So the fact that McConnell on Tuesday got 50 votes for the motion to proceed to debate on whatever is in the bill means nothing. Even making this limited procedural step was a near-run thing, coming down to a tie-breaking vote from Vice President Mike Pence. Ultimately the only reason it passed was so that Sen. John McCain (R-Ariz.) could give a vain, self-serving, feel-good speech about the virtues of bipartisanship and regular order rules and the high and noble calling of the United States Senate. McCain himself seemed to hint that he would not vote for any bill that did not have the approval of Arizona Gov. Doug Ducey (R), who supports the expansion of Medicaid. Then there is Sen. Ron Johnson (R-Wis.), all but left for dead by his party during his re-election bid last fall, who only voted yes after a lengthy conference with leadership in which he seemed all but forced to give his assent directly after McCain waltzed in to the applause he so obviously craves. Nevermind Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Alaska), who have made it clear that nothing considered by their party in either the House or the Senate so far is deserving of their support. Nor is there any guarantee that following concessions to these four McConnell will not face defections from Sens. Rand Paul (R-Ky.) or Ted Cruz (R-Texas).