I ask myself this question regularly these days. The only answer that makes sense to me is that it’s better than the alternative. I can’t imagine voting for the lunacy represented by Nancy Pelosi, Maxine Waters, Cherokee Liz Warren, Crazy Bernie Sanders, or the woman who thinks she actually won the election, Hillary Clinton.

I would rather be voting for a great political party, rather than voting against a distasteful one. Given the state of the current two parties, the distinction is not that clear. It’s more like saying I’d rather die from a heart attack in my sleep than from pancreatic cancer. Both roads lead to the morgue. It’s the journey that differs.

One could argue that Neil Gorsuch would not be a Supreme Court justice if the Democrats controlled Congress. President Trump might already be impeached and removed from office, with Maxine Waters and Kathy Griffin holding his bloody head as a trophy of a Democrat-controlled Congress.

I’ll concede these points but still harken back to my original question, why vote Republican? This is not the first time I asked this question.

In 2015, after the November midterm elections gave control of both the House and Senate to Republicans, President Obama announced his amnesty plan. Senate Majority Leader Mitch McConnell, rather than exercising his constitutional duty to check and balance an overzealous executive branch, folded like a cheap suit and funded Obama’s plans.

Feeling frustrated over Republican capitulation to the minority party in Congress, I wrote, Why Vote Republican? I hoped my lowly voice would serve as a warning to Republicans ahead of the presidential election that voters needed a reason to vote. More than simply giving control of the White House and Congress to Republicans, with the hope and empty promises that they would accomplish something.

Instead we heard whining and excuses rivaling those of Hillary Clinton. In 2010, Republicans said they needed the House before they could repeal ObamaCare and cut taxes. America gave them the House. In 2014, the House wasn’t enough, since the Democrats controlled the Senate. America gave Republicans the Senate. What have they done? Any legislation? Any defunding of the Obama agenda? Any checks or oversight against a lawless executive branch weaponizing the IRS and intelligence agencies against political opponents? Nah. Just excuses.

Obama had his veto pen. Republicans couldn’t get anything done without a Republican in the White House. Asked and answered with President Trump. Still more excuses. And a lousy budget. So, I wrote part two a few weeks ago, "Why bother voting for Republicans?"

Congressional Republicans recently crafted a 1600-page budget bill, funding Planned Parenthood and EPA but no money for Trump’s promised border wall. A budget that pleased Chuck Schumer and Nancy Pelosi. Isn’t that nice.

Those two might have well been in charge of Congress and the budget. They got what they wanted. Presumably most Republican members of Congress also got what they wanted, else they wouldn’t have voted for it. They pleased their paymasters in the Chamber of Commerce and the donor class which supports their campaigns. What about the voters? Main Street rather than Wall Street. The voters are the only ones shortchanged.

It’s much like the Nigerian email scams. Give me your vote and I promise you a conservative agenda. Vote given and you get a liberal agenda. Similar to Lucy promising to let Charlie Brown kick the football, always pulling it away at the last minute.

Time for part three of “why vote Republican.” A few days ago, Senator McConnell fired up his Kentucky excuse machine over ObamaCare repeal. He complained to Reuters, “I don’t know how we get to 50 [votes] at the moment.” Last I checked, Republicans held 52 seats. And the tie-breaking vice-president’s vote on top of that.

Can’t get to 50? That’s something Chuck Schumer might say having only 48 votes in his caucus. But why would Mitch McConnell say such a thing?

Harry Reid never had such problems. All Senate Democrats voted for ObamaCare back in 2009. I don’t recall hearing Reid telling his voters and his president, “I don’t know how we get to 50 [votes] at the moment.” He knew how to get each and every vote in his caucus. And he did.

That’s called leadership. Say what you want about Harry Reid, and there is plenty to criticize, but he did his job as party leader in the Senate. He delivered for his constituents and his president.

Repeal and replace ObamaCare. Something Republicans have been promising for the past eight years. One of their president’s campaign promises. The campaign is over. The Republicans won. Time to govern. Time to deliver on their campaign promises. Time for the rubber to meet the road.

House Speaker Paul Ryan at least delivered something. Not a repeal, but instead an ObamaCare retread. Better than nothing? That’s up for debate. But even “he recognizes Republicans will face blowback if they fail to repeal and replace Obamacare.” Ya think? He went further, "I accept that we will get hit for this. We're in leadership, we don't have a choice, we're a majority.” No kidding.

Here we are in month five of the Trump presidency. Republicans control Congress and the White House following an epic campaign and election. Promises were made to the American people who expect more than talk and excuses. We want results. Not the excuses we hear from GOP Senator Richard Burr, “It’s unlikely that we will get a healthcare deal” this year.

ObamaCare repeal, tax cuts, oversight and accountability over Obama’s weaponized executive branch, defunding wasteful government programs, and “build the wall.” Zero, zip, nada.

Instead many in the GOP are joining the Democrat obsession over Trump-Russia collusion and whether or not James Comey is a good guy or a nut job. That’s not what they campaigned on. Not what they promised to do if elected. Many Republicans have joined the Democrats in denying the legitimacy of Trump, thinking “he’s not my president.” But to most Republicans voters, Trump is their president. They have an allegiance to Trump that they won’t have to GOP members of Congress in November 2018.

Leading me to ask again, Why Vote Republican? Now for the third time. Will Paul Ryan and Mitch McConnell answer my question? Or will I be asking this again each time Congressional leaders make yet another excuse?

The 2018 midterms are not that far away. Republicans can grow their majorities if they demonstrate to the voters that they are serious about governing, that they can walk the walk, not just do the campaign talk.

Conversely if they dither and dawdle, accomplishing little other than leaving Trump’s campaign promises flapping in the wind, many Republican voters will stay home in November 2018, muttering Mrs. Clinton’s words, “What difference does it make?”

Brian C Joondeph, MD, MPS, a Denver based physician and writer. Follow him on Facebook, LinkedIn and Twitter.