $50,000 repayment for his seat only on more than two dozen charter jet flights, costing taxpayers a total of $400,000 or so. He never explained who would pay for staff who accompanied their boss on these travels. He claimed (but no record has surfaced yet) that he had reimbursed Uncle Sam for his wife’s travel on military transports, on which he racked up an estimated $600,000 in charges.

Price resigned, his conduct an even more egregious flash point because he not only was the ostensible point person and lead co-conspirator on Congress’ repeated failures to repeal and replace Obamacare but also the architect of the Trump Administration’s campaign to slash billions of dollars in federal funding to programs for medical research and medical services to the poor.

ACA sabotage?

Yet Price’s political harm survives him. Evidence mounts by the day that Trump officials are working to undermine the ACA administratively. They are dragging their feet with month-by-month payments of key cost subsidies for Americans who can least afford health insurance, a move that has added to insurer uncertainty and caused coverage cost increases for those who get Obamacare. The administration has slashed support for ACA outreach, moves to get younger, healthier Americans to get insured and to broaden risk-pools and thereby reduce coverage costs for all. Trump officials, who already shrunk the ACA open enrollment period, also have announced they will shut down systems for online Obamacare sign-ups for long spans on weekends, ostensibly for needed computer maintenance.

Price and other Trump officials already had carved at ACA efforts to improve the quality and efficiency of medical services, for example by holding up pushes to get providers to provide “bundled” payments for select procedures like common and costly knee and hip replacements, rather than allowing them to run up charges with multiple fees for procedures. The Administration also has sought to foster state-by-state changes to the Obamacare-expanded Medicaid programs, now helping a huge and broad range of Americans. These would be allowed under ACA waivers, and they might include cruel requirements for the working poor to take repeated time off work to re-up their benefits or for the ailing aged and chronically ill to prove they cannot work. They also have included innovative attempts to curb costs, notably for prescription drugs.

In my practice, I see not only the harms that patients suffer while seeking medical services but also their toil and struggle to afford medical care, especially if they lack or have poor health insurance. After more than five dozen attempts over seven years to vaporize the ACA, GOP lawmakers have succeeded mostly in showing they have zero understanding of Americans’ health plight and how insurance coverage makes or breaks them. Medical costs persist as a leading cause of personal bankruptcy (though the ACA helped cut this significantly), and some Americans spend disproportionate amounts of their household income on medical care.

Helping the neediest

The New York Times’ Upshot feature, which focuses on evidence-based responses to public policy challenges, has pointed out that partisans seem blind to the public demand for good health and its security, not necessarily to the messy complexities of health insurance or the health system on which they spend $3 trillion a year.

Because of their failure in discernment, GOP lawmakers, especially, balk at the mere notion of shared risk. They won’t accept the reality of an insurance fundamental: High costs for medical services for a few constitute less of a burden if spread among many. Instead, Price, Trump, and other GOP officials have pressed for a system where if Americans get sick, they’re on their own. They refuse to consider, as growing numbers of their voters have, that health care is a right, not a privilege, especially of wealth. (There’s an excellent new New Yorker article on this issue.)

As the Upshot has noted: “Just 1 percent of patients account for 20 percent of costs, and 5 percent of the population accounts for nearly half the nation’s health care spending. But exactly who these patients are — and how we can better meet their needs — is less clear.”

The column by Dhruv Khullar, a New York physician and public health researcher, goes on to identify the high-needs Americans, whose demands for care the country must address if it really wants its health system to function better, more efficiently, and at lower cost, as:

They are veterans with disabilities, grandparents with Alzheimer’s, young women with lupus, kidney transplant recipients, factory workers with cancers that rage through rounds of chemo. Three-fourths are white, two-thirds are women, half are over 65, and more than a quarter did not finish high school. They have more social stressors like housing insecurity and social isolation, and many have serious mental illness and substance use issues that contribute to higher rates of emergency department visits, hospitalizations and difficulty navigating the health system. More than 80 percent are publicly insured through Medicare or Medicaid.

Khullar quotes David Blumenthal, a health policy expert and president of the Commonwealth Fund, observing: “We can’t make the system work unless we do better with this population. It’s important from a humane standpoint — these are our friends, our family. But it’s also important from a cost standpoint, and the effect on taxpayers.”

Under the current system, which Price defended to the teeth, doctors, hospitals, and the health system gets paid, piece meal, for caring for patients—a fee for every service. The chronically ill don’t get comprehensive services that would better address their conditions. The country keeps developing wonder drugs that cost a half-million dollars a dose, while refusing to consider whether spending a few hundred dollars on food and van services would keep some repeat patients out of emergency room admissions that cost the system millions of dollars each.

CHIPs and congressional staffers’ stock trading

It’s worth noting that Congress was so obsessed with bashing the ACA that it left town without reauthorizing the Children’s Health Insurance Program, aka CHIPs. It provides coverage to 9 million poor and moderately poor youngsters, and its federal funding—for which a long-term bipartisan deal purportedly had been struck—officially expired on Sept. 30 and will run dry in states soon. It’s ridiculous that lawmakers can’t get this program funded when its long-term returns, both financially and in children’s health, are undisputed.

Congress’ incapacity to focus on public priorities like kids’ health, of course, may be driven by some other factors. Politico here, again, deserves huge credit for digging into awful regulatory gaps that allow congressional staff to wheel and deal in stocks of companies that may be affected by legislation before them. Reporters have detailed how staffers have quietly bought and sold Big Pharma shares, even as committees they work on have considered crack downs or legislation on drug makers. They have engaged in health care stock transactions throughout lawmaker deliberations over the ACA. Many say their bosses know about and approve their conduct, or their dealings are handled in ways so they are blind to their benefits or losses. Who’s draining this swamp?