As a presidential candidate four years ago, Donald Trump not only railed against the Affordable Care Act; he also made bold promises about the magnificence of his alternative plan. The Republican’s alternative to “Obamacare” would offer everything Americans they could dream of, including better coverage at a lower price. All voters had to do was elect him.

In reality, of course, Trump didn’t know and didn’t care about how to deliver on these promises. He was peddling post-policy nonsense, counting on the electorate to not know the difference.

As a president, when it came time to follow through, Trump was lost without a map, amazed to discover the complexities of an issue he never even tried to understand. The Republican endorsed plans that did the opposite of what he told voters he’d do, and when it came time to engage in actual negotiations, Trump struggled to keep up — his ignorance kept getting in the way.

Four years later, with his Supreme Court justices positioned to tear down the nation’s health care system, Trump has a new pitch, which sounds an awful lot like his old pitch. Here was the presidential message he published to Twitter yesterday afternoon:

“We will have Healthcare which is FAR BETTER than ObamaCare, at a FAR LOWER COST – BIG PREMIUM REDUCTION. PEOPLE WITH PRE EXISTING CONDITIONS WILL BE PROTECTED AT AN EVEN HIGHER LEVEL THAN NOW. HIGHLY UNPOPULAR AND UNFAIR INDIVIDUAL MANDATE ALREADY TERMINATED. YOU’RE WELCOME!”

Seven minutes later, he added, “Republicans must state loudly and clearly that WE are going to provide much better Healthcare at a much lower cost. Get the word out! Will always protect pre-existing conditions!!!”

In context, the president must’ve been watching the Senate Judiciary Committee proceedings, with one Democratic senator after another stressing the importance of the existing health care system. Apparently feeling vulnerable, this led Trump to argue that health care voters shouldn’t fear his re-election.

The problem — one of them, anyway — is that Trump doesn’t have the foggiest idea what he’s talking about. If it was possible for GOP officials to craft a plan that offers better care at a lower cost, with lower premiums and even stronger protections for those with pre-existing conditions, Republicans would’ve unveiled it by now.

Indeed, consider how long Americans have been hearing pie-in-the-sky rhetoric along these lines, waiting for Trump and his party to deliver. The president has had four years to come up with a comprehensive plan, not including the year and a half he spent on the campaign trail making related boasts. What’s more, Republicans started promising to unveil a superior alternative to the Affordable Care Act in 2009, which means we’ve actually been waiting for more than a decade.

And yet, there is no such proposal. Three weeks ago, the president claimed he was unveiling a “plan” to improve health care and to protect Americans with pre-existing conditions, but what Trump actually signed were some executive orders that literally didn’t do anything.

Why does this matter? For one thing, because Trump is — right now, as Election Day nears — actively involved in a legal effort to destroy the nation’s existing health care system, stripping tens of millions of families of benefits they’ve come to rely on. He wants Americans to believe they need not fear his success, because he’ll replace the ACA with a superior alternative, but the entire pitch is a brazen lie.

For another, this isn’t even a fight the president should want to have right now: health care is, and has been, a losing issue for Trump. The more he focuses attention on this, the more it hurts his candidacy.

But as important as these details are, it’s the big picture that’s worth remembering: Trump pulled a con on health care four years ago, and a lot of people fell for it. Four years later, he’s trying to run the identical scam.