Even while he's floundering and crimin' his way across the landscape, El Caudillo del Mar-a-Lago still needs watching—not just because of his many offenses against the Constitution and against human decency, but also for all the standard Republican policy goals that he's putting within reach. For example, on Thursday, the president* signed an executive order that supposedly "improved" Medicare. Then he flew to Florida to lie about it in front of an audience of the elderly. Within the executive order is a poison pill the size of a horse's head. Check out Section 3.

Section 3: Providing More Plan Choices to Seniors. (a) Within 1 year of the date of this order, the Secretary shall propose a regulation and implement other administrative actions to enable the Medicare program to provide beneficiaries with more diverse and affordable plan choices. The proposed actions shall:



(i) encourage innovative MA benefit structures and plan designs, including through changes in regulations and guidance that reduce barriers to obtaining Medicare Medical Savings Accounts and that promote innovations in supplemental benefits and telehealth services;

(ii) include a payment model that adjusts supplemental MA benefits to allow Medicare beneficiaries to share more directly in the savings from the program, including through cash or monetary rebates, thus creating more incentives to seek high-value care; and

(iii) ensure that, to the extent permitted by law, FFS Medicare is not advantaged or promoted over MA with respect to its administration.

(b) The Secretary, in consultation with the Chairman of the Council of Economic Advisers, shall submit to the President, through the Assistants to the President for Domestic and Economic Policy, a report within 180 days from the date of this order that identifies approaches to modify Medicare FFS payments to more closely reflect the prices paid for services in MA and the commercial insurance market, to encourage more robust price competition, and otherwise to inject market pricing into Medicare FFS reimbursement.

That, dear friends, is pretty much the same plan that Paul Ryan, the zombie-eyed granny starver from the state of Wisconsin, spent years trying to slime into law. It is the first big step toward Ryan's lifetime goal of privatizing the Medicare system, which, as someone who has enjoyed its benefits for almost a year, I can tell you is a terrible idea. Look at all the little buzzing land mines in there. "Competition." "Market pricing." This thing even expands Medical Savings Accounts, a terrible idea that emerged in the 1990s and that Bill Frist was going to ride into the White House in 2000.

The president* is a blight and impeachment is the only cure, but the conservative project rolls merrily on. I'm not entirely sure he knew what he was signing, because he doesn't know anything about anything, but the people who find him useful do, which is why he'll be around for a while longer.

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Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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