This week marked the utter collapse of health care reform efforts in the U.S. Senate. With several GOP defections, the Senate’s bill was mercifully put out of its misery.

Of course, Mitch McConnell has put forward the very idea he appears to have wanted to avoid by calling for a floor vote for a full repeal of the Affordable Care Act… which, if you recall, is the entire reason the voters supported the GOP in three of the last four election cycles.

However, to say that there is a lack of confidence that this current plan will succeed is an understatement.

The GOP struggles in Congress when it comes to leadership. And, the Senate is the prime example of leadership failure. Mitch McConnell, the Senate Majority Leader, bears a lot of the blame for the chamber’s failure to push a conservative agenda.

To be fair, Mitch McConnell is great at winning battles. He thrives in a fight, and he is an able tactician when it comes to orchestrating a floor fight. Where McConnell struggles is long-term strategy and pushing an agenda, and it is a weakness that has caused the GOP-run Senate to flounder even while the party holds the White House.

One of the problems is that McConnell’s heart is simply not into conservative agendas. A lot of his best fights are ones that involve his power base. He can make conservative-ish decisions when they ensure his position or elevate his profile. But, when it comes to making conservative legislative choices for the sake of ideology, he simply cannot make himself do it.

Another big problem is that McConnell and his ilk do not like to start from the right on any issue. They start from the middle. Whether it is a liberal streak that keeps him from putting too much conservatism into his legislative efforts or just laziness in wanting to avoid negotiation, the result is that he always finds himself having to deal with conservative insurgency just to get a single idea put in.

The health care reform battle is a case in point. With more than half a decade to come up with a plan, the Senate puts forward a bill that violates the spirit of the GOP’s central promise to its voters (repeal Obamacare), and it is a bill that would have done better if it were the end result of negotiations, and not the first and seemingly only draft McConnell and other GOP leaders wanted to put forward.

So, on health care reform, the single biggest reason that the GOP has enjoyed electoral success since 2010, the GOP has absolutely dropped the ball, and the problem (no matter what GOP leadership like McConnell will tell you) is not that conservatives are obstructionists. The problem is with the liberal streak running rampant through the GOP in Congress.

What made Ronald Reagan, one of the templates of conservative leadership, so great is that he led his party by starting as far to the right as possible on an issue and negotiating his way inward. Sure, the Democrats picked up some victories, but there was a lot of moving the ball down the field when it came to conservatism.

Those days are long gone now as McConnell and gang skip the negotiation part and start in the middle. The result is that they give up so much and the Democrats pick up greater victories as a result. And that’s when McConnell can manage to get a bill passed.

There is no easy solution here. McConnell excels at short-term battles, so dethroning him is not going to be easy. He and his friends also direct a lot of resources to beating any challengers to the more liberal senators in the GOP caucus. If conservatives want to get anywhere, they have to overcome these factors and get conservative fighters into the Senate.

Until then, however, call your senators and apply as much pressure as possible. They ran for years on certain promises, and they have to be held accountable here. If they aren’t, then we can kiss good conservative reform under a GOP administration goodbye.