Yes, it is difficult to dismantle any major piece of social policy. Once Americans become used to a program, no matter how controversial, taking away those benefits often fails. History is filled with examples, such as Social Security, where battles to retrench the social safety net go down in flames. But the Senate Republicans fell only one vote short of the number needed to keep the repeal effort alive.
Senate Majority Leader Mitch McConnell is blaming the Democrats for the defeat that makes him look like much less than a master of the Senate.
Yet in this case the President must bear a huge part of the burden. This was an epic fail. With united government, a stunned Democratic Party and a promise to repeal that had been the rallying cry for the GOP since Congress passed the Affordable Care Act in 2010, Republicans faced pretty good odds that they could get some kind of bill to the President's desk.
But that didn't happen. Trump subverted their efforts at each step. The endless distractions and chaos from his Twitter account were devastating. There was no sustained effort from the White House to build legislative support for the bill or to sell the notion of an alternative health care system to the public.
At most he used his social media pulpit to castigate and cajole congressional Republicans who were in fact trying to work around the obstacles he created. Without any kind of message or vision, voters didn't see any reason to rally around this plan -- and enough Republicans on the Hill heard the message loud and clear. His biggest speech during the final days of the legislative battles was a fiery campaign one to the Boy Scouts.
The sudden announcement about reversing the Obama administration's policy allowing transgender people to serve in the military shocked and stunned Washington right when senators were trying to vote. At the key moment of decision-making, the new White House communications director was doing his job in very new ways by engaging in "locker room talk" with a New Yorker reporter about the President's top advisers.
The truth is out. Nobody is in control of this show.
The entire process was really a stunning display of dysfunctional policymaking. Historically whenever presidents take up major domestic initiatives, they have their staff work out broad objectives or detailed plans that become the basis of congressional debate.
They don't allow the entire process to deteriorate into what we saw -- legislators voting on invisible plans and then trying to make a big decision in a haphazard way, threatening to make massive changes to a key part of the economy without any sense of what they were doing. The President's decision to allow the debate to go this way reflected his complete lack of engagement with public policy.
The road is littered with the bodies of politicians who have been insulted and humiliated by Trump, and they aren't at all inclined to help him. Sen. John McCain, the Vietnam War hero whom Trump once mocked for having been taken captive, cast a pivotal vote against the "skinny bill" that would have given the GOP one more shot to work out a deal in conference committee. Though McCain disappointed many people when he voted earlier this week to allow the bill to be debated, in the end he had no interest in enabling this chaos to continue.
Other senators such as Alaska's Lisa Murkowski refused to be intimidated by Trump's threats. And Trump didn't earn much credit when he publicly threatened Sen. Dean Heller rather than courting him.
Reports suggest that Trump's decision to lash out publicly at Attorney General Jeff Sessions not only angered Republicans on Capitol Hill but spread doubts they could trust him to stand by the party down the line after they took a tough and unpopular vote. Disloyalty matters in Washington.
While Trump likes to dismiss all the norms and processes of Washington as a bad odor from the "swamp" that needs to be drained, in reality they are the product of decades of politics as presidents have learned through experience how to make things work in our complicated and disjointed political system. A president ignores all of this received wisdom at his own risk.
We live in an era when everyone mocks Washington insiders, but the ultimate outsider president could have benefited from some insider knowledge. Trump seemed to have almost no idea how the legislative process worked. When he called the House bill "mean," Trump didn't seem to understand the kind of political risks legislators have to take when they vote at each step of an uncertain process.
After the Senate voted to let the bill reach the floor, Trump seemed to think that victory had been achieved. "They say, if you look historically, this is the tough vote to get." His experts didn't fill him in about how the rest of the process works. Early Friday, he learned along with the rest of us that the Republicans couldn't get enough votes to pass a repeal bill.
The timing of the entire battle was thrown off by Trump's antics and the energy the Russia investigation has consumed -- largely because of the President's own statements and actions, along with misleading information from members of his team.
Democrats shouldn't pop the champagne corks too soon. McConnell could try for another repeal vote. Trump could move forward with his plan to subvert the Affordable Care Act from within, by failing to enforce the individual mandate to buy health insurance, holding back subsidies or continuing to create doubts about the future of the program that cause major insurers to pull out. All of this would be extraordinarily damaging to Obamacare, preventing it from fulfilling its objectives.
Back on the Hill, there remains the slim possibility that Senate Republicans will move in a different path now, working around Trump and accepting Sen. Chuck Schumer's offer to find a bipartisan fix to health care.
It is not a surprise that more conservative voices are slowly, and hesitantly, starting to express their opposition to Trump. His failures as a leader are coming at a high cost. President Lyndon Johnson always reminded his advisers that time was the most valuable commodity in Washington since the party in power has so little of it. Legislators quickly focus on the next midterm campaign and are less willing to take risks for the president. The opposition party, moreover, becomes less hesitant about taking on the president as the "momentum" from the presidential election fades.
As the month of July comes to a close, it should be clear to Republicans they are losing their opportunity to enact major legislation even though they control Congress and the White House. They must be realizing that things are not going to get better in the Oval Office. There is no pivot coming; this is the new normal.
In January, many experts -- including me -- were predicting that President Barack Obama's legacy was at serious risk. Some of the predictions have turned out to be true, such as on measures to curb climate change. But thus far with health care, Trump is turning out to be Obama's savior.