It’s a typically hot and sticky July in Washington, but in some ways it feels just like late March all over again. A health-care bill backed by President Trump has collapsed in dramatic fashion, and Trump knows just who to blame: anyone but himself.

The latest failures, first of a Senate Republican bill to repeal and replace the Affordable Care Act and then the expected defeat of a subsequent, last-ditch effort to simply repeal the law and worry about a replacement later on, offer a vivid picture of Trump’s leadership style, his strategic and tactical missteps, and why he can’t seem to push any of his priorities through in Washington, despite holding majorities in both the House and Senate.

For one thing, Trump has been almost entirely absent from the process with this bill. He’s recently been traveling—first to Poland and the G20, and then another trip to France—and dealing with the increasingly toxic Russia situation, including the revelation that his son met with a Russian lawyer in hopes of getting dirt on Hillary Clinton. He’s largely been disengaged from the process of twisting arms and changing hearts on the health bill.