US President Donald Trump is seeing the limits of healthcare rhetoric. Credit:Bloomberg By lunch time, McConnell had pulled the pin, telling reporters he would not bring the health bill to the Senate floor. The Kentucky senator tried to put a brave face on his admission of defeat. "We haven't given up on changing the American health care system," he told reporters. "We are not going to be able to do that this week." But that "this week" reference was a nod to Senate reality. The expiry this week of a Senate voting rule means that, in any future R-and-R attempt, the Democrats will be able to filibuster. That means that, instead of having to hold on to a handful of his own GOP members, McConnell would need more than a handful of Democrat votes to win.

Senate Majority Leader Mitch McConnell pulled the pin on the health care vote. Credit:AP Here was the party - which likes to tell voters it represents the natural order - in total disorder as its near decade-long campaign to destroy Trump's predecessor's signature legislation collided, terminally, according to most analysts, with the brick wall of its own incompetence. They tried repeatedly to kill the nearest the US has come to a national health scheme while Obama was in office. Despite serial failures, they kept coming back, as Paul Keating would say, "like a dog returns to its vomit". Trump supporters believed House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer of NY. Credit:AP With control of the White House, the House and the Senate Republicans had carelessly assured their base that R-and-R would be a mere formality.

So obsessed were they about the "repeal" part, they never seriously addressed the "replace" part of the deal. Senator Susan Collins of Maine Credit:AP And with control of all the levers of power in Washington, they confronted a horrible reality: as a party, the Republicans could not agree on how to replace Obamacare. As each iteration of "replace" was rolled out, the Republicans started quibbling about how big the toll would be. That only 16 million Americans were likely to be denied health cover, as opposed to 22 million or 32 million, never detracted from the enormity of the blow they would strike.

But they pressed on in disarray, with any concession to one faction making others dig in their heels. Moderates could not accept the millions being denied cover; hardliners thought the bill was too Obamacare Lite-ish. Then there were lone, wildcat strikes, such as former presidential hopeful Ted Cruz's push for so-called "junk" policies, which would take the punters' money but give them meaningless cover. Popular support for the latest R-and-R proposal registered as low as 24 per cent, suggesting that voters could see the essential building blocks of the deal. These amounted to tax cuts for the rich and massive cuts in government spending that could only mean reduced services. Bribery didn't work. The architects of the latest bill were willing to throw bags of money at the states represented by likely "no" voters - $US1 billion in the case of Susan Collins' home state - Maine. She didn't buckle. Threats didn't work. Trump put the weights on Collins in a Monday phone call. He warned Nevada Senator Dean Heller that he might campaign against him. He denounced Arizona Senator John McCain's opposition as "a tremendous slap in the face to the Republican Party". And he said of all who were expected to vote "no": "We are disappointed in certain so-called Republicans."

Secrecy didn't work. Bills were drafted behind tightly closed doors and they abandoned the American tradition of congressional hearings, at which experts are heard on big-ticket items. On the latest go-round there was just a single hearing, which was held in a room that could seat just 30 members of the public. When they erupted in protest they were thrown out, leaving a public audience of just five - three of whom reportedly were lobbyists. And misrepresentation didn't work. Obamacare was rammed through in the dead of night, they claimed. But the Obama health makeover was publicly debated for more than a year. There were close to 200 congressional hearings. Hundreds of amendments were debated in public, and the Congressional Budget Office assessed it repeatedly.

And Republican claims that Obamacare is collapsing and so something must be done, were debunked. It has problems to be sure, but voters have made clear that they appreciate and value it. A recent study by the Kaiser Family Foundation concluded that as many as 80 per cent of individual health market enrolees deemed their coverage as "excellent, very good, or good". Only 5 per cent said it was "poor," which is to say that many of the key components of the existing regime have become non-negotiable - at least in the minds of voters. The Republicans seemingly have been blinded by desperate fear - as much of their base voters as of their donors. Fulfilling a pledge Their last argument was this: the bill must be passed because they said they would act.

That policy bankruptcy was revealed by Iowa Republican and chairman of the Senate Judiciary Committee Senator Chuck Grassley when he said last week: "I could maybe give you 10 reasons why this bill shouldn't be considered, but Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. "That's pretty much as much of a reason as the substance of the bill." He was talking about the faithful who kept turning up to hear Trump's campaign promises. But the chief of the GOP's Senate fundraising machine, Cory Gardner, was talking about the donors when he warned colleagues at a lunch two weeks ago that their failure to pass substantive legislation was causing donors to turn off the money spigot. Steve Schmidt, who headed McCain's presidential campaign in 2008, explained the donor logic to the Vox news site: "There's not an actual human constituency for any aspect of the Republican Congressional agenda. Instead it's an inside game that is judged, win or lose, on the basis of which entrenched permanent interests gain advantage or disadvantage, and how that affects the endless fundraising process".

Trump also needed a win. R-and-R was critical to riling up his supporters at campaign rallies, so Trump was as desperate as the rest of the GOP to have a legislative win that he could brandish. Otherwise they might think he was becoming too hugger-mugger with "Chuck and Nancy", the Democratic congressional leaders with whom Trump has been palling around. Staring at defeat on the health bill, the President's less appealing traits came to the fore: lies about what was in the bill; accusations of betrayal (some senators who he had thought were friends "might not be very much longer"), and backsliding (despite all the R-and-R promises, he might have been happy to just "repeal"). History will cherish Trump's most revealing observation on health policy that "nobody knew that health care could be so complicated". But he can't say he wasn't warned. As Obama left the White House, he threw down a challenge to the Republicans, saying, "Now is the time when Republicans have to go ahead and show their [healthcare] cards.

Loading "If in fact they have a program that would genuinely work better, and they want to call it whatever they want - Trumpcare or McConnellcare or Ryancare - if it actually works, I will be the first one to say, 'Great'." But, said the outgoing president: "I suspect that will not happen."