As the Republican-controlled Congress rams through a national budget and a package of changes to the tax system, President Trump and his partisans are staying true to course. They’re determined to slash taxes for the rich, even if they only half-heartedly tackle one of the biggest public health crises in decades, and if they inflict great harms on the health of the poor, sick, young, and old.

In answer to long and increasing criticism, Trump finally declared the opioid drug abuse epidemic a “public health emergency” (with zero new dollars in spending)  but not a “national emergency,” which would have opened the door for millions in new spending.  He scored points with some commentators with his discussion of how alcoholism destroyed his older brother Fred’s life, and, how his brother’s advice and example had kept him from any temptations of substance abuse. (He also reminded critics of ineffectual “Just say no” anti-drug campaigns.)

But for all his pronouncements, the president’s actions fell short of what many anti-drug experts and advocates had hoped would be White House leadership against opioids abuse and overdose deaths, a scourge that has claimed almost 60,000 lives since 2016.

That’s because Trump, who often boasts about his wealth, business acumen, and personal intelligence, failed to identify or to provide any added money to fight drug abuse and overdoses. As the New York Times summarized the president’s “public health” plan, it will allow:

… some grant money to be used to combat opioid abuse, permit the hiring of specialists to tackle the crisis, and expand the use of telemedicine services to treat people in rural areas ravaged by opioid use, where doctors are often in short supply. Mr. Trump said his plan would include a requirement that federally employed prescribers be trained in safe practices for opioid prescriptions, and a new federal initiative to develop nonaddictive painkillers, as well as intensified efforts to block shipments of fentanyl, a cheap and extremely potent synthetic opioid manufactured in China, into the United States.

These steps, however, won’t do much to dent the suffering and deaths caused by opioids, especially as they keep acting as a gateway to more dangerous, lethal, and illicit drugs, including heroin and fentanyl, critics have said.

They say that federal agencies, especially the Health and Human Services department—which is without a chief after Tom Price was forced out after spending $1 million in taxpayer funds for charter and military jet flights—must step up efforts to reduce prices and availability of naxalone, an opioid-reversing medication. Uncle Sam also must help millions of Americans, many of them blue-collar, rural, Southern and Midwestern whites who are the GOP base, get costly treatment for their painkiller addictions.

Here, of course, is where the Republican crazy-making kicks into high gear. That’s because the chief way that tens of millions of lower- and middle-class Americans get medical and mental health services they need to kick opioid addictions and to care for conditions, many chronic, that afflict them with debilitating pain comes through Medicaid and Medicare—two programs loathsome to the GOP.

House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell have pledged to get passed a GOP tax package by December. To do so, they also had to ram through a new budget, which, for technical reasons, will allow consideration of the prospective and still undefined tax changes under the arcane Senate reconciliation rules. Translation: Republicans can jam through their tax cuts for the rich with little fear of a Senate filibuster by Democrats and with 50 votes. This is the exact plan GOP lawmakers followed to repeated defeat in their latest efforts to repeal and replace the Affordable Care Act, aka Obamacare.

But with the budget and taxes, President Obama can’t be the partisans’ bogey-man, as he was with Obamacare. The GOP is crystal clear now on its harsh assaults on most Americans’ health and well-being to benefit the rich, with Congress approving a budget resolution that vaporizes somewhere between $1.8 trillion to $2 trillion in funding for health programs with no specifics on how or why. Meantime, the unspecified GOP plans would slash taxes for the wealthy by anywhere between $900 billion to $1.6 trillion in the same period.

To be clear, the GOP approved budget resolution isn’t a final document that will dictate the nation’s spending—yet. As with the various versions of Trumpcare, lawmakers haven’t drafted a bill that shows in black and white how any tax changes might occur. It isn’t clear if the package will eliminate or curb popular tax breaks, such as deductions for home mortgage interest and for state and local taxes, as well as reductions in tax-advantaged contributions to retirement savings programs like 401Ks.

The Republicans could see their budget and tax schemes blow up as did their efforts to kill the ACA by legislative vote. The House approved the budget resolution in a 216-212 vote, with 20 Republicans dissenting—not a great sign for what lies ahead. It’s also worth noting that reputable polls show that fewer than a third of Americans support the president’s tax plans, especially with their huge payday for plutocrats.

In my practice, I see not only the harms patients suffer while seeking medical services but also the horrors they experience with dangerous drugs, and their terrible ordeals in figuring how they can afford the skyrocketing costs of medical care. It’s beyond confounding to me how partisans could have been so battered in the ACA rout and not emerged with a sense of how deep and broad is the need and support for Medicaid and the array of medical services it provides to so many Americans, especially the poor but also the middle-class. With 10,000 baby boomers retiring daily and shockingly few of them with sufficient savings to be anywhere close to comfortable when they do so, it’s also stunning to see the GOP attack Medicare.

It is good to see that the tide of public opinion has shifted so profoundly about the gravity of the opioid drug epidemic that some of the wealthy who have helped foster this health crisis finally are getting some deserved comeuppance:

• John Kapoor, who founded Insys, a drug firm that enriched him and itself by peddling Subsys, a medication that is fentanyl sprayed under the tongue, has been arrrested and charged by federal prosecutors with “leading a nationwide conspiracy” to profit from illegally distributing pain medication.
• Purdue Pharma Inc., which has made huge profits from its sales of its OxyContin painkiller, is under its second federal investigation, reportedly over its aggressive and sketchy advertising and marketing.
• Arthur, Mortimer, and Raymond Sackler—all physicians—and their heirs are sharing in some deserved ignominy in a detailed New Yorker profile of how this philanthropic dynasty has been the secret owners, boosters, and beneficiaries of booty from Purdue. It is a privately held company whose corporate ownership by the Sacklers long has been shielded from public view, also protecting the Sacklers from the growing scandal about its big role in the opioid drug abuse epidemic. Has their major family underwriting of arts, cultural, medical, and scientific institutions immunized them from criticism and blame for Purdue’s rapacious selling of OxyContin? The literary magazine titles its expose: The family that built an empire of  pain.

Meantime, as Congress obsesses about how to make America’s richest 1 percent happy, lawmakers continue their unacceptable neglect of the nation’s needy children. The Children’s Health Insurance Program, aka CHIPs, helps ensure the health and well-being of 9 million poor and lower-income children, and it has won bipartisan support. Lawmakers have claimed they have reached a deal to ensure the program, whose funding expired Oct. 1, keeps up its good works for at least five years, without the need for a year-by-year reauthorization.

But partisan squabbling has erupted and CHIPs support, which some states already have run out of, is in peril. C’mon, Congress, take a break from fawning over the rich and help poor kids at least.