President-elect Donald Trump speaks during a "USA Thank You" tour event on Thursday.` Credit:AP This choice probably means that the Affordable Care Act is doomed - and Trump's most enthusiastic supporters will be among the biggest losers. The first thing you need to understand here is that Republican talk of "repeal and replace" has always been a fraud. The GOP has spent six years claiming that it will come up with a replacement for Obamacare any day now; the reason it hasn't delivered is that it can't. Obamacare looks the way it does because it has to: you can't cover Americans with pre-existing conditions without requiring healthy people to sign up, and you can't do that without subsidies to make insurance affordable.

Obamacare critic Tom Price has been nominated as Trump's secretary of health and human services. Credit:AP Any replacement will either look a lot like Obamacare, or take insurance away from millions who desperately need it. What the choice of Price suggests is that the Trump administration is, in fact, ready to see millions lose insurance. And many of those losers will be Trump supporters. You can see why by looking at census data from 2013 to 2015, which shows the impact of the full implementation of Obamacare. Over that period, the number of uninsured Americans dropped by 13 million; whites without a college degree, who voted for Trump by about two to one, accounted for about 8 million of that decline. So we're probably looking at more than 5 million Trump supporters, many of whom have chronic health problems and recently got health insurance for the first time, who just voted to make their lives nastier, more brutish, and shorter.

Why did they do it? They may not have realised that their coverage was at stake. Over the course of the campaign, the news media barely covered policy at all. Or they may have believed Trump's assurances that he would replace Obamacare with something great. Either way, they're about to receive a rude awakening, which will get even worse once Republicans push ahead with their plans to end Medicare as Americans know it, which seem to be on even though the President-elect had promised specifically that he would do no such thing. And just in case you're wondering - no, Trump can't bring back the manufacturing jobs that have been lost over the past few decades. Those jobs were lost mainly to technological change, not imports, and they aren't coming back. There will be nothing to offset the harm workers suffer when Republicans rip up the safety net. Will there be a political backlash, a surge of buyer's remorse? Maybe. Certainly Democrats will be well advised to hammer Trump's betrayal of the working class non-stop. But we do need to consider the tactics that he will use to obscure the scope of his betrayal.

One tactic, which we've already seen with last week's ostentatious announcement of a deal to keep some Carrier jobs in America, will be to distract the nation with bright, shiny, trivial objects. True, this tactic will work only if news coverage is both gullible and innumerate. No, Trump didn't "stand up" to Carrier - he seems to have offered it a bribe. And we're talking about a thousand jobs in a huge economy; at the rate of one Carrier-size deal a week, it would take Trump 30 years to save as many jobs as President Barack Obama did with the car bailout; it would take him a century to make up for the overall loss of manufacturing jobs just since 2000. But judging from the coverage of the deal so far, assuming that the news media will be gullible and innumerate seems like a good bet. If, and when, the reality that workers are losing ground starts to sink in, I worry that the Trumpists will do what authoritarian governments often do to change the subject away from poor performance: go find an enemy. Remember what I said about Trump Twitter. Even as he took a big step toward taking health insurance away from millions, Trump started ranting about taking citizenship away from flag-burners. This was not a coincidence.

Loading The point is to keep your eye on what's important. Millions of Americans have just been sucker-punched. They just don't know it yet. The New York Times