01/19/2011 11:06 pm ET Updated May 25, 2011

Health Care Repeal Vote Exposes Real Threats to Law

House Republicans are celebrating a victory Wednesday after successfully voting to roll back health care reform by a margin of 245 to 189. Outright repeal is a fool's errand, of course -- it won't survive the Democratic-controlled Senate or President Obama's veto pen -- but the vote does expose real threats to the law's future.

Wednesday served its purpose partly by providing the requisite theatrics for Republicans to placate their Tea Party base, to which they promised repeal. It also allowed them rub it in President Obama's face that he has failed to win over the public despite bringing health care to millions while reducing the deficit.

Polls say a significant percentage of the public supports repeal of the law (although the figure has dipped in the aftermath of the Tucson massacre). But surveys also reveal the public to be deeply misinformed about what's in it. In large numbers, Americans wrongly believe it will raise their taxes, increase the deficit, cut Medicare benefits, and force them to change their insurance plans.

Meanwhile, the actual elements of the law are mostly popular. The public strongly favors universal coverage and banning insurance companies from discriminating against sick people. The individual mandate is disliked, of course, but it's the third leg of the stool vital to holding the measure together. Also well-liked are provisions that close the Medicare "doughnut hole," offer tax credits to small businesses, and allow young adults to stay on a parent's insurance plan until 27.

So, why is the public so confused? Chalk it up to a ferocious Republican assault on the bill -- much of it based on lies -- throughout the deliberations and the November elections, as Democrats displayed a battlefield timidity early on and then scurried away from their landmark accomplishment after it was signed.

The nonpartisan Congressional Budget Office reports that the Republican repeal plan would prevent 32 million nonelderly Americans from getting insurance while adding roughly $230 billion to the deficit through 2021 -- an awkward fact given GOP claims that the reforms will bankrupt the nation.

It's also awkward because deficit reduction is a core Republican promise that helped win them the House and expand their voices in the Senate. And while party leaders are seeking to resolve this cognitive dissonance by discrediting the official score, it was just years ago that the Republican finance chairman touted the CBO as an arbiter that Congress is "required by law to abide by."

And few realize that Republicans are smiting their own ideas. For Obama's reform law, which conservatives today dismiss as socialism, is virtually identical to the bill Mitt Romney enacted as governor of Massachusetts in 2006, which was championed by the right-wing Heritage Foundation. It's also remarkably similar to the Republican alternative to Bill Clinton's health plan in the early 1990s.

The conservative nature of the law is why progressives have been lukewarm in their enthusiasm, which has also hurt its public perception. But liberal activists can't be blamed for that; they wanted progressive reforms -- ideally Medicare for all, but at least a public option or a Medicare buy-in -- and instead got a Republican bill.

Ultimately, though, the sight of Obama embracing GOP ideas was enough for Republicans to ditch them. That's because, from a political standpoint, spending the next two years waging a full-frontal assault on Obama's top priority weakens him and his party -- it serves the dual purpose of putting Democrats on defense and stalling their agenda ahead of the 2012 elections, in which the White House and Senate are up for grabs.

Thus one shouldn't expect Republican battering of health care to let up, even after repeal dies in the Senate. It's too sweet a target -- their base hates the law, and Democrats have so far failed to boost its image in the public eye. The GOP's Plan B is to choke off the legislation one limb at a time by blocking funds for implementation between now and 2014, when the crux of it kicks in. Plan C is to build judicial support to gut the mandate through the courts. Neither of the two strategies is out of the question.

Democrats are finally rising to the challenge, and have instigated a public relations blitz to tout the law's benefits to consumers while depicting Republicans as pawns of the insurance industry. It's an uphill battle given the lost time, but if successful, it could turn the game against Republicans -- polls show that the more people learn about the measure, the more they like it.

However this unfolds, the writing on the wall is clear: Democrats' biggest achievement in a generation will shrivel up and die unless they change enough minds to persuade enough lawmakers not to cut off its oxygen supply.