Great Expectations is more than a Charles Dickens novel from the 19th century.  It is also one of the primary reasons 63 million Americans cast their votes for Donald Trump last November.  Americans also had great expectations for Barack Obama in 2008 – our first "post-racial" president, bringing an end to racial strife, not to mention lowering the sea levels.  Hope and change.  Great expectations.

Fast-forward eight years.  Obama didn't deliver on expectations, whether on health care or economic growth.  He did not bring peace in the Middle East – instead, further chaos and the rise of ISIS.  There were racial unrest and riots reminiscent of the 1960s.  Donald Trump came along and, with four simple words, "Make America Great Again," gave America real hope for real change.  Great expectations.  And the Obama coalition was sent packing.

Congress too created great expectations.  When Barack Obama was elected president, Democrats controlled the House and the Senate.  Obamacare was passed and implemented, immediately making health care more expensive and less accessible to many Americans.  Republicans, none of whom voted for the original Obamacare legislation, immediately promised that if given the reins of power, they would repeal it.

In 2010, Republicans told America to vote them control of the House so they could repeal Obamacare, cut wasteful spending, and implement a conservative agenda.  Done.  Republicans then told America the House couldn't do anything alone; they needed the Senate, too. Delivered in 2014.  Obamacare repeal bills were passed, multiple times, and sent to the president's desk for the expected veto.

Congress next told America Republicans needed the White House to avoid Obama's veto pen.  This too was delivered, although not the president most in Congress would have preferred, but the clear choice of the voters.  Great expectations met.  Republican control of Congress and the White House.  An electoral majority not seen in nearly a century.  Time to deliver.

Now, seven months into the Trump presidency, Congress has delivered little other than Neil Gorsuch to the Supreme Court.  What happened to the great expectations?

Senate majority leader Mitch McConnell certainly gave America reason for high hopes.  Last December, basking in the glow of another banner election for Republicans, McConnell promised that Obamacare repeal was "the first item up in the new year."  He doubled down on expectations, saying, "We have an obligation to the American people to change it and to do a better job."  We took him at his word.

How did that work out?  The Senate waited six months to get to Obamacare, certainly not the "first item up" on their legislative agenda.  When they got to it, did they repeal it?  Revise it?  Skinny repeal?  Nope.  So much for "doing a better job."

After failing to deliver on myriad promises, Senator McConnell, like a true Senate milquetoast, turned around and blamed President Trump over his expectations.  At a recent Rotary Club meeting in Kentucky, he told his audience, "I think he had excessive expectations about how quickly things happen in the democratic process."

Funny that Nancy Pelosi and Harry Reid weren't lecturing their president about "expectations."  They got stuff done, for better or for worse, including passage of Obamacare.  Despite President Trump's campaign promises, it's common knowledge that legislation originates in the legislative branch, meaning Congress.  Trump can't repeal Obamacare.  He can't replace it, either.  He can certainly support congressional efforts, which he did, but that's it.

Trump responded to McConnell's excuses in typical Trump fashion, tweeting, "Senator Mitch McConnell said I had 'excessive expectations,' but I don't think so. After 7 years of hearing Repeal & Replace, why not done?"

True leaders, including the Senate majority leader, lead.  Excuses are for Hillary Clinton and her supporters – not for Republican leaders sitting on a once-in-a-lifetime electoral majority and a long awaited opportunity to deliver on years of campaign promises.

Promises lead to expectations.  These are the same promises that gave Republicans the votes they needed to now be in the majority – and the expectation by voters that they do what they promised.

Senator McConnell, don't blame your legislative ineptitude on President Trump.  Or on "artificial deadlines unrelated to the reality of the legislature which may have not been understood."

We elected these people to lead.  We have great expectations of them and their colleagues.

We expect them to say what they mean and mean what they say.  Spare us the talk of deadlines and legislative realities.

We expect them to support their president – not blind obedience, but fealty to the campaign promises made by President Trump and Republican members of Congress.  Recall that these are the promises that gave the Republicans more votes than your electoral opponents.

We expect action, not excuses.

We expect McConnell and the rest, if they can't deliver on their promises, to abdicate in favor of their colleagues who can.

As Uncle Ben told the Spiderman, "With great power comes great responsibility."  Senator McConnell and his merry band of do-nothings should keep that in mind.  The 2018 midterm elections are not too far away.

Brian C Joondeph, M.D., MPS is a Denver-based physician and writer.  Follow him on Facebook, LinkedIn, and Twitter.