After a year - decades, really - the debate over health care reform came down to a climactic vote in the United States House of Representatives. Many people of good faith in both political parties were separated by a genuine - and fundamental - ideological divide. But as their ferocity revealed, for the GOP the conflict all along was more about power than policy. Republicans were afraid not that Democratic health care reforms would fail the American people, but that they would succeed.
Back in 1993, former Quayle chief of staff and Republican strategist William Kristol warned his GOP allies that a Clinton victory on health care would earn the thanks of a grateful American public and guarantee Democratic majorities for the foreseeable future. "The Clinton proposal is also a serious political threat to the Republican Party," Kristol wrote in his infamous December 3, 1993 memo, adding:

"Its passage in the short run will do nothing to hurt (and everything to help) Democratic electoral prospects in 1996. But the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for "security" on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government."

And that, for Kristol, meant it had to be stopped at all costs:

"The first step in that process must be the unqualified political defeat of the Clinton health care proposal. Its rejection by Congress and the public would be a monumental setback for the president; and an incontestable pice of evidence that Democratic welfare-state liberalism remains firmly in retreat."

The rest, as they say, is history.
But when Barack Obama was swept into the White House with a much larger Democratic majority in November 2008, Kristol looked to repeat history. Now as then, Obama's initiatives to rescue the economy and save the failing American health care system had to be met by complete Republican obstructionism. As he told Fox News' Neil Cavuto in February 2009, that stonewalling needed to start with the stimulus:

"But the loss of credibility, even if they jam it through, really hurts them on the next, on the next piece of legislation. Clinton got through his tax increases in '93, it was such a labor and he had to twist so many arms to do it and he became so unpopular...
...That it made, that it made it so much easier to then defeat his health care initiative. So, it's very important for Republicans who think they're going to have to fight later on on health care, fight later on maybe on some of the bank bailout legislation, fight later on on all kinds of issues. It's very important for them, I think, not just to stay united at this time, though that's important, but to make the arguments."

In a rare moment of candor, Utah Senator Orrin Hatch acknowledged that the prospect that the American people would reward the Democratic Party for addressing a health care system in crisis. Again, his darkest fear wasn't that Democratic health insurance reform was bad public policy, but instead great politics. As Hatch told CNS last fall:

HATCH: That's their goal. Move people into government that way. Do it in increments. They've actually said it. They've said it out loud.
Q: This is a step-by-step approach --
HATCH: A step-by-step approach to socialized medicine. And if they get there, of course, you're going to have a very rough time having a two-party system in this country, because almost everybody's going to say, "All we ever were, all we ever are, all we ever hope to be depends on the Democratic Party."
Q: They'll have reduced the American people to dependency on the federal government.
HATCH: Yeah, you got that right. That's their goal. That's what keeps Democrats in power.

What might keep the Democrats is power is the recognition that they at long last delivered on health care reform. And that third pillar of the American social contract, like Social Security and Medicare, will have been realized by large Democratic majorities in the face of staunch Republican opposition. On Sunday, conservative analyst and former Bush speechwriter David Frum admitted as much, announcing "Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s."
As for Bill Kristol, he's already preparing for Round 3 in the health care wars. The man who in July told Republicans to "kill it and start over" on Sunday had a new message and a prediction:

"People are concerned about the future of this country and they think this bill is bad for it by a majority, and I believe that will be the Republican message and the Republican message will be a responsible one to repeal this bill and replace it with better health care reforms and to get a handle on the debt, which this bill increases...The American public are going to insist on its repeal over the next three years. We are! I predict in 2013 the bulk of this will be repealed and replaced with better health care legislation."

Or better yet, for Kristol's Republicans, none at all.