Far be it for Donald Trump to pass up an opportunity to make another mess for the political party that he now dominates. So he decides to promise the greatest of all health care plans.

He even named the three senators who he said will lead the charge in repealing and replacing the Affordable Care Act. Problem is, they all seem to be busy with other more important things – like watching grass grow.

The best and brightest in the White House apparently didn’t bother to explain to Trump that there is no Republican plan for health care, and more importantly, the party’s members in Congress won’t go near the issue with a ten foot pole.

There does seem to be some acknowledgement among Republicans that health care issues are important to a large portion of the American electorate. Losing forty seats in the House of Representatives in campaigns that highlighted things like protection for pre-existing medical conditions has certainly focused attention, even with a president who wouldn’t have a clue about what would go into a Republican health care plan.

This is all consistent for the gang that can’t shoot straight, but nonetheless, it brings attention to the importance of health care as a 2020 issue.

Democrats, of course, are all over the lot on the subject. Bernie Sanders and the Bernie-want-to-be’s, including Senators Corey Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren, are pushing “Medicare-for-All,” a plan that would create a federal single-payer program to cover all Americans.  Despite the arguments of some Republicans who are still trying to re-litigate the 1965 law, Medicare is not just settled law, it is chiseled in stone.  And Medicare is the most efficiently run health care coverage in the country.

If the founding fathers (because the founding mothers were not allowed to be involved in such decisions) had debated medical insurance coverage back in 1787 they might very well have come up with something like Medicare-for-All. The problem that Congress faces in 2019 is that we are not starting from a blank slate when trying to fashion a better health care system.

Medicare-for-All would essentially eliminate all private medical insurance through employers while also sweeping aside subsidized Obamacare coverage and the Medicaid system. Sanders wants the available- to-all Medicare to provide for more things than are currently covered, but the expanded coverage is not defined.  Deductibles and co-pays would go away.  Federal taxes would pay for the system.

Nobody really knows what Sanders’ plan would cost, including Sanders. Estimates run as high $32 trillion over the next ten years.

The intention is that the program would be paid for by higher –much higher – taxes but that overall costs to Americans would be less because of what they would save on insurance premiums, deductibles and co-pays compared with the increase in their taxes. Natural public suspicion, taken to its current high point in the age of Trump, will make explaining, much less convincing people to support the plan, a pipe dream.

And how would Bernie navigate the political rocks and shoals that would challenge any effort to install Medicare-for-All into law? He will lead a revolution of the people, who will rise up and tell Congress what they want.  Sort of like the tea party on steroids.  “You say you want a revolution; [w]ell, you know we all want to change the world.”

So the questions for Sanders and his followers (including some of his fellow presidential candidates) are: “Is it honest to play make believe with the public about what you are proposing? What is the value of creating an illusion when there is really no path to implementing what you propose?”

Another alternative would be to make Medicare coverage available to people under the age of 65 while maintaining private coverage for those who prefer it. This would give people options.  Congressman Brian Higgins is working on such a plan.  Public details, again, are next to none, but at least the idea is planted in the reality of the legislative process.

Then there is the possibility of tinkering with the existing Obamacare coverage, which House Speaker Nancy Pelosi seems to favor. This would include providing additional financial subsidies to the state health exchanges.  Or perhaps ending the Trump-loving option of creating health care association plans, which he sells as inexpensive health care, but which are, in reality, nothing but fake insurance.

If then politicians on the right or left, Democrat or Republican, are really interested in providing access to affordable quality health care, what do the pols do to bring about a solution?

For Democrats the strategy is a bit simpler. Pretty much every Democratic politician wants to expand the availability of health care.  The trick will be to not let the perfect get in the way of the good when it comes to health care reform.

Republicans, on the other hand, are in many cases still doing all they can to prevent people from getting quality health care.  Consider the eight year game that the party played about repealing and replacing the Affordable Care Act.  They could not pull it off, even when controlling all the levers of federal power, because they lied about having some alternative plan in their back pocket.

Trump’s Justice Department has joined with some Republican state Attorneys General in a lawsuit to declare the entire Affordable Care Act unconstitutional. Up to twenty million people would lose health coverage if that were to happen, and things like protections for those with pre-existing conditions and continued family insurance for children up to the age of 26 would be gone.

Consider also the situation occurring in red states where the voters approved referenda to expand Medicaid only to have the Republicans running those states (Utah, Missouri, Maine) working to overturn the will of the people.

What it comes down to is that Republicans come at health care from a different angle, which basically says, “I’ve got mine, good luck getting yours.” These politicians are not bothered by the fact that many people in this country must often choose between feeding their family and seeing a doctor.

There is a great deal of talk from Democrats and Republicans, including Trump, about at least doing something about the skyrocketing costs of prescription drugs. Such action could provide great benefits to pretty much everyone in this country.  Government costs could be minor by essentially letting the companies absorb more of the cost of what people now pay for their prescriptions by reducing drug company profits.  The problem is that Big Pharma is big and powerful and has many friends in Congress and in the administration.

The year 2019 will be some sort of test for the United States. Is it possible, given all the collective interest in some solution, that the powers-that-be can at least come together to handle the universally supported and politically obtainable goal of reducing and controlling drug costs?  We are already seeing the run-up to the 2020 elections, but just maybe it is possible to do one good and important thing that will help everyone before the campaign silly season takes hold.