Fake Don promised "something terrific!" healthcare reform that would "cover everybody!" at "less cost!" Nearly three years into the Era of Trumpery, the already obscenely-exorbitant cost of US healthcare continues to rise, millions more are uninsured, and they have their bloated medical costs routinely dumped on the taxpayer. Of course, Trump routinely lies, but the powerful parasites that feed off the system feverishly lobby and carrot-and-stick congressman to keep their turgid cash cow permanently on the extravagant life support. Medicare for All is the actuarily-sound approach as repeatedly demonstrated by advanced nations, but is still politically impracticable in the US. Millions of Americans derive their living by performing multiply-duplicated functions in multiply-duplicated granfalloons that recompense multiple-duplicated executives with multiply-duplicated exorbitant compensation packages, as well as consigning a sizable portion of every health care dollar to agency compensation, overhead, advertising, marketing, and the aforementioned industrial-strength lobbying. This is a shamefully inefficient use of the healthcare dollar. Progress is desperately needed, but abrupt progress is as prudent as putting the pedal to the metal when the traffic light turns green. The nation, confronting the ever-rising cost of TrumpCare (amidst the inevitable monumental cost of mitigating anthropogenic climate change) must adopt a better approach. I had previously suggested an incremental lowering of the Medicare eligibility age that would progressively incorporate lower-risk demographics into the pool, but the US has 50 laboratories where alternative approached can be tried. Economy of scale demands national participation to be optimal, but a state by state approach may contribute to a solution. Eventually, the federal government will have to extract itself from the private sector, and stop paying billions of taxpayer dollars in subsidies to divert employers' pursuit of profit to administer the plethora of diverse, group health plans (a diversity that increases cost at the provider end as well, obviously.) Progress must happen, but entrenched special interests and dogmatic ideologues will vehemently oppose it. An incremental approach is far superior to an unsustainable stagnation.