Until now the plan has proven too radical for mainstream adoption, compared to more moderate reforms proposed by the likes of Ted Cruz and Paul Ryan. Representative Price has taken some iteration of the bill to the floor each year since the Affordable Care Act was passed, each time unsuccessfully. As Senator Charles Schumer described Price’s plans this week, these efforts have been seen as “far out of the mainstream of what Americans want.”

But when Donald Trump tapped Price as his secretary of health and human services on Tuesday, the Georgia surgeon’s plan took several sudden leaps toward becoming a part of all American lives.

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Tom Price, who will oversee a budget of more than $1 trillion, is a man of definitive ideology. A founding member of the Tea Party Caucus, he has vowed to fight what he calls “the vile liberal agenda.” That has included the Affordable Care Act, as well as legal access to abortions and marriages. When same-sex marriage was affirmed by the Supreme Court, Price called it “a sad day for marriage.”

Price has painted the health-care reform passed during the Obama presidency as a manifestation of “oppressive” government. He has rallied against the Affordable Care Act since before its passage in 2010, saying it was “doomed to fail from the beginning” and playing a vocal role in seeing that through.

Yet Price’s vision for health transcends simply opposing President Obama, and his work is evidence that he is doing more than echoing partisan rhetoric. This week, The New York Times editorial board described Price as “a man intent on systematically weakening, if not demolishing, the nation’s health-care safety net.”

As Price puts it, though, the goal is rather to improve patient-doctor interactions.

From the perspective of a doctor who went into politics to get government out of the way of medical practice, among the barriers are elements of Medicaid and Medicare—the so-called safety-net programs that provide health care to poor, disabled, and older Americans. In an attempt to contain spending and ensure quality, Medicare and Medicaid come with guidelines that dictate reimbursement. Many doctors find the systems’ requirements tedious and cumbersome—a common and serious complaint among doctors, who tell me they feel the art and autonomy of medicine are lost amid tedious paperwork and other minutiae.

For many doctors, then, wealthy patients who can simply pay in cash, or through expensive private insurance plans, are relatively hassle-free (and more lucrative) prospects. This leaves a clear target for a doctor who is also deeply ideologically opposed to most any form of government intervention. Downsizing these programs would mean freeing doctors from dealing with patients insured by the cost-containing plans that many feel are too bureaucratic.