Introduction
Obamacare has now passed the House, and will almost certainly also pass the Senate. That is the worst of it. Now, let's think about what this means,
Will It Go Into Effect?
To actually go into effect, Obamacare must not only pass the Senate and be signed into law by the President (both likely enough that we may take it for granted, now), but also must survive Court challenges from several angles regarding its Constitutionality. These include challenges on the Tenth Amendment (states' rights, and several states are already preparing court challenges, or passing laws which will create direct court tests on the 10th) and on others from the Bill of Rights (4th, 5th and 9th: 4th in that the mandate to buy is an "unreasonable seizure," 5th in that it constitutes a denial of "due process" while not being a "tax" within the purview of the 16th Amendment, and 9th in that it constitutes an arrogation by the Federal Govenrment of rights reserved to the people. If any of these challenges succeed at the Federal Circuit level, implementation will be delayed; if any at the Supreme Court level, it will never be implemented, partially or fully.
In addition to this, the Obamacae must face the strong possibility of either partial or full legislative repeal or executive non-enforcement before 2014 (when its main "benefits" kick in). In 2010, there is a very strong chance that the Democrats will lose control of the House and Senate; in 2012 a strong chance that we will see a Republican-dominated Congress and Republican President. This creates multiple legislative and executive chances to knock down the bill.
What Obamacare WILL Do
Obamacare, if put into effect, will seriously damage the American health care system, through either bankrupting the insurance companies or forcing them to significantly inflate the costs of coverage; forcing most Americans to use government-run government health care systems, with resultant reductions of treatment quality and lengthening of waiting lists. The regulations imposed by the program will drive a significant minority of professionals (the number I keep hearing is "one third") out of the medical fields. The taxes on the pharmaceutical companies will choke off the supply of new medicines.
The cost of the program will render it impossible to balance the budget, and make it inevitable that we will suffer severe inflation or be forced to default on Treasury bonds. If the former happens, America is going to suffer a severely devalued currency; if the latter, there will be a global economic collapse equivalent to the Great Depression.
Finally, once Obamacare has been in effect for any period after 2014, it will create a huge dependent constituency which can be counted on to never vote out nationalized health care. This will force America to either accept permanent neutralization on the international scene (owing to the cost of the program), or to carry out a policy of imperial conquest and exploitation (as the dole did in the Roman Republic).
What Obamacare CANNOT Do
The passage of Obamacare does NOT mean that Barack Obama has now been crowned King of America, with Nancy Pelosi his evil witch whipping up Ro-Beasts on demand. Yes, it increases his current political capital, but it does so at the price of forcing the Democrats to win political victories in November 2010 and November 2012 and November 2014 in order to defend his program. If the Democrats do not do at least decently in all three of these election years, Obamacare will not last long enough to do any but short-term damage to America.
Obamacare does not make it easier for the Democrats to win any of these elections. In fact, it makes it harder, because they have given the Republicans a huge issue to use against them. The Democrats are neither favored to win in 2010, nor in 2012.
As for dirty tricks: sure, the Democrats will try them, but the Republicans have a huge edge in the polls, and tricks dirty enough to counter this edge would be noticed by everyone, and lead to results being successfully challenged, either in the courts, or in the councils of the US Armed Forces. IMO, short of outright having armed Democrat militias blocking the voting booths, the Democrats can't win through dirty tricks, and if they did that, they would find out that armies beat mobs every day of the week.
Obamacare does not instantly lock everyone into the role of "dependent constituency." Aside from the fact that most of the people who opposed it before would still oppose it for years after 2014, its major benefits don't even kick in until 2014. That's four years from now. That gives us a lot of time to stop it, with the Democrats potentially losing support from the moderates in every one of those three election years.
Obamacare is not an unstoppable juggernaut. At best it is a poorly controlled truck which has to defeat several crash barriers to hit the gas station and cause disaster, and there are a lot of people pushing other vehicles into place to stop it.
We can still win. We will probably still win. There is much need for action, but none, yet, for panic.