Mark Shields is off. The following is a column by Joe Conason.

Even before the embarrassing demise of his health care legislation, Donald Trump could no longer claim that he would ”take care of everybody” with a ”beautiful” new system that insures all Americans, regardless of their ability to pay. Such election-year vows were abandoned months ago, when the Trump White House allowed Republican Congressional leaders to shape the ”repeal and replace” bill he had also promised.

The result, as everyone knows, was a series of proposals so ”mean” — according to Trump himself — as to end coverage for tens of millions of Americans.

Trump’s broken promises of cheaper and better medical care for all, which were surely never sincere, crystallized the intellectual and moral laziness of his presidency. But with this president, bad inexorably becomes worse. And now, following the defeat of his terrible Trumpcare initiative, he is plotting revenge that would gravely harm still more people, many of them in families that supported him.

In a fit of tweeted pique, Trump threatened to withhold the Affordable Care Act’s ”bailouts” of insurance companies, a reference to ”cost-sharing reduction” subsidies that help poor families cover co-payments on drugs and medical care. At the same time, his administration is undermining Obamacare enrollment efforts. The impact of these actions could be ruinous to the insurance market, driving companies out of state exchanges and driving up premiums paid by struggling families.

No president in recent memory has taken such an irresponsible, vengeful and destructive approach to public policy.

Indeed, Trump has frightened some of the most conservative Republicans in Congress, who appear to realize that if the insurance market crashes, voters will blame them — not President Obama and not the Democrats who passed Obamacare.

Senator Lamar Alexander, the Tennessee Republican who chairs Senate’s Health, Education, Labor and Pensions Committee, is pleading with the president to approve the Obamacare payments for the coming two months, and wants to include them in the 2018 budget. Even Rep. Mark Meadows, R-N.C., who chairs the ultra-right House Freedom Caucus, wants to continue the subsidies. Many Republican lawmakers who held their noses to vote for the awful health care bills pushed by Trump and Majority Leader Mitch McConnell are simply terrified the president will do something stupid that causes permanent damage.

The ironic effect of Trump’s Twitter tantrums has been to force Republicans to begin talking with Democrats about how to preserve and repair Obamacare. That is exactly what they have refused to do, strictly for partisan reasons, ever since the law passed. No matter what Trump had promised, they expected to ram through a ”health care bill” that was actually a huge tax cut for the wealthy and a giant benefit cut for poor and working Americans. But their own constituents revolted against this scheme and defeated the bill.

Now, dozens of Republicans in both the House and Senate are engaged in negotiations with Democratic colleagues over ways to maintain the subsidies, at least temporarily.

But with the House on recess, those suddenly sensible conservatives are not in any position to prevent Trump from wreaking havoc on health care. Before Congress can take any action, the Trump White House can simply order an end to the payments, which have continued on a month-to-month basis, and let the markets collapse. Of course, the Republicans can hardly complain now, since they supported his candidacy despite the obvious defects in his character and personality.

It was always predictable that Trump would inflict great harm on the Americans who voted for him and whose interests he swore to protect. With his ego at stake on health care, those people are in grave danger of losing their health coverage. And having lost that coverage, some of them will lose their lives.

To find out more about Joe Conason and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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