What did Donald Trump do today?

He revealed his new healthcare plan: pay for every medical expense out of pocket, like a billionaire.

The federal government has been shut down for 39 days because Trump refuses to fund the Affordable Care Act.  This means that the 24 million Americans who buy private insurance through ACA exchanges are seeing sharp and in some cases massive increases in their premiums.

The ACA, sometimes unofficially referred to as Obamacare, requires insurance companies to offer high-quality plans with yearly and lifetime limits on out-of-pocket costs. It covers preventive medicine like annual checkups, immunizations, mammograms, and other routine diagnostic exams. Crucially, it also prevents insurance companies from dropping a patient because of preexisting conditions. These benefits make health insurance actually useful and affordable for people who are not covered through an employer plan—but they also increase costs for the companies. Federal subsidies, which Trump is refusing to pay, are part of the bargain.

Trump himself belongs to a vanishingly small number of Americans who have never had or relied on private health insurance. Instead, his health care has come from two sources: the unlimited resources of the federal government, and physicians he hires personally. Private-pay arrangements are extremely rare precisely because few Americans can afford to simply pay out of pocket for everything from diagnosing a sprained ankle (which might cost about a thousand dollars without insurance) to performing an organ transplant (which might cost more than a million dollars).

Or to take another example, treatment of the "bone spurs" that Trump got diagnosed by a private physician in 1968, just before his final legitimate Vietnam draft deferment expired, would have cost about $11,000 in today's money—if he'd actually had them.

But that ability to pay for medical care out of pocket may explain Trump's announcement today of his new healthcare "plan." He called for the abolition of "BIG, BAD" health insurance altogether, and to give Americans a one-time payment to use towards a lifetime of medical expenses. At least, that was his plan this morning, according to a post to his private social media network before a day of relaxing at his golf resort:

I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over. In other words, take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare. Unrelated, we must still terminate the Filibuster!  

Trump has seethed for almost a decade now about his inability to dismantle one of the major domestic policy achievements of the Obama administration. While it's long been clear that Trump doesn't actually know what the program is or how it works—for example, he still seems to think that "ObamaCare" is a single private health insurance company—he's animated by his longstanding hatred for his predecessor.

Why does this matter?

• A healthcare plan that relies on every American being able to afford to spend money like a billionaire is a stupid plan.  

• It's more important that Americans have health insurance than it is that Donald Trump settle a personal grudge.