Back to healthcare drawing board for Republicans

McCain announced his opposition to the last Republican healthcare bill shortly after returning from having a brain tumour removed

John McCain's announcement that he opposes the latest healthcare proposal wasn't nearly as dramatic as his late-night vote that derailed an earlier plan, but it should prove equally fatal to Republican hopes.

With Senator Rand Paul already a hard no - because the measure doesn't go far enough - all eyes turn to Susan Collins of Maine and Lisa Murkowski of Alaska. Neither seems likely to support the bill now, and only one of them needs to give the thumbs-down to seal the deal.

The Graham-Cassidy proposal was always a bit of a desperation effort - essentially passing the tough decisions about health insurance coverage and benefits to the states, while making sizable cuts to the amount of money they receive from the federal government.

As several Republican senators explained - ones who were firm "yesses" - the main attraction for the plan was that it was the only plan on the board.

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Healthcare providers have mostly opposed the latest Republican bill

Now it appears Republicans will have to go back to the drawing board. Although the end of September is the deadline for passing a bill with a simple majority in the Senate for this federal budget, there's no reason the party couldn't start the wheels turning for another vote next year - or, conceivably, simply change the rules, as President Donald Trump has suggested.

None of that will alter the simple dynamic that made itself clear over the course of the past months, however. The Republican Party, despite campaigning ferociously for Obamacare repeal for nearly seven years, could never agree on how to turn those promises into reality without sending the healthcare industry into a tailspin.

There had been some progress towards a series of small bipartisan compromises that would tweak the existing system, but they had been put on hold when it appeared Graham-Cassidy was picking up steam.

Then virtually every interested party - outside the Republican caucus in the Senate - came out against the bill.

The health insurers, the doctors, the hospitals and AARP, the influential elderly advocacy group, expressed their dissatisfaction.

Jimmy Kimmell, the late-night talk show host, went on a multi-day crusade against Mr Cassidy, who he said had lied to him about his legislative intentions.

Then Mr McCain lowered the hammer. Again.