Will Republicans learn the limits of oppositional politics?
"All politics is local," was the famed dictum of the legendary House Speaker Tip O'Neill.
O'Neill hailed from an age when lawmakers had a more intimate relationship with the voters who sent them to Washington and were also more willing to cut deals with their partisan adversaries.
Nowadays, however, it would seem that all politics is oppositional.
The Republican healthcare debacle is but another reminder of how a solutions-based politics has given way to a protest-based politics, how for many lawmakers in Washington it has primarily become a negative pursuit.
For the best part of a decade, the GOP revelled in its success as the Party of No, obstructing and paralysing Barack Obama's legislative agenda.
Rather than paying a penalty at the polls for its blocking strategy, it was rewarded. It retained control of the House of Representatives from 2011 to the present day, and became the majority party in the Senate at the 2014 mid-term elections.
Its wrecking tactics also helped create a rubble-strewn path for Donald Trump's insurgent presidential campaign. So badly was Washington broken, became his refrain, only an outsider could fix it.
As the new president discovered last week, however, sections of the Party of No remain the Party of No.
House Speaker Paul Ryan candidly conceded as much last Friday. "We were a 10-year opposition party," he said, dejectedly. "Being against things was easy to do."
Representative Tom Rooney of Florida, who before entering Congress in 2009 served as a military lawyer, delivered an even more withering assessment of his own party.
"I've been in this job of eight years," he told The Atlantic, "and I'm wracking my brain to think of one thing our party has done that's been something positive, that's been something other than stopping something else from happening."
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Rather than lash out at the Democrats, as the president did, Paul Ryan put this humiliating defeat down to the GOP making a painful transition from opposition to government.
But the problem is not so easily explained away. This is not transitory. The DNA of the GOP has changed. No longer does it operate as a conventional, cohesive party.
Rather it is acting more like a protest movement. The inability of the Republican Congress to advance the Trump administration's legislative agenda will be a recurring problem.
Part of the Republican dilemma, obviously, is arithmetic. The Freedom Caucus, this dissident rump of ideological hardliners that neither Trump nor Ryan could corral, has enough members to cancel out the party's 20-plus seat majority in the House.
But the problem posed by the Freedom Caucus is also attitudinal and ideological. Being part of government will not automatically alter its obstructionist modus operandi, because the 30 or so lawmakers who comprise its membership are so mistrustful of government.
Many were elected during the 2010 Tea Party rebellion, and arrived in Washington seeking to upend the city.
As they showed last week, they are much more than pebble-throwers. They can hurl a wrecking ball at Trump's presidency.
It explains Thursday's extraordinary tweet, which doubled as a declaration of war: "The Freedom Caucus will hurt the entire Republican agenda if they don't get on the team, & fast. We must fight them, & Dems, in 2018!"
Because of the checks and balances hard-wired into the US system, a well-organised minority has always been able to thwart the majority, especially in the Senate.
Just recall the immense power of the Southern Caucus in the Democratic Party for much of the last century. This well-disciplined rump of diehard segregationists kept the Jim Crow system of racial apartheid in place until the mid-1960s.
Its members turned the Senate into what William S White of the New York Times memorably described in the mid-1950s as "the South's unending revenge upon the North for Gettysburg".
Civil rights legislation could only overcome southern filibusters with bipartisan support.
But that level of bipartisanship, the triumph of patriotism over party, is no longer a feature of Washington life. It ceased to be a long while ago.
Nor does the Trump White House and the Republican congressional leadership merely have to contend with the Freedom Caucus. Appeasing hardliners on healthcare meant losing support from Republican moderates.
On tax reform, if Paul Ryan pushes a border adjustment tax - a tax on imports combined with a tax break on exports - he will run into problems with free traders in his party.
A costly infrastructure bill, not to mention the expense of Trump's border wall with Mexico, will incur the wrath of Republican deficit hawks. However artful the dealmaker, these are hard circles to square.
It would be misleading to suggest that oppositional politics is solely a problem of the right. The Democrats have signalled they intend to pursue much the same "Politics of No" approach under Trump as the GOP did under Barack Obama.
The Senate Minority leader Chuck Schumer has already vowed to deploy the filibuster against Trump's Supreme Court nominee Neil Gorsuch.
Sixty votes in the Senate are required to overcome this blocking device. The Republicans have only 52. The talk is already of what's being called a "nuclear" showdown.
Hillary Clinton's failed presidential campaign also underscored the limitations of unrelenting negativity. Her stump speech, rather than offering a vision of what America would look like under her presidency, was primarily an assault on Donald Trump.
What was her signature policy proposal? What was her economic message? I covered her campaign closely for 18 months, and honestly could not answer that question. Her uninspiring campaign was centred on taking down the man rather than offering a manifesto.
Both healthcare and Hillary point to another failing of oppositional politics: its intellectual and programmatic emptiness. Make America Great Again. Build the Wall. Stronger Together. Take back control, the battle cry of Britain's Brexiteers. Oppositional politics is expressed these days in short slogans rather than big ideas.
With political dialogue increasingly expressed in catchphrases, the tendency is for campaign slogans to be superseded by governing slogans: "Repeal and Replace" in Washington, "Brexit Means Brexit" in Westminster. But what do those mantras actually mean?
The Republicans had seven years to come up with an answer, and failed. In Britain, even as Article 50 is triggered, there's still great uncertainty among policy-makers, and still more among voters, as to what precisely Brexit will entail.
Post-referendum Britain also illustrates how a politics defined by opposition can quickly turn winners into losers. UKIP has been in internal disarray since last year's referendum, partly because it does not have the European Union to rail against.
In Washington it required the presence in the White House of Barack Obama to unify the Republican Party. Rallying around Donald Trump does not come so easily. And while gridlock is ordinarily the consequence of divided government, the healthcare debacle suggests it has become endemic.
Even a party with a monopoly on Washington power could not get a major bill through the House of Representatives, where it commands a comfortable majority.
This impasse was decades in the making. It has shown once again that as the Republican Party on Capitol Hill has become more unmanageable, the United States has become more ungovernable.
So while the main headline from last week's debacle was Trump's humbling setback, the larger historical take is the chronic dysfunction in Washington. As Governor John Kasich, a former Republican congressman himself, said during a visit to the capital this week. "There is a fundamental flaw in this place. It does not work anymore."