Overselling the number of people who will be hurt by Trump’s move misses the point. The most striking feature of his decision is its arbitrariness. Actual “straight-up sabotage” would look very different from this executive order. This is not something you do when you are applying all your natural cunning and resources to the cause of hurting people; it’s something you do because it is 1 p.m. and you are still in your pajamas feeling listless and bored and want to check at least one thing off your long-forgotten to-do list.
This policy-making as ennui therapy has been a long-running feature of the GOP’s various undifferentiated attempts to “repeal and replace” ObamaCare. No sentient adult human being actually thought about the prospective changes, such as keeping but not funding the expansion of Medicaid, swapping an income-based tax credit with one based on age, and eliminating the tax penalty for the uninsured and replacing it with a handout to insurers. I am no statistician, but I feel comfortable saying that it would not take a room full of chimpanzees with keyboards a hundred years to come up with a bill objectively superior to the ill-fated Graham-Cassidy health-care bill and its many predecessors; it would take a single, possibly intoxicated ape about five hours, assuming he was a slow typist. Nobody thought about any of this. Nobody cared.