The punch line to an old joke about Abraham Lincoln. Paul Krugman has what I consider to be a pretty summary of how we got here. I'll wait while you go read it ...
So I would only expand on a couple of his ideas. Clearly (in my opinion) Obama wanted some degree of Republican participation in writing the bill. Now, I wouldn't have gone that route personally, and I suspect the Congressional Democrats would not have welcomed Republicans to the table, certainly not in the House. On the other hand, you may remember that when Olympia Snowe, Susan Collins and our Arlen approached Harry Reid regarding the stimulus bill (over a year ago), they got pretty much all they wanted. So who knows, but the Republicans decided early on to go a different road, one of whipping up public sentiment against the bill (hey, it worked in 1993).
When the bill was started, at least some versions of it included a public option, a government run health insurance plan that would have provided low cost health insurance to the poor. This would have made our reformed health insurance market look a bit like Switzerland's, with a tightly regulated private market and including a government plan. By the way, we are number one in spending per capita on health care, but the Swiss are number two, so it is not like the original plan was too radical. Except that it was, at least for Democrats in conservative states. I've already talked about my feelings about the bill, so I will leave it at that.
So the Republicans did not give Obama a defeat yesterday (jumping forward to today). And for ever after, Obama will be the President who passed health care reform. It may be that the Republicans will re-take the Congress in November, and repeal the bill, but that won't change the fact that it passed on Obama's watch.
But I don't think it is bad for the Republicans that they couldn't block the bill. They now have their wedge and fear issue, which they can ride all the way to November.
Even back two Novembers ago, the country was pretty evenly split between voting for the crazy old guy and the cool and articulate but black guy. A little more than half of the voting public either enthusiastically or reluctantly voted for Obama. And part of what he ran on was health care reform. Things have obviously changed since then, and Obama might not win if the election were held today. Or more importantly, the county may decide, state by state or district by district, to return Congress to the Republicans. That may happen if the Republicans can use HCR as a "fear" issue. It speaks poorly of us as a country if that works, but realistically it has a chance.