On health care, Republicans finally have it all but can't figure out what to do with it

Senate Republicans were told never to bet against Majority Leader Mitch McConnell. His storied legislative craftiness might seem beyond their ken but it would save their skins in the end. Under his audacious direction, after all, they had recently snatched a Supreme Court appointment out of the hands of Barack Obama.

So there was only a little grumbling during the weeks when McConnell was keeping the draft health reform bill secret from everyone except his own staff.

Even the 12 men on the committee assigned to work with him found themselves outside the room and away from the action, hovering like expectant fathers.

"Waiting to see if it's a boy or a girl," quipped Senator Lindsey Graham.

• Republicans postpone vote on their health-care bill until July

Finally, last week, the thing was delivered and boom! Immediately the senators spotted its striking resemblance to the much-maligned bill that their House colleagues had barely and hesitantly passed only a few weeks earlier.

Legislative letdown.

The House bill would have added more than 20 million people to the ranks of the uninsured, made drastic cuts to Medicaid, and left many parts of Obamacare in place while giving hundreds of billions in tax cuts to the wealthiest people.

The president, who at first celebrated it, had described it as "mean."

Unexpected arrival

Senators had said the bill was "dead on arrival" in their chamber. And yet there it was. Tweaked a bit, but still alive and now theirs. What a nightmare.

The Congressional Budget Office then weighed in Monday to confirm the fears of moderate Republicans that the bill went too far in rolling back health benefits, as well as the fears of conservatives that it didn't go far enough.

There was wavering. So many Republicans said they wouldn't vote for it that it seemed doomed. But McConnell, unfazed, said he would go ahead with a vote this week.

Again, many Republicans bravely assumed the wily Kentuckian was playing a multi-dimensional game that only he could grasp and everything would eventually be all right. Surely he would find the requisite 50 votes.

He couldn't.

By delaying the vote, as he decided he would after lunch with his caucus yesterday, McConnell seems to have confirmed what Democrats have been saying: after all their promises to repeal and replace Obamacare, Republicans really don't agree on what they mean by that.

Their problem has many roots.

• Republicans hid their 'monster' health-care bill. Now they'll ram it through a Senate vote

First, Republicans don't agree even on the fundamental question of whether the government should have a role in people's health insurance. Some think it shouldn't and would be fine with repealing Obamacare and not replacing with anything.

Others think the government can have a role in health insurance, and decades ago developed the concept of the "individual mandate" a law that forces all Americans to have health insurance so there is enough money from the premiums to oblige insurers to offer benefits to everyone.

The Donald Trump problem

That idea came from the conservative Heritage Foundation in the late 1980s. It was championed by Republicans right up until the moment Barack Obama embraced it and made it the core of Obamacare.

Now Republicans have disowned the individual mandate and are bent on repealing Obamacare even though its essence was an idea poached from them.

• 22 million more Americans would become uninsured under Senate health bill: CBO

There is also the Donald Trump problem. His extravagant promises about health care before he was elected are irreconcilable with his behaviour in office. No one can say for sure what policy he wants.

He campaigned on replacing Obamacare with something better and cheaper, at times even promising universal health care.

But when House Speaker Paul Ryan came up with a bill that cut hundreds of billions in taxes on the wealthiest while taking health care away from the poorest, Trump went for that too, and talked some reluctant Republicans into supporting it.

Then, in a flash, he turned on them, called their bill "mean," and said the Senate would do better, leaving them to defend themselves to the voters in their districts.

Senator Graham's advice: "If you're counting on the president to have your back, you need to watch it."

The president seems confused about where to lead Republicans on health care reform, while proving they can't trust him to stick to whatever course he chooses anyway.

Airing it out

A frustrated McConnell admitted yesterday that his own plan needed more airing. He seemed to concede that having drawn it up in secret, he'd not allowed his colleagues the opportunity to properly consider it.

There is suspicion he might not want it properly considered, least of all by voters. Anger from the districts back home has reportedly been jamming the phone lines and filling up the in-boxes of Republicans on Capitol Hill since the details of the bill seeped out last week.

Only a couple of Republicans have scheduled their usual town halls for the coming summer break.

McConnell told his colleagues yesterday that doing nothing about health care reform is not an option. But he warned that if they wouldn't get on board to negotiate something with him, then he might have to start talking to Democrats.

What a sobering thought that must be.

After seven years of bold talk about repealing and replacing Obamacare, the Republicans finally have what they need to do it: control of the House, the Senate and the White House.

But like the dog that catches the car, they seem never to have thought what their next move should be.