The Senate confirmation hearings of the genteel ideologues and shockingly unqualified rubes who would make up President-elect Trump's cabinet dutifully continued Wednesday afternoon, as Georgia congressman Tom Price, who Trump has tapped to head the federal Department of Health and Human Services, dutifully took his turn in the spotlight. Although Price has been dogged by allegations of trading on insider information while serving as a legislator, the most important aspect of his hearing is that his would-be job is the one that appears most poised to dominate headlines in 2017 as Speaker Ryan and friends work to appeal the Affordable Care Act without boning over the millions of their constituents who depend on the care it provides. (Whenever you're ready, guys.)

Congressman Price had a ton of pressure on him this afternoon, and it showed rather quickly. Massachusetts senator Elizabeth Warren, the former Harvard Law School professor whose reputation as a savage question-asker has certainly carried over to her tenure in the Senate, asked Price about his intentions with respect to Medicare or Medicaid. When Price gamely tried to pivot, Warren pounced.

WARREN: Can you guarantee to this Committee that you will safeguard President-elect Trump's promise, and while you are HHS secretary you will not use your administrative authority to carry out a single dollar of cuts to Medicare or Medicaid eligibility or benefits?

PRICE: What the question presumes is what money is the metric. From my view, from a scientific standpoint—

WARREN, EXASPERATED: Yes, I am asking that.

PRICE: —if patients aren't receiving care even though we're providing the resources, then it doesn't work for patients.

WARREN, NOT AT ALL SORRY: I'm sorry to interrupt, but we're very limited on time. The metric is money. And the quote from the President-elect of the United States was not a long discourse on this. He said he would not cut dollars from these programs, so that's the question I'm asking you. Can you assure this Committee that you will not cut one dollar for Medicaid should you be confirmed to this position?


PRICE: Senator, I believe the metric ought to be the care that the patients are receiving

WARREN, FUMING: I take that that's a no?

PRICE: That's the wrong metric—

WARREN, ALMOST PITYINGLY: I'm not asking whether you think of a better metric. I'm asking you a question about dollars, yes or no?

And so on and so forth. Warren finished her time with a rhetorical dagger twist so condescending that it hurt my feelings.

You might want to print out President-elect Trump's statement—"I am not going to cut Medicare or Medicaid"—and post that above your desk in your new office.

At first blush, this "not one dollar" standard might seem like a rather high one to hold Congressman Price to. But, sure enough, as the Washington Post discovered, it turns out President-elect Trump spent a lot of time on the campaign trail making this same promise.

In fact, Reince Priebus confidently reiterated this position just this last Sunday.

Price tried out this "disagree with the premise" tack several times during his hearing, plaintively arguing that the result for the patient, not the method of achieving that result, is what's important. In a limited sense, he's right—if Trump can cook up a social safety net that provides the same care provided under Medicare and Medicaid, great. The point Senator Warren was driving home, though, is that there is a notable, alarming dissonance between what the president-elect promised and what his cabinet nominee apparently believes— in fact, it wouldn't be the first time, either.

There are three possible explanations for this exchange, and none of them are good.

1. Trump has no idea what his nominees stand for, and he really just picked them because they're all rich, which is the only type of success he can comprehend.

2. Members of Trump's cabinet-to-be are acting as surrogates for the president-elect, and are laying the groundwork for breaking his campaign promises before he even takes office.

3. The grimmest option, though, is that the Trump repeatedly promised to save Medicare and Medicaid while having no idea whether that was realistic, because he knew that's what the crowds who attended his rallies and pledged their support wanted to hear.

All the Americans who depend on Medicaid and Medicare for their healthcare—both those who didn't vote for him, and those who did—will suffer the consequences.